title: Fetal growth and subsequent maternal risk of colorectal cancer.
abstract: BACKGROUND
  High birth weight has been associated with subsequent increased risk of breast cancer in the infant's mother, possibly related to maternal estrogen and growth factor pathways. However, its association with maternal risk of colorectal cancer, the third most common cancer among women, is unknown.
  
  
  METHODS
  We conducted a national cohort study of 1,838,509 mothers who delivered 3,590,523 babies in Sweden in 1973-2008, followed up for colorectal cancer incidence through 2009.
  
  
  RESULTS
  There were 7,318 mothers diagnosed with colorectal cancer in 36.8 million person-years of follow-up. After adjusting for maternal age, body mass index, diabetes, and other potential confounders, high fetal growth was associated with a subsequent increased risk of colorectal cancer in the mother [incidence rate ratio (IRR) per additional 1 SD relative to mean birth weight for gestational age and sex, 1.05; 95% confidence intervals (CI), 1.03-1.07; P < 0.0001]. Each 1,000 g increase in the infant's birth weight was associated with a 12% increase in the mother's subsequent risk of colorectal cancer (IRR, 1.12; 95% CI, 1.07-1.17; P < 0.0001). Multiple gestation was also independently associated with increased maternal risk of colorectal cancer (IRR for twin or higher order vs. singleton, 1.22; 95% CI, 1.04-1.44; P = 0.02).
  
  
  CONCLUSIONS
  In this large cohort study, high fetal growth and multiple gestation were independently associated with subsequent higher maternal risk of colorectal cancer. These findings warrant further investigation of maternal growth factor and estrogen pathways in the etiology of colorectal cancer.
  
  
  CONCLUSIONS
  If confirmed, our findings may help identify subgroups of women at high risk of colorectal cancer.
authors.affiliation: Department of Medicine, Stanford University, Stanford, California. kccrump@stanford.edu.
authors.forename: Casey
authors.initials: C
authors.lastname: Crump
authors.affiliation: Center for Primary Health Care Research, Lund University, Malmö, Sweden. Stanford Prevention Research Center, Stanford University, Stanford, California.
authors.forename: Jan
authors.initials: J
authors.lastname: Sundquist
authors.affiliation: Department of Health Research and Policy, Stanford University, Stanford, California.
authors.forename: Weiva
authors.initials: W
authors.lastname: Sieh
authors.affiliation: Stanford Prevention Research Center, Stanford University, Stanford, California.
authors.forename: Marilyn A
authors.initials: MA
authors.lastname: Winkleby
authors.affiliation: Center for Primary Health Care Research, Lund University, Malmö, Sweden. Stanford Prevention Research Center, Stanford University, Stanford, California.
authors.forename: Kristina
authors.initials: K
authors.lastname: Sundquist
mesh_terms: D015331:Cohort Studies; D005260:Female; D047109:Fetal Development / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009035:Mothers; D011247:Pregnancy; D012307:Risk Factors