A protective effect of
calcium and/or dairy products on
colorectal cancer has been reported in epidemiological studies but the findings are considered inconsistent. In particular, it is unclear whether they act at a particular step of the
adenoma-
carcinoma sequence. To investigate the effect of dairy product consumption and
dietary calcium,
vitamin D and
phosphorus intake on the
adenoma-
carcinoma sequence in the French E3N-EPIC prospective study. The population for the study of risk factors for
adenomas was composed of 516
adenoma cases, including 175 high-risk
adenomas, and of 4,804
polyp-free subjects confirmed by colonoscopy. The population for the
colorectal cancer study was composed of 172 cases and 67,312
cancer-free subjects. Diet was assessed using a self-administered questionnaire completed at baseline. There was a trend of decreasing risk of both
adenoma (ptrend=0.04) and
cancer (ptrend=0.08) with increasing
calcium intake, with RRs for
adenoma and
cancer of 0.80 (IC 95%=0.62-1.03) and 0.72 (95% CI=0.47-1.10), respectively, in the fourth quartile compared to the first. A protective effect of dairy products on
adenoma (RRQ4 vs. Q1=0.80, 95% CI=0.62-1.05, ptrend=0.04) was observed and of milk consumption on
colorectal cancer (RRQ4vs. Q1=0.54, 95% CI=0.33-0.89, ptrend=0.09), although the latter did not reach significance.
Phosphorus intake also decreased the risk of
adenoma (RRQ4 vs. Q1=0.70, 95% CI=0.54-0.90, ptrend=0.005). No
vitamin D effect was identified. Our data support the hypothesis that
calcium, dairy products and
phosphorus exert a protective effect at certain steps of the
adenoma-
carcinoma sequence.