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1. In Response

   • Shumin M Zhang, MD, ScD
   • Paul M Ridker, MD, MPH

   Brigham and Women’s Hospital

   To the Editor:

   We thank Mascitelli and Pezzetta for their interest in our paper. They suggest that abnormal glucose metabolism might be responsible for the null association between C-reactive protein (CRP) levels and risk of colorectal cancer that we observed (1). We conducted an analysis excluding 681 women who reported a history of diabetes mellitus at baseline from our study population, and the associations between C-reactive protein and risk of colorectal cancer did not appreciably change. The multivariable hazard ratios and their corresponding 95% confidence intervals according to cutoff points for CRP were 0.74 (0.49 to 1.11) for the category of 1 to 3 mg/L and 0.66 (0.42 to 1.03) for the category of greater than 3 mg/L (P for trend = 0.12), compared with the category of less than 1 mg/L. These data suggest our findings are unlikely to be explained by confounding by diabetes mellitus.

   Shumin M. Zhang, MD, ScD Assistant Professor of Medicine and Epidemiology Division of Preventive Medicine, shumin.zhang@channing.harvard.edu

   Paul M Ridker, MD, MPH

   Brigham and Women’s Hospital Boston, MA 02215

   References:

   1. Zhang SM, Buring JE, Lee IM, Cook NR, Ridker PM. C-reactive protein levels are not associated with increased risk for colorectal cancer in women. Ann Intern Med. 2005;142:425-32.

   Conflict of Interest: None declared

   Conflict of Interest:

   None declared

   Submit response
   Published May 6, 2005
2. Diabetes and colorectal cancer

   • Luca Mascitelli, MD
   • Francesca Pezzetta, MD

   Comando Brigata alpina "Julia"

   TO THE EDITOR: Zhang and colleagues reported that C-reactive protein levels were not significantly associated with increased risk for developing colorectal cancer in women (1). However, they did not consider diabetic status in the studied population. There is a growing body of evidence that type 2 diabetes mellitus is associated with increased risk of colorectal cancer (2-4). Furthermore, elevated glycated hemoglobin concentrations, even at levels below those used for diagnosis of diabetes, have been shown to be associated with increased colorectal cancer risk (5). Thus, abnormal glucose metabolism might have been a confounder in this study (1).

   Luca Mascitelli, MD Comando Brigata alpina “Julia” Udine, Italy 33100

   Francesca Pezzetta, MD Ospedale di San Vito al Tagliamento San Vito al Tagliamento, Italy 33078

   REFERENCES

   1. Zhang SM, Buring JE, Lee IM, Cook NR, Ridker PM. C-reactive protein levels are not associated with increased risk for colorectal cancer in women. Ann Intern Med. 2005;142:425-32.

   2. Will JC, Galuska DA, Vinicor F, Calle EE. Colorectal cancer: another complication of diabetes mellitus? Am J Epidemiol 1998;147:816-25.

   3. Hu FB, Manson JE, Liu S, Hunter D, Colditz GA, Michels KB, et al. Prospective study of adult onset diabetes mellitus (type 2) and risk of colorectal cancer in women. J Natl Cancer Inst. 1999;91:542-7.

   4. Kaaks R, Toniolo P. Akhmedkhanov A, Lukanova A, Biessy C, Dechaud H, et al. Serum C-peptide, insulin-like growth factor (IGF)-I, IGF-binding proteins, and colorectal cancer risk in women. J Natl Cancer Inst. 2000;92:1592-600.

   5. Khaw KT, Wareham N, Bingham S, Luben R, Welch A, Day N. Preliminary communication: glycated hemoglobin, diabetes, and incident colorectal cancer in men and women: a prospective analysis from the European prospective investigation into cancer-Norfolk study. Cancer Epidemiol Biomarkers Prev. 2004;13:915-9.

   Conflict of Interest:

   None declared

   Submit response
   Published March 21, 2005