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Previous Volume 340:101-107 January 14, 1999 Number 2 Next

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ABSTRACT

Background and Methods Laboratory, clinical, and epidemiologic evidence suggests that calcium may help prevent colorectal adenomas. We conducted a randomized, double-blind trial of the effect of supplementation with calcium carbonate on the recurrence of colorectal adenomas. We randomly assigned 930 subjects (mean age, 61 years; 72 percent men) with a recent history of colorectal adenomas to receive either calcium carbonate (3 g [1200 mg of elemental calcium] daily) or placebo, with follow-up colonoscopies one and four years after the qualifying examination. The primary end point was the proportion of subjects in whom at least one adenoma was detected after the first follow-up endoscopy but up to (and including) the second follow-up examination. Risk ratios for the recurrence of adenomas were adjusted for age, sex, lifetime number of adenomas before the study, clinical center, and length of the surveillance period.

Results The subjects in the calcium group had a lower risk of recurrent adenomas. Among the 913 subjects who underwent at least one study colonoscopy, the adjusted risk ratio for any recurrence of adenoma with calcium as compared with placebo was 0.85 (95 percent confidence interval, 0.74 to 0.98; P=0.03). The main analysis was based on the 832 subjects (409 in the calcium group and 423 in the placebo group) who completed both follow-up examinations. At least one adenoma was diagnosed between the first and second follow-up endoscopies in 127 subjects in the calcium group (31 percent) and 159 subjects in the placebo group (38 percent); the adjusted risk ratio was 0.81 (95 percent confidence interval, 0.67 to 0.99; P=0.04). The adjusted ratio of the average number of adenomas in the calcium group to that in the placebo group was 0.76 (95 percent confidence interval, 0.60 to 0.96; P=0.02). The effect of calcium was independent of initial dietary fat and calcium intake.

Conclusions Calcium supplementation is associated with a significant — though moderate — reduction in the risk of recurrent colorectal adenomas.

Source Information

From the Departments of Medicine (J.A.B., R.R.), Community and Family Medicine (J.A.B.), and Anesthesia (M.B.) and the Norris Cotton Cancer Center (E.R.G.), Dartmouth–Hitchcock Medical Center, Lebanon, N.H.; the Veterans Affairs Medical Center, White River Junction, Vt. (M.B.); the Department of Environmental and Occupational Health, School of Public Health and School of Medicine (J.S.M.), and the Departments of Pathology (D.C.S.) and Medicine (J.H.B.), School of Medicine, University of Minnesota, and the Veterans Affairs Medical Center (J.H.B.), Minneapolis; the Center for Colon Polyps and Colon Cancer, Department of Gastroenterology (R.U.S.), and the Department of Biostatistics and Epidemiology (G.J.B.), Cleveland Clinic Foundation, Cleveland; the Department of Preventive Medicine, University of Southern California School of Medicine, Los Angeles (R.W.H.); the Department of Medicine, University of North Carolina, Chapel Hill, N.C. (R.S.S.); the James A. Clifton Center for Digestive Diseases, Department of Internal Medicine, University of Iowa College of Medicine, Iowa City (R.W.S.); and the Department of Pathology, Fairview Southdale Hospital, Minneapolis (D.C.S.). Other authors were H. Frankl, M.D., Department of Internal Medicine, Southern California Permanente Group, Los Angeles; and L. Pearson, M.Phil., Department of Community and Family Medicine, Dartmouth–Hitchcock Medical Center, Lebanon, N.H.

Address reprint requests to Dr. Baron at 7927 Rubin Bldg., Dartmouth–Hitchcock Medical Center, 1 Medical Center Dr., Lebanon, NH 03756.

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• Cho, E., Smith-Warner, S. A., Spiegelman, D., Beeson, W. L., van den Brandt, P. A., Colditz, G. A., Folsom, A. R., Fraser, G. E., Freudenheim, J. L., Giovannucci, E., Goldbohm, R. A., Graham, S., Miller, A. B., Pietinen, P., Potter, J. D., Rohan, T. E., Terry, P., Toniolo, P., Virtanen, M. J., Willett, W. C., Wolk, A., Wu, K., Yaun, S.-S., Zeleniuch-Jacquotte, A., Hunter, D. J. (2004). Dairy Foods, Calcium, and Colorectal Cancer: A Pooled Analysis of 10 Cohort Studies. JNCI J Natl Cancer Inst 96: 1015-1022 [Abstract] [Full Text]  
• Schatzkin, A., Peters, U. (2004). Advancing the Calcium-Colorectal Cancer Hypothesis. JNCI J Natl Cancer Inst 96: 893-894 [Full Text]  
• Wallace, K., Baron, J. A., Cole, B. F., Sandler, R. S., Karagas, M. R., Beach, M. A., Haile, R. W., Burke, C. A., Pearson, L. H., Mandel, J. S., Rothstein, R., Snover, D. C. (2004). Effect of Calcium Supplementation on the Risk of Large Bowel Polyps. JNCI J Natl Cancer Inst 96: 921-925 [Abstract] [Full Text]  
• Kelloff, G. J., Schilsky, R. L., Alberts, D. S., Day, R. W., Guyton, K. Z., Pearce, H. L., Peck, J. C., Phillips, R., Sigman, C. C. (2004). Colorectal Adenomas: A Prototype for the Use of Surrogate End Points in the Development of Cancer Prevention Drugs. Clin. Cancer Res. 10: 3908-3918 [Full Text]  
• Tsao, A. S., Kim, E. S., Hong, W. K. (2004). Chemoprevention of Cancer. CA Cancer J Clin 54: 150-180 [Abstract] [Full Text]  
• Peters, U., Hayes, R. B., Chatterjee, N., Shao, W., Schoen, R. E., Pinsky, P., Hollis, B. W., McGlynn, K. A., the Prostate, Lung, Colorectal and Ovarian Cancer, (2004). Circulating Vitamin D Metabolites, Polymorphism in Vitamin D Receptor, and Colorectal Adenoma Risk. Cancer Epidemiol. Biomarkers Prev. 13: 546-552 [Abstract] [Full Text]  
• Chlebowski, R. T., Wactawski-Wende, J., Ritenbaugh, C., Hubbell, F. A., Ascensao, J., Rodabough, R. J., Rosenberg, C. A., Taylor, V. M., Harris, R., Chen, C., Adams-Campbell, L. L., White, E., the Women's Health Initiative Investigators, (2004). Estrogen plus Progestin and Colorectal Cancer in Postmenopausal Women. NEJM 350: 991-1004 [Abstract] [Full Text]  
• Cullen, J., Schwartz, M. D., Lawrence, W. F., Selby, J. V., Mandelblatt, J. S. (2004). Short-Term Impact of Cancer Prevention and Screening Activities on Quality of Life. JCO 22: 943-952 [Abstract] [Full Text]  
• Frank, D. H., Roe, D. J., Chow, H-H. S., Guillen, J. M., Choquette, K., Gracie, D., Francis, J., Fish, A., Alberts, D. S. (2004). Effects of a High-Selenium Yeast Supplement on Celecoxib Plasma Levels: A Randomized Phase II Trial. Cancer Epidemiol. Biomarkers Prev. 13: 299-303 [Abstract] [Full Text]  
• White, E., Patterson, R. E., Kristal, A. R., Thornquist, M., King, I., Shattuck, A. L., Evans, I., Satia-Abouta, J., Littman, A. J., Potter, J. D. (2004). VITamins And Lifestyle Cohort Study: Study Design and Characteristics of Supplement Users. Am J Epidemiol 159: 83-93 [Abstract] [Full Text]  
• Lieberman, D. A., Prindiville, S., Weiss, D. G., Willett, W. (2003). Risk Factors for Advanced Colonic Neoplasia and Hyperplastic Polyps in Asymptomatic Individuals. JAMA 290: 2959-2967 [Abstract] [Full Text]  
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• Nicklas, T. A. (2003). Calcium Intake Trends and Health Consequences from Childhood through Adulthood. J. Am. Coll. Nutr. 22: 340-356 [Abstract] [Full Text]  
• Chu, D. Z. J., Chansky, K., Alberts, D. S., Meyskens, F. L. Jr., Fenoglio-Preiser, C. M., Rivkin, S. E., Mills, G. M., Giguere, J. K., Goodman, G. E., Abbruzzese, J. L., Lippman, S. M. (2003). Adenoma Recurrences After Resection of Colorectal Carcinoma: Results From the Southwest Oncology Group 9041 Calcium Chemoprevention Pilot Study. Ann. Surg. Oncol. 10: 870-875 [Abstract] [Full Text]  
• Pierre, F., Tache, S., Petit, C. R., Van der Meer, R., Corpet, D. E. (2003). Meat and cancer: haemoglobin and haemin in a low-calcium diet promote colorectal carcinogenesis at the aberrant crypt stage in rats. Carcinogenesis 24: 1683-1690 [Abstract] [Full Text]  
• Sabichi, A. L., Demierre, M.-F., Hawk, E. T., Lerman, C. E., Lippman, S. M. (2003). Frontiers in Cancer Prevention Research. Cancer Res. 63: 5649-5655 [Full Text]  
• Brown, J. K., Byers, T., Doyle, C., Courneya, K. S., Demark-Wahnefried, W., Kushi, L. H., McTiernan, A., Rock, C. L., Aziz, N., Bloch, A. S., Eldridge, B., Hamilton, K., Katzin, C., Koonce, A., Main, J., Mobley, C., Morra, M. E., Pierce, M. S., Sawyer, K. A. (2003). Nutrition and Physical Activity During and After Cancer Treatment: An American Cancer Society Guide for Informed Choices. CA Cancer J Clin 53: 268-291 [Abstract] [Full Text]  
• Probst-Hensch, N. M., Wang, H., Goh, V. H. H., Seow, A., Lee, H.-P., Yu, M. C. (2003). Determinants of Circulating Insulin-like Growth Factor I and Insulin-like Growth Factor Binding Protein 3 Concentrations in a Cohort of Singapore Men and Women. Cancer Epidemiol. Biomarkers Prev. 12: 739-746 [Abstract] [Full Text]  
• Boyapati, S. M., Bostick, R. M., McGlynn, K. A., Fina, M. F., Roufail, W. M., Geisinger, K. R., Wargovich, M., Coker, A., Hebert, J. R. (2003). Calcium, Vitamin D, and Risk for Colorectal Adenoma: Dependency on Vitamin D Receptor BsmI Polymorphism and Nonsteroidal Anti-Inflammatory Drug Use?. Cancer Epidemiol. Biomarkers Prev. 12: 631-637 [Abstract] [Full Text]