Calcium intake and risk of colorectal cancer according to expression status of calcium-sensing receptor (CASR)

Wanshui Yang, Li Liu, Yohei Masugi, Zhi Rong Qian, Reiko Nishihara, Na Na Keum, Kana Wu, Stephanie Smith-Warner, Yanan Ma, Jonathan A. Nowak, Fatemeh Momen-Heravi, Libin Zhang, Michaela Bowden, Teppei Morikawa, Annacarolina Da Silva, Molin Wang, Andrew T. Chan, Charles S. Fuchs, Jeffrey A. Meyerhardt, Kimmie NgEdward Giovannucci, Shuji Ogino, Xuehong Zhang

Research output: Contribution to journalArticlepeer-review

37 Citations (Scopus)


Objective Although evidence suggests an inverse association between calcium intake and the risk of colorectal cancer, the mechanisms remain unclear. The calcium-sensing receptor (CASR) is expressed abundantly in normal colonic epithelium and may influence carcinogenesis. We hypothesized that calcium intake might be associated with lower risk of CASR-positive, but not CASR-negative, colorectal cancer. Design We assessed tumour CASR protein expression using immunohistochemistry in 779 incident colon and rectal cancer cases that developed among 136 249 individuals in the Nurses' Health Study and Health Professionals Follow-Up Study. Duplication method Cox proportional hazards regression analysis was used to assess associations of calcium intake with incidence of colorectal adenocarcinoma subtypes by CASR status. Results Total calcium intake was inversely associated with the risk of developing colorectal cancer (p trend =0.01, comparing ≥1200 vs <600 mg/day: Multivariable HR=0.75, 95% CI 0.60 to 0.95). For the same comparison, higher total calcium intake was associated with a lower risk of CASR-positive tumours (p trend =0.003, multivariable HR=0.67, 95% CI 0.51 to 0.86) but not with CASR-negative tumours (p trend =0.67, multivariable HR=1.15, 95% CI 0.75 to 1.78; p heterogeneity =0.06 between the CASR subtypes). The stronger inverse associations of calcium intake with CASR-positive but not CASR-negative tumours generally appeared consistent regardless of sex, tumour location and source of calcium. Conclusions Our molecular pathological epidemiology data suggest a causal relationship between higher calcium intake and lower colorectal cancer risk, and a potential role of CASR in mediating antineoplastic effect of calcium.

Original languageEnglish
Pages (from-to)1475-1483
Number of pages9
Issue number8
Publication statusPublished - 2018 Aug 1
Externally publishedYes


  • calcium
  • calcium-sensing receptor
  • cancer epidemiology
  • cancer prevention
  • cohort study
  • colon cancer
  • diet
  • etiologic heterogeneity
  • molecular pathological epidemiology
  • rectal cancer
  • tumor microenvironment.

ASJC Scopus subject areas

  • Gastroenterology


Dive into the research topics of 'Calcium intake and risk of colorectal cancer according to expression status of calcium-sensing receptor (CASR)'. Together they form a unique fingerprint.

Cite this