**9.2.3 Gender**

188 Cancer Prevention – From Mechanisms to Translational Benefits

mucosal hyperproliferation (Nelson, 2001). The results obtained by other studies deny the role of dietary Fe and iron status for CRC development (Tseng et al., 1997). N-nitrous compounds in the red meat and produced during the food processing with high temperature polycyclic carbohydrates and heterocyclic amines are also possible reasons for the harmful effect of red meat (De Meester & Gerber, 1995) Red meat consumption in

We believe that chronic alcohol abuse is a major risk factor for gastrointestinal polyps and cancer formation in esophagus, stomach, colon and rectum. High alcohol intake (>21 units/week) of beer, wine and spirits significantly increases the risk for CRP and CRC. These findings are probably due to the effect of acetaldehyde, which damages colorectal mucosa and elevates cell regeneration. Folic acid and methionine deficiency in persons who chronically abuse with alcohol are also risk factors for development of CRC (Giovannucci et al., 1995). Alcohol is an inducer of cytochrome P-405 2E1, which contributes to increased production of free radicals (Seitz & Osswald, 1992). Alcohol diminishes the transformation of retinol into retinoic acid and as result cell proliferation is upregulated (Seitz et al., 1998).

We found that fried and grilled food is a risk factor for CRC and CRP. Cooking of the food at high temperatures and usage of grill induces formation of heterocyclic amines in the meat, which own mutagenic and pro-carcinogenic activity (Sigimura et al., 2004; De Meester & Gerber, 1995). Biochemical interactions between proteins, carbohydrates and fats during food processing are also of great importance for the formation of carcinogenic compounds.

Five percent of cardiovascular mortality rate is caused by low physical activity. 13% is the estimated value for CRC (Slattery & Potter, 2002). This is probably due to the combination of low physical activity, nutrition, lifestyle, and their cross-interactions. The mode of action of physical activity upon CRC is not clear, but decrease in inflammation and insulin levels is supposed. A middle intensive physical activity 3-4 times per week with 1.5 h duration is advisable. Increased physical activities, especially in men, reduce the risk for CRC with 40- 50% (Scottish Intercollegiate Guidelines Network. Management of Colorectal cancer. A

Many authors consider CRC as tobacco-related, taking into account the duration of smoking. It is estimated that 12% of the cases of CRC are related to smoking (Courtney et al., 2004). The present study confirmed the role of tobacco smoking as a risk factor for CRP and CRC. The risk is elevated proportionally to the years of smoking. Tobacco smoking disrupts conjugation of glutathione, cytochromes and damages DNA (Pfohl-Leskowitcz et al, 1999). Inhalation of carcinogens from tobacco smoke could trigger microsatellite instability (Yang

**9.2 Nonalimentary risk factors for colorectal polyps and cancer** 

elderly individuals should be limited to 70-80g/day.

**9.1.6 Alcohol** 

**9.1.7 Food processing** 

**9.2.1 Physical activity** 

national clinical guideline., 2003).

**9.2.2 Tobacco smoking** 

et al., 2000).

The incidence of CRC is almost always higher in men (Parkin et al., 1999). Our data support these findings, as the men/women ratio was 1.2/1 in patients with CRP and 1.23/1 in patients with CRC. These differences could be explained with different life style, diet habits, physical activity, tobacco smoking, and consumption of alcohol, usage of NSAID and iron stores. There are and speculations about the protective role of female sex hormones (Crandall, 1999). Hormone replacement therapy in women is not recommended, because of the risk of vascular damages, thromboembolism and breast cancer (Scottish Intercollegiate Guidelines Network. Management of Colorectal cancer. A national clinical guideline, 2003).
