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    Cancer Epidemiology
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    Associations of serum CRP levels with demographics, health behaviors, and T risk of cancer among the Mexican American Mano A Mano Cohort
    Jie Shena, Daphne Hernandezc, Lorna Haughton McNeillb, Wong-Ho Chowa, Hua Zhaoa,
    a Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA b Department of Health and Human Performance, University of Houston, TX, USA c Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
    Mexican Americans
    Cancer risk 
    C-Reactive protein (CRP) is a well-known inflammatory marker, and elevated CRP levels has been reported to be associated with the risk of various cancers. To date, no study has investigated the association between elevated CRP and incidents of cancer among Mexican Americans. In the current prospective cohort study, we measured pre-diagnostic CRP levels in serum samples and evaluated their relationships with demographic characteristics and health behaviors associated with cancer risk among 2753 Mexican Americans selected from the Mano-A-Mano Mexican American Cohort Study. At baseline, median levels of serum CRP significantly differed by de-mographics (sex, age category, marital status, and education levels) and health behaviors (cigarette smoking status, alcohol drinking status, BMI category, and physical activity levels). In the multivariable analysis, the study participants who were women, older, never drinking alcohol, overweight or obese, and physically inactive had increased likelihood of having high CRP levels (≥ median levels among all study participants) compared to their counterparts. A total of 177 cancer cases were identified during the follow-up with a median follow-up time of 127 months. In the quartile analysis, study participants in the 4th quartile with highest CRP levels had sig-nificantly 1.88 fold increased risk of cancer (hazard ratio (HR) = 1.88, 95%CI: 1.12, 3.13) compared to those in the 1st quartile with lowest CRP levels. The association was further confirmed in analyses using clinical CRP levels. In summary, our findings suggested that serum CRP levels have potential to serve as a predictive marker of cancer risk in Mexican Americans.
    1. Introduction
    C-Reactive Protein (CRP), a 118 kDa non-glycosylated protein in the Pentraxin family, acts as a major acute-phase protein, and mediates the innate and adaptive immune response [1]. It is mainly produced by hepatocytes in response to a variety of inflammatory cytokines in-cluding interleukin (IL)-6 during infection, tissue injury and in-flammation, and subsequently released into circulation [2]. After binding to the surface of damaged cells and platelets, CRP could acti-vate the cascade of innate inflammation. CRP has been reported to be the independent predictor of cardiovascular events and diabetes, and is associated with different features of metabolic syndrome [3–6]. Due to its high sensitivity, CRP was identified by The American Heart Asso-ciation and the Centers for Disease Control and Prevention as the best systematic marker of inflammation for clinical diagnosis [7].
    Investigation of CRP is of particular interest to cancer since several health behaviors and chronic diseases are major risk factors of common
    types of cancer, such as tobacco use, alcohol use, radiation, high-calorie diet, obesity, chronic infections, etc., have been linked to inflammation [8]. As a matter of fact, epidemiologic studies in the past decade have provide accumulating evidence for the association of elevated CRP le-vels and the risk of a variety of cancers, including ovarian, breast, liver, lung, endometrial, and colorectal cancers [9–15]. However, most of the studies have been carried out in Caucasian populations.
    Mexican immigrants are the fastest growing minority group. In the U.S., obesity/overweight is a major public health problem among those with Mexican origin. Unfortunately, to date, no prospective study has evaluated the association between elevated CRP and incidents of cancer among Mexican Americans. In the current study, we analyzed pre-di-agnostic CRP levels in serum samples in relation to demographic characteristics and health behaviors at baseline among 2753 Mexican Americans without cancer identified from the Mano-A-Mano Mexican American Cohort study. In addition, we investigated the relationship between elevated CRP and cancer risk.