in a case-control study of 264 men and 98 women. This association was independent of other risk factors including smoking, gender, and alcohol consumption. In a later study in heterozygous carriers of the gene for hemochromatosis, Nelson and coworkers (1995) found a small, but statistically significant increase in the apparent relative risk for colorectal cancer, hematological malignancy, colonic adenomas, and stomach cancer.
There is no doubt that iron accumulation in the liver is a risk factor for hepatocellular carcinoma in patients with hemochromatosis. However, the evidence for a relationship between dietary iron intake and cancer, particularly colon cancer, in the general population is inconclusive.
Between 1 in 200 and 1 in 400 individuals of northern European descent are affected by an autosomal, recessive disorder known as hereditary hemochromatosis (Bacon et al., 1999). In populations of Celtic extraction, a single missense mutation of the hemochromatosis (HFE) gene (C282Y) is found in over 90 percent of affected individuals. A few patients with hemochromatosis are compound heterozygotes for C282Y and a second mutation, H63D, which is relatively common in the general population (Beutler et al., 2000), but on its own does not appear to cause iron overload (Worwood, 1999). The remaining patients lack an identified mutation suggesting evidence of other undiscovered genetic disorders. The clinical disorder is characterized by excessive absorption of food iron associated with the failure to store the additional iron in reticuloendothelial cells. The iron intake of these individuals is in the normal range. Iron accumulation occurs at a rate of about 2 mg/day with the development of clinical manifestations between the fourth and sixth decades of life. At this stage, the total body iron burden may reach 20 to 30 g. The additional iron is stored preferentially in parenchymal cells. Extensive organ damage is the result. If untreated, the disorder results in cirrhosis of the liver, primary liver cancer, myocardial injury with congestive cardiopathy and heart failure, and damage to endocrine organs, particularly the pancreatic islets and the anterior pituitary gland, with resultant diabetes and impotence or amenorrhea (Bothwell and MacPhail, 1998; Walker et al., 1998). Arthritis and increased pigmentation of the skin are also characteristic findings (Bothwell et al., 1979; Olynyk et al., 1999). Individuals with hereditary hemochromatosis as described above (i.e., homozygotes for the HFE gene) are considered distinct and exceptionally sensi-