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CagA status and successful eradication of Helicobacter pylori

colorectal cancer. Zucker et al. claim that they have done analyses using NHANES I data in which they did not identify an association between smoking, a positive family history and the incidence of colorectal cancer. From this, they conclude that there must be something wrong with the NHANES I data and, therefore, by extension, our results which use NHANES I data. We think it would be unwise for readers to rely on descriptions of the results of these unpublished analyses and consider them as evidence for or against the quality of NHANES I data. NHANES I data have been used for more than 500 research papers, including multiple papers with cancer outcomes, and they are generally regarded as having some of the highest quality epidemiological data available. The fact is that in our analyses of this same data set, we observed that the incidence of colorectal cancer was higher in men than in women, slightly higher in obese and overweight persons than in normal weight persons, and increased with increasing age, consistent with known epidemiological associations of colorectal cancer. In conclusion, we would like to point out here (as in our research paper) that, the results of the original cross-sectional study published by Zucker et al. using NHANES III data may not accurately depict the association between serum bilirubin and the incidence of colorectal cancer given that serum bilirubin levels were measured years after colorectal cancer occurred and only among survivors who had surgical resection. We believe that relatively more weight should be given to results obtained in cohort studies (such as ours) in which levels of serum bilirubin are measured at baseline and the incidence of colorectal cancer is ascertained during follow-up. We do agree that our study should not be considered ‘conclusive’, and we look forward to seeing the results of future cohort studies on this association.