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Smoking a Significant Risk Factor for Colorectal Polyps

Smoking a Significant Risk Factor for Colorectal Polyps

SEATTLE—Cigarette smoking appears to be a significant risk factor for
colon polyps, equal to a family history of colon cancer, according to Rajeev
Attam, MD, a senior fellow in the Division of Gastroenterology, Stony Brook
University School of Medicine, New York. In a large colon cancer screening
study, approximately 19% of ex-smokers and 17% of nonsmokers had polyps,
compared with 25% of current smokers.

Dr. Attam, who presented the results during the President’s Plenary
Session of the 67th Annual Scientific Meeting of the American College of
Gastroenterology (abstract 5), called smoking a key risk factor for
colorectal polyps. He suggested that physicians may consider performing
screening colonoscopies in current smokers before the age of 50, the standard
age for average-risk individuals.

Dr. Attam and his colleagues evaluated 1,041 nonsmokers, 338 smokers
(smoked more than 10 pack-years), and 371 ex-smokers (quit smoking more than
10 years ago and smoked more than 10 pack-years) who had undergone screening
colonoscopy between December 1999 and April 2002. Subjects were also assessed
for age, sex, body mass index, family history of colorectal neoplasia, ethni-city,
socioeconomic status, alcohol use, daily exercise, daily NSAID use, and
dietary patterns such as consumption of fruits and vegetables.

"Smokers had a much higher prevalence of colorectal neoplasia, compared
with nonsmokers," Dr. Attam said. "There was no significant difference in
prevalence between nonsmokers and ex-smokers." Smokers also had a higher
prevalence of significant left-sided neoplasia, compared with nonsmokers.

Significant colorectal neoplasias were defined as more than two polyps,
polyps larger than 1 cm, and villous or high-grade dysplasia. Using
multivariate analysis, the only significant predictive factors for this type
of lesion were age over 60 years and a history of smoking. Significant
colorectal dysplasias were found in 13% of smokers, 8% of ex-smokers, and
only 7% of nonsmokers.

Female sex and drinking wine appeared to lower the risk of polyps overall,
as did quitting tobacco for more than 10 years. Body mass index, weekly
exercise, daily NSAID use, and consumption of fruits and vegetables did not
appear to be predictive of colorectal polyps.

Smokers should be considered as high risk, similar to individuals with a
family history of colon cancer, and smokers may need to be screened at an
earlier age, Dr. Attam concluded. "On the basis of our findings," he said,
"smokers may benefit from periodic flexible sigmoidoscopies between


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