Search

Adenomatous polyps (hereinafter referred to as adenomas) are known precursors of colorectal cancer. Cigarette smoking has been associated with adenomas but not with colorectal cancer, while alcohol and fat intake have been associated with both adenomas and cancer in some studies. Approximately 30 percent of patients with resected adenomas develop another adenoma within three years. This case-control study explores the association of cigarette smoking with adenoma recurrence. Between April 1986 and March 1988, we administered a questionnaire to colonoscoped patients aged 35 to 84 years in three New York City (NY, USA) practices. We compared 186 recurrent polyp cases (130 males, 56 females) and 330 controls (187 males, 143 females) who had a history of polypectomy but normal follow-up colonoscopy, by cigarette-smoking pack-years adjusted for possible confounders. Risk for a metachronous or recurrent adenoma was significantly greater in the highest quartile of smokers than in never-smokers among both men (odds ratio [OR] = 1.8, 95 percent confidence interval [CI] = 1.0-3.4) and women (OR = 3.6, CI = 1.7-7.6). Adjustment for time since smoking cessation reduced risk only slightly, as did adjustment for dietary fat intake, which itself remained significant. No association was found between alcohol intake and risk of recurrence. Cigarette smokers appear to have an elevated risk of adenoma recurrence that is not eliminated entirely by smoking cessation. Intervention trials that use adenoma recurrence as an endpoint should take smoking into account.

Objective: To investigate the association of dietary factors with the incidence and recurrence of colorectal adenomatous polyps., Design: Two case-control studies., Setting: Three university-based colonoscopy practices in New York City., Patients: For the incidence study, 286 patients with pathologically confirmed incident adenomatous polyps (162 men and 124 women) were compared with 480 controls (210 men and 270 women) with no current or previous neoplasia. For the recurrence study, 186 patients with recurrent polyps (130 men and 56 women) were compared with 330 controls (187 men and 143 women). These patients had a history of polyps but no current neoplasia., Measurements: Structured interviews using the Block food frequency questionnaire were conducted on all participants and were compared over quartiles of crude nutrient intake of total and saturated fat; fiber; protein; carbohydrates; carotene; vitamins A, C, and E; and various food groups. Data were adjusted for age, Quetelet index, and caloric intake by multiple logistic regression for men and women separately., Results: For incident polyps, elevated adjusted odds ratios (high to low quartile) for women were found for saturated fat (odds ratio, 2.3; 95% CI, 0.9 to 5.8) and the ratio of red meat to chicken and fish intake (odds ratio, 1.9; CI, 1.0 to 3.6). Protective associations were observed for fish and chicken (odds ratio, 0.6; CI, 0.3 to 1.2) and vitamin A intake (odds ratio, 0.4; CI, 0.2 to 0.9). Among women, recurrent polyps showed an association with total dietary fat (odds ratio, 4.4; CI, 1.0 to 19.5), saturated fat (odds ratio, 3.8; CI, 1.0 to 14.9; P = 0.15 for the trend), and total fiber (odds ratio, 0.2; CI, 0.1 to 0.5; P = 0.01) and a borderline association with carbohydrates (odds ratio, 0.3; CI, 0.1 to 1.3; P = 0.10). No consistent relations were observed for men, although increased caloric intake increased the risk for incidence and recurrence in both men and women., Conclusions: These findings are consistent with previously described relations between diet and the incidence of colon cancer and suggest that, at least in women, dietary modification may be warranted in patients diagnosed with polyps.

Although there is a known reciprocal association between breast and colorectal cancer in women, few studies have investigated whether a similar association exists between breast cancer and colorectal adenomatous polyps, known to be precursor lesions for colon cancer. A case-control study was conducted on patients in three colonoscopy practices in New York to determine possible risk factors for adenomatous polyps. Among women studied, there were 128 patients with incident adenomatous polyps and 284 control subjects who underwent colonoscopy and had no colorectal neoplasia. No significant association between the incidence of an adenomatous polyp in the colon or rectum and a history of breast cancer was found (odds ratio, 0.71; 95% confidence interval, 0.34 to 1.64). If shared risk factors for breast and colorectal cancer are the reasons for the concurrence of these two malignant lesions, these results suggest that these factors act at the level of promoting adenomatous polyps of the colon and rectum into colorectal cancer.

Obesity has been investigated as a risk factor for various malignancies, including colon cancer. A case-control study was conducted on patients in three colonoscopy practices in New York City to determine possible risk factors for colorectal adenomatous polyps, a known precursor lesion for most cases of colorectal cancer. Among 301 case subjects with incidence adenomatous polyps (174 men and 127 women) and 506 control subjects (223 men and 283 women), an increased risk was observed with increasing body mass index in women (odds ratio 2.1, 95% confidence interval 1.1-4.0; for highest versus lowest quartile, linear trend P = .02). A nonsignificant trend was observed for men. The increased risk seen in women is consistent with prior observations regarding reproductive hormonal and dietary risk factors for colorectal cancer.

Of 276 patients who underwent an initial colonoscopic polypectomy for adenomatous polyps over a 45-month period, 118 subsequently had one or more repeat screening colonoscopies. The mean follow-up time was 26 months with an overall polyp recurrence rate of 30%. Analysis of these data retrospectively suggests that the bulk of the recurrences occurred within the first year. Increasing age was found to be a significant risk factor for polyp recurrence. Asymptomatic recurrence of adenomatous polyps detectable by colonoscopy is a common occurrence in postpolypectomy patients. Prospective studies utilizing colonoscopy as a screening tool are needed to establish a rational screening policy for this high-risk group.