CIGARETTE-SMOKING AND OTHER BEHAVIORAL RISK-FACTORS FOR RECURRENCE OFCOLORECTAL ADENOMATOUS POLYPS (NEW-YORK-CITY, NY, USA)

Adenomatous polyps (hereinafter referred to as adenomas) are known pre cursors of colorectal cancer. Cigarette smoking has been associated wi th adenomas but not with colorectal cancer, while alcohol and fat inta ke have been associated with both adenomas and cancer in some studies. Approximately 30 percent of patients with resected adenomas develop a nother adenoma within three years. This case-control study explores th e association of cigarette smoking with adenoma recurrence. Between Ap ril 1986 and March 1988, we administered a questionnaire to colonoscop ed patients aged 35 to 84 years in three New York City (NY, USA) pract ices. We compared 186 recurrent polyp cases (130 males, 56 females) an d 330 controls (187 males, 143 females) who had a history of polypecto my but normal follow-up colonoscopy, by cigarette-smoking pack-years a djusted 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 percen t 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 slig htly, 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 ad enoma recurrence that is not eliminated entirely by smoking cessation. Intervention trials that use adenoma recurrence as an endpoint should take smoking into account.