Risk factors for colorectal cancer in patients with multiple serrated polyps: a cross-sectional case series from genetics clinics

• Published in: PloS one 2010-07, Vol.5 (7), p.e11636-e11636
• Main Authors: Buchanan, Daniel D, Sweet, Kevin, Drini, Musa, Jenkins, Mark A, Win, Aung Ko, English, Dallas R, Walsh, Michael D, Clendenning, Mark, McKeone, Diane M, Walters, Rhiannon J, Roberts, Aedan, Pearson, Sally-Ann, Pavluk, Erika, Hopper, John L, Gattas, Michael R, Goldblatt, Jack, George, Jill, Suthers, Graeme K, Phillips, Kerry D, Woodall, Sonja, Arnold, Julie, Tucker, Kathy, Muir, Amanda, Field, Michael, Greening, Sian, Gallinger, Steven, Perrier, Renee, Baron, John A, Potter, John D, Haile, Robert, Frankel, Wendy, de la Chapelle, Albert, Macrae, Finlay, Rosty, Christophe, Walker, Neal I, Parry, Susan, Young, Joanne P
• Format: Article
• Language: English
• Subjects: Adenoma; Adult; Age; Aged; Biomarkers; Bowel disease; Cancer; Cancer genetics; Cancer patients; Cigarette smoking; Cigarettes; Colonic Polyps - complications; Colonic Polyps - epidemiology; Colonoscopy; Colorectal cancer; Colorectal carcinoma; Colorectal Neoplasms - epidemiology; Colorectal Neoplasms - etiology; Epidemiology; Ethnicity; Female; Females; Gastroenterology; Gastroenterology and Hepatology/Colon and Rectum; Gastroenterology and Hepatology/Gastrointestinal Cancers; Genetics; Genetics and Genomics/Cancer Genetics; Genetics and Genomics/Genetics of Disease; Genotype & phenotype; Health aspects; Health risk assessment; Health risks; Hospitals; Humans; Hypotheses; Identification methods; Laboratories; Logistic Models; Male; Males; Medical research; Medicine; Middle Aged; Mutation; Odds Ratio; Pathology/Surgical Pathology; Patients; Polyposis; Polyps; Population; Rectum; Risk analysis; Risk Factors; Risk reduction; Sex Factors; Smoke; Smokers; Smoking; Smoking - adverse effects; Statistical analysis; Tumors
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0011636

Patients with multiple serrated polyps are at an increased risk for developing colorectal cancer (CRC). Recent reports have linked cigarette smoking with the subset of CRC that develops from serrated polyps. The aim of this work therefore was to investigate the association between smoking and the risk of CRC in high-risk genetics clinic patients presenting with multiple serrated polyps. We identified 151 Caucasian individuals with multiple serrated polyps including at least 5 outside the rectum, and classified patients into non-smokers, current or former smokers at the time of initial diagnosis of polyposis. Cases were individuals with multiple serrated polyps who presented with CRC. Controls were individuals with multiple serrated polyps and no CRC. Multivariate logistic regression was performed to estimate associations between smoking and CRC with adjustment for age at first presentation, sex and co-existing traditional adenomas, a feature that has been consistently linked with CRC risk in patients with multiple serrated polyps. CRC was present in 56 (37%) individuals at presentation. Patients with at least one adenoma were 4 times more likely to present with CRC compared with patients without adenomas (OR = 4.09; 95%CI 1.27 to 13.14; P = 0.02). For females, the odds of CRC decreased by 90% in current smokers as compared to never smokers (OR = 0.10; 95%CI 0.02 to 0.47; P = 0.004) after adjusting for age and adenomas. For males, there was no relationship between current smoking and CRC. There was no statistical evidence of an association between former smoking and CRC for both sexes. A decreased odds for CRC was identified in females with multiple serrated polyps who currently smoke, independent of age and the presence of a traditional adenoma. Investigations into the biological basis for these observations could lead to non-smoking-related therapies being developed to decrease the risk of CRC and colectomy in these patients.