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. 2018 Aug;155(2):355-373.e18.
doi: 10.1053/j.gastro.2018.04.019. Epub 2018 Apr 24.

Association Between Risk Factors for Colorectal Cancer and Risk of Serrated Polyps and Conventional Adenomas

Xiaosheng He  1 , Kana Wu  2 , Shuji Ogino  3 , Edward L Giovannucci  4 , Andrew T Chan  5 , Mingyang Song  6
Affiliations

Association Between Risk Factors for Colorectal Cancer and Risk of Serrated Polyps and Conventional Adenomas

Xiaosheng He et al. Gastroenterology. 2018 Aug.

Abstract

Background & aims: Serrated polyps (SPs) and conventional adenomas are precursor lesions for colorectal cancer (CRC), but they are believed to arise via distinct pathways. We characterized risk factor profiles for SPs and conventional adenomas in a post hoc analysis of data from 3 large prospective studies.

Methods: We collected data from the Nurses' Health Study, the Nurses' Health Study 2, and the Health Professionals Follow-up Study on subjects who developed SPs or conventional adenomas. Our analysis comprised 141,143 participants who had undergone lower gastrointestinal endoscopy, provided updated diet and lifestyle data every 2-4 years, and were followed until diagnosis of a first polyp. We assessed 13 risk factors for CRC in patients with SPs or conventional adenomas and examined the associations according to histopathology features.

Results: We documented 7945 SPs, 9212 conventional adenomas, and 2382 synchronous SPs and conventional adenomas during 18-20 years of follow-up. Smoking, body mass index, alcohol intake, family history of CRC, and height were associated with higher risk of SPs and conventional adenomas, whereas higher intake of vitamin D and marine omega-3 fatty acid were associated with lower risk. The associations tended to be stronger for synchronous SPs and conventional adenomas. Smoking, body mass index, and alcohol intake were more strongly associated with SPs than conventional adenomas (P for heterogeneity <.05), whereas physical activity and intake of total folate and calcium were inversely associated with conventional adenomas but not SPs. For SPs and conventional adenomas, the associations tended to be stronger for polyps in the distal colon and rectum, of 10 mm or larger or with advanced histology.

Conclusions: In an analysis of data from 3 large prospective studies, we found that although SPs and conventional adenomas share many risk factors, some factors are more strongly associated with one type of lesion than the other. These findings provide support for the etiologic heterogeneity of colorectal neoplasia.

Keywords: BMI; Interval Cancer; Sessile Serrated Adenoma; Surveillance.

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Conflict of interest statement

Conflicts of interest: Andrew T. Chan previously served as a consultant for Bayer Healthcare and Pfizer Inc. for work unrelated to the topic of this manuscript. This study was not funded by Bayer Healthcare or Pfizer Inc. No other conflict of interest exists.

References

    1. Fearon ER, Vogelstein B. A genetic model for colorectal tumorigenesis. Cell. 1990;61:759–67. - PubMed
    1. Hawkins N, Norrie M, Cheong K, et al. CpG island methylation in sporadic colorectal cancers and its relationship to microsatellite instability. Gastroenterology. 2002;122:1376–87. - PubMed
    1. Spring KJ, Zhao ZZ, Karamatic R, et al. High prevalence of sessile serrated adenomas with BRAF mutations: a prospective study of patients undergoing colonoscopy. Gastroenterology. 2006;131:1400–7. - PubMed
    1. Bettington M, Walker N, Rosty C, et al. Critical appraisal of the diagnosis of the sessile serrated adenoma. Am J Surg Pathol. 2014;38:158–66. - PubMed
    1. Snover DC, Ahnen DJ, Burt RW, et al. Serrated polyps of the colon and rectum and serrated polyposis. In: Bosman FT, Carneiro F, Hruban RH, et al., editors. WHO Classification of Tumours of the Digestive System. 4th. Lyon: IARC Press; 2010.

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