This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (86)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Topic Collections  • Oncology  • Colon Cancer  • Gastroenterology  • Gastrointestinal Diseases  • Alert me on articles by topic  Social Bookmarking   What's this?

David A. Lieberman, MD; Sheila Prindiville, MD, MPH; David G. Weiss, PhD; Walter Willett, MD, DrPH; for the VA Cooperative Study Group 380

JAMA. 2003;290:2959-2967.

Context  Knowledge of risk factors for colorectal neoplasia could inform risk reduction strategies for asymptomatic individuals. Few studies have evaluated risk factors for advanced colorectal neoplasia in asymptomatic individuals, compared risk factors between persons with and without polyps, or included most purported risk factors in a multivariate analysis.

Objective  To determine risk factors associated with advanced colorectal neoplasia in a cohort of asymptomatic persons with complete colonoscopy.

Design, Setting, and Participants  Prospective, cross-sectional study of 3121 asymptomatic patients aged 50 to 75 years from 13 Veterans Affairs medical centers conducted between February 1994 and January 1997. All participants had complete colonoscopy to determine the prevalence of advanced neoplasia, defined as an adenoma that was 10 mm or more in diameter, a villous adenoma, an adenoma with high-grade dysplasia, or invasive cancer. Variables examined included history of first-degree relative with colorectal cancer, prior cholecystectomy, serum cholesterol level, physical activity, smoking, alcohol use, and dietary factors.

Main Outcome Measures  An age-adjusted analysis was performed for each variable to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) associated with having advanced neoplasia compared with having no polyps. We developed a multivariate logistic regression model to identify the most informative risk factors. A secondary analysis examined risk factors for having hyperplastic polyps compared with having no polyps and compared with having advanced neoplasia.

Results  Three hundred twenty-nine participants had advanced neoplasia and 1441 had no polyps. In multivariate analyses, we found positive associations for history of a first-degree relative with colorectal cancer (OR, 1.66; 95% CI, 1.16-2.35), current smoking (OR, 1.85; 95% CI, 1.33-2.58), and current moderate to heavy alcohol use (OR, 1.02; 95% CI, 1.01-1.03). Inverse associations were found for cereal fiber intake (OR, 0.95; 95% CI, 0.91-0.99), vitamin D intake (OR, 0.94; 95% CI, 0.90-0.99), and use of nonsteroidal anti-inflammatory drugs (NSAIDs) (OR, 0.66; 95% CI, 0.48-0.91). In the univariate analysis, the inverse association was found with cereal fiber intake greater than 4.2 g/d, vitamin D intake greater than 645 IU/d, and daily use of NSAIDs. Marginal factors included physical activity, daily multivitamin use, and intake of calcium and fat derived from red meat. No association was found for body mass index, prior cholecystectomy, or serum cholesterol level. Three hundred ninety-one patients had hyperplastic polyps as the worst lesion found at colonoscopy. Risk variables were similar to those for patients with no polyps, except that past and current smoking were associated with an increased risk of hyperplastic polyps.

Conclusions  Our data endorse several important risk factors for advanced colonic neoplasia and provide a rationale for prudent risk reduction strategies. Further study is needed to determine if lifestyle changes can moderate the risk of colorectal cancer.

Author Affiliations: Department of Veterans Affairs Medical Center, Portland, Ore (Dr Lieberman); National Cancer Institute, Bethesda, Md (Dr Prindiville); Department of Veterans Affairs Medical Center, Perry Point, Md (Dr Weiss); and Harvard School of Public Health, Boston, Mass (Dr Willett).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

TGF-{alpha} Expression as a Potential Biomarker of Risk Within the Normal-appearing Colorectal Mucosa of Patients with and without Incident Sporadic Adenoma
Daniel et al.
Cancer Epidemiol. Biomarkers Prev. 2009;18:65-73.
ABSTRACT | FULL TEXT  

Computed virtual chromoendoscopy versus standard colonoscopy with targeted indigocarmine chromoscopy: a randomised multicentre trial
Pohl et al.
Gut 2009;58:73-78.
ABSTRACT | FULL TEXT  

Vitamin D and Prevention of Colorectal Adenoma: A Meta-analysis
Wei et al.
Cancer Epidemiol. Biomarkers Prev. 2008;17:2958-2969.
ABSTRACT | FULL TEXT  

Colorectal Cancer Is an Ambulatory Care Sensitive Condition
Sarfaty and Yuen
Cancer Epidemiol. Biomarkers Prev. 2008;17:2531-2535.
ABSTRACT | FULL TEXT  

Alcohol Drinking, Cigarette Smoking, and Risk of Colorectal Adenomatous and Hyperplastic Polyps
Shrubsole et al.
Am J Epidemiol 2008;167:1050-1058.
ABSTRACT | FULL TEXT  

A prospective randomised study on narrow-band imaging versus conventional colonoscopy for adenoma detection: does narrow-band imaging induce a learning effect?
Adler et al.
Gut 2008;57:59-64.
ABSTRACT | FULL TEXT  

Association Between Cigarette Smoking and Colorectal Cancer in the Women's Health Initiative
Paskett et al.
JNCI J Natl Cancer Inst 2007;99:1729-1735.
ABSTRACT | FULL TEXT  

The Surgeon's Role in Cancer Prevention. The Model in Colorectal Carcinoma
Chu et al.
Ann. Surg. Oncol. 2007;14:3054-3069.
ABSTRACT | FULL TEXT  

Prevalence of Colorectal Neoplasm Among Patients With Newly Diagnosed Coronary Artery Disease
Chan et al.
JAMA 2007;298:1412-1419.
ABSTRACT | FULL TEXT  

The relation of magnesium and calcium intakes and a genetic polymorphism in the magnesium transporter to colorectal neoplasia risk
Dai et al.
Am. J. Clin. Nutr. 2007;86:743-751.
ABSTRACT | FULL TEXT  

Nonsteroidal Anti-inflammatory Drugs and Cyclooxygenase-2 Inhibitors for Primary Prevention of Colorectal Cancer: A Systematic Review Prepared for the U.S. Preventive Services Task Force
Rostom et al.
ANN INTERN MED 2007;146:376-389.
ABSTRACT | FULL TEXT  

Change in Body Size and the Risk of Colorectal Adenomas
Sedjo et al.
Cancer Epidemiol. Biomarkers Prev. 2007;16:526-531.
ABSTRACT | FULL TEXT  

Colonoscopy Screening for Detection of Advanced Neoplasia
Latreille et al.
NEJM 2007;356:632-634.
FULL TEXT  

Colon cancer screening: the good, the bad, and the ugly.
Roy et al.
Arch Intern Med 2006;166:2177-2179.
FULL TEXT  

Alleviating the Burden of Cancer: A Perspective on Advances, Challenges, and Future Directions.
Schottenfeld and Beebe-Dimmer
Cancer Epidemiol. Biomarkers Prev. 2006;15:2049-2055.
ABSTRACT | FULL TEXT  

A Follow-up Study of Physical Activity and Incidence of Colorectal Polyps in African-American Women.
Rosenberg et al.
Cancer Epidemiol. Biomarkers Prev. 2006;15:1438-1442.
ABSTRACT | FULL TEXT  

Associations between the age at diagnosis and location of colorectal cancer and the use of alcohol and tobacco: implications for screening.
Zisman et al.
Arch Intern Med 2006;166:629-634.
ABSTRACT | FULL TEXT  

Fiber, sex, and colorectal adenoma: results of a pooled analysis
Jacobs et al.
Am. J. Clin. Nutr. 2006;83:343-349.
ABSTRACT | FULL TEXT  

The Role of Vitamin D in Cancer Prevention
Garland et al.
Am. J. Public Health 2006;96:252-261.
ABSTRACT | FULL TEXT  

The Association of Calcium and Vitamin D with Risk of Colorectal Adenomas
Hartman et al.
J. Nutr. 2005;135:252-259.
ABSTRACT | FULL TEXT  

Vitamin D Intake: A Global Perspective of Current Status
Calvo et al.
J. Nutr. 2005;135:310-316.
ABSTRACT | FULL TEXT  

Risk Factors for Advanced Colonic Neoplasia and Hyperplastic Polyps
JWatch Gastroenterology 2004;2004:2-2.
FULL TEXT