Abstract
Background
Lifestyle factors may help to identify individuals at high-risk for colorectal cancer
(CRC).
Aims
To examine the association between lifestyle, referral for follow-up colonoscopy and
proximal neoplasia detection in CRC screening.
Methods
In this observational study, 14,832 individuals aged 50–74 years were invited to faecal
immunochemical test (FIT) or sigmoidoscopy screening. Advanced lesions (AL), including
advanced adenomas, advanced serrated lesions and CRC were divided according to location:
distal-only, or proximal with or without distal AL. We collected information on smoking
habit, body mass index and alcohol intake through a questionnaire.
Results
Out of 3,318 FIT and 2,988 sigmoidoscopy participants, 516 (16%) and 338 (11%), respectively,
were referred for follow-up colonoscopy after a positive screening test. Two-hundred-and-fifty-six
(4%) had distal-only and 119 (2%) proximal AL. In FIT participants, obesity and high
alcohol intake were associated with proximal AL; odds ratio (95% confidence interval)
2.68 (1.36–5.26) and 2.16 (1.08–4.30), respectively. In sigmoidoscopy participants,
current smoking was associated with proximal AL; 4.58 (2.24–9.38), and current smoking
and obesity were associated with referral for colonoscopy; 2.80 (2.02–3.89) and 1.42
(1.01–2.00), respectively.
Conclusion
Current smoking, obesity and high alcohol intake were associated with screen-detected
proximal colorectal AL. Current smoking and obesity were associated with referral
for follow-up colonoscopy in sigmoidoscopy screening.
Keywords
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References
- Smoking and colorectal cancer risk, overall and by molecular subtypes: a meta-analysis.Am J Gastroenterol. 2020; (Aug 6)
- Diet, nutrition, physical activity and cancer: a global perspective.The Third Expert Report. 2018;
- Colorectal cancer risk prediction tool for white men and women without known susceptibility.J Clin Oncol. 2009; 27: 686-693
- Personalizing colorectal cancer screening: a systematic review of models to predict risk of colorectal neoplasia.Clin Gastroenterol Hepatol. 2014; 12 (1624–34 e1)
- The IARC perspective on colorectal cancer screening.N Engl J Med. 2018; 378: 1734-1740
- Sensitivity of immunochemical faecal occult blood testing for detecting left- vs right-sided colorectal neoplasia.Br J Cancer. 2011; 104: 1779-1785
- Differences in epidemiologic risk factors for colorectal adenomas and serrated polyps by lesion severity and anatomical site.Am J Epidemiol. 2013; 177: 625-637
- Risk factors for advanced colorectal neoplasms in the proximal colon in 6218 subjects undergoing complete colonoscopy.J Gastroenterol Hepatol. 2019; 34: 113-119
- Body size and colorectal cancer risk after 16.3 years of follow-up: an analysis from the Netherlands Cohort Study.Am J Epidemiol. 2011; 174: 1127-1139
- Heterogeneity of colorectal cancer risk factors by anatomical subsite in 10 European countries: a multinational cohort study.Clin Gastroenterol Hepatol. 2019; 17 (e6): 1323-1331
- Adherence to the World Cancer Research Fund/American Institute for Cancer Research 2018 recommendations for cancer prevention and risk of colorectal cancer.Cancer Epidemiol Biomarkers Prev. 2019; 28: 1469-1479
- Association between risk factors for colorectal cancer and risk of serrated polyps and conventional adenomas.Gastroenterology. 2018; 155 (e18): 355-373
- High prevalence of sessile serrated adenomas with BRAF mutations: a prospective study of patients undergoing colonoscopy.Gastroenterology. 2006; 131: 1400-1407
- Metabolic predispositions and increased risk of colorectal adenocarcinoma by anatomical location: a large population-based cohort study in Norway.Am J Epidemiol. 2015; 182: 883-893
- Strong associations of a healthy lifestyle with all stages of colorectal carcinogenesis: results from a large cohort of participants of screening colonoscopy.Int J Cancer. 2019; 144: 2135-2143
- Prospective investigation of body mass index, colorectal adenoma, and colorectal cancer in the prostate, lung, colorectal, and ovarian cancer screening trial.J Clin Oncol. 2013; 31: 2450-2459
- Alcohol drinking and the risk of colorectal adenoma: a dose-response meta-analysis.Eur J Cancer Prev. 2015; 24: 286-295
- Lifestyle risk factors for serrated colorectal polyps: a systematic review and meta-analysis.Gastroenterology. 2017; 152: 92-104
- Sigmoidoscopy and faecal occult blood test – a comparative screening trial.Tidsskr Nor Legeforen. 2017; 137: 3
- Under- and overreporting of energy intake related to weight status and lifestyle in a nationwide sample.Am J Clin Nutr. 1998; 68: 266-274
Norwegian Institute of Public Health. About CONOR - data from several regional health studies, https://www.fhi.no/en/studies/conor/about-conor---data-from-several-regional-health-studies/ (Last accessed 30 November 2020).
- Long-term lifestyle changes after colorectal cancer screening: randomised controlled trial.Gut. 2015; 64: 1268-1276
National Cancer Institute. NCI Dictionary of Cancer Terms - Distal colon, 2019. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/distal-colon (Last accessed 11 Feburay 2019).
National Cancer Institute. NCI Dictionary of Cancer Terms - Proximal colon, 2019. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/proximal-colon (Last accessed 11 Feburary 2019).
- Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2020.Endoscopy. 2020; 52: 687-700
- Lifestyle factors, obesity and the risk of colorectal adenomas in EPIC-Heidelberg.Cancer Causes Control. 2009; 20: 1397-1408
- Anatomic distribution of cancers and colorectal adenomas according to age and sex and relationship between proximal and distal neoplasms in an i-FOBT-positive average-risk Italian screening cohort.Int J Colorectal Dis. 2014; 29: 57-64
Statistics Norway. Smoking habits, 2014, https://ssb.no/en/helse/statistikker/royk (Last accessed 9 December 2015).
- The use of aspirin for primary prevention of colorectal cancer: a systematic review prepared for the U.S.Preventive Services Task Force. Ann Intern Med. 2007; 146: 365-375
- 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.Ann Intern Med. 2007; 146: 376-389
- Sex- and gender-specific disparities in colorectal cancer risk.World J Gastroenterol. 2015; 21: 5167-5175
- Primary prevention of colorectal cancer.Gastroenterology. 2010; 138: 2029-2043
- Determining Risk of Colorectal Cancer and Starting Age of Screening Based on Lifestyle, Environmental, and Genetic Factors.Gastroenterology. 2018; 154: 2152-2164
- Colonoscopy in colorectal-cancer screening for detection of advanced neoplasia.N Engl J Med. 2006; 355: 1863-1872
- Combining risk factors with faecal immunochemical test outcome for selecting CRC screenees for colonoscopy.Gut. 2014; 63: 466-471
- Colorectal cancer screening: systematic review of screen-related morbidity and mortality.Cancer Treat Rev. 2017; 54: 87-98
Article info
Publication history
Published online: December 10, 2020
Accepted:
November 19,
2020
Received:
August 25,
2020
Identification
Copyright
© 2020 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
