The Association Between Cigarette Smoking and Colorectal Polyp Recurrence (United States) (original) (raw)
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Cigarette Smoking and Colorectal Cancer Mortality in the Cancer Prevention Study II
2000
Background: Recent studies suggest that long-term cigarette smoking is associated with an increased risk of colorectal cancer. Whether the association is causal or due to confounding remains unclear. Methods: We examined cigarette smoking in relation to colorectal cancer mortality, evaluating smoking duration and recency and controlling for potential confounders in the Cancer Prevention Study II. This prospective nationwide mortality study of 1 184 657 adults (age ≥30 years) was begun by the American Cancer Society in 1982. After exclusions, our analytic cohort included 312 332 men and 469 019 women, among whom 4432 colon or rectal cancer deaths occurred between 1982 and 1996 among individuals who were cancer free in 1982. Rate ratios (RRs) and 95% confidence intervals (CIs) were estimated by fitting Cox proportional hazards models. All statistical tests were two-sided. Results: Multivariate-adjusted colorectal cancer mortality rates were highest among current smokers, were intermediate among former smokers, and were lowest in lifelong nonsmokers. The multivariate-adjusted RR (95% CI) for current compared with never smokers was ) among women. Increased risk was evident after 20 or more years of smoking for men and women combined as compared with never smokers. Risk among current and former smokers increased with duration of smoking and average number of cigarettes smoked per day; risk in former smokers decreased significantly with years since quitting. If the multivariate-adjusted RR estimates in this study do, in fact, reflect causality, then approximately 12% of colorectal cancer deaths among both men and women in the general U.S. population in 1997 were attributable to smoking. Conclusions: Long-term cigarette smoking is associated with increased risk of colorectal cancer mortality in both men and women. Clear reduction in risk is observed with early smoking cessation. [J Natl Cancer Inst 2000;92:1888-96]
Cancer Epidemiology Biomarkers & Prevention, 2009
Background: Many studies have reported a 20% to 60% increase in risk of colorectal cancer associated with active smoking. However, neither the U.S. Surgeon General nor the IARC have classified the relationship as causal because of concern about residual confounding. Methods: In a prospective study of 184,187 people followed from 1992 to 2005, we used Cox proportional hazard models to examine the relationship of cigarette smoking to incident colorectal cancer, controlling for screening and multiple known and putative risk factors. Information on smoking and time-varying covariates was updated in 1997, 1999, 2001, and 2003. Results: The incidence of colorectal cancer was significantly higher in current [hazard ratios (HR), 1.27; 95% confidence intervals (CI), 1.06-1.52] and former smokers (HR, 1.23; 95% CI, 1.11-1.36) compared with lifelong nonsmokers in analyses that controlled for 13 covariates, including screening. The relative risk was greatest among current smokers with at least 50 years of smoking (HR, 1.38; 95% CI, 1.04-1.84). Among former smokers, risk of colorectal cancer decreased with greater time since cessation (P trend = 0.0003), and also decreased with earlier age at cessation (P trend = 0.0014). No association was seen among former smokers who had quit before age of 40 years or abstained for 31 years or more. Conclusions: Long-term cigarette smoking is associated with colorectal cancer, even after controlling for screening and multiple other risk factors. (Cancer Epidemiol Biomarkers Prev 2009;18(12):3362-7)
Cancer …, 2009
BACKGROUNDThe majority of recent, well-designed studies have shown that long-term cigarette smoking increases colorectal cancer risk, but older studies with shorter durations of exposure often found no association. This study aimed to examine colorectal cancer risk by smoking exposure using data collected in the late 1950s and early 1960s.METHODSThis case-control study examined colorectal cancer risk by lifetime smoking history. There were 1,365 patients who visited Roswell Park Cancer Institute (RPCI) between 1957 and 1965 diagnosed with primary, incident colorectal cancers that were matched to 4,096 malignancy-free controls on gender and age. Odds ratios were calculated using separate logistic regression models for each smoking exposure, while controlling for other tobacco use, county of residence, race, age, gender, and body mass index (BMI).RESULTSThe adjusted OR for individuals who reported their greatest level of smoking to be more than 1 pack/day was 0.87 (95% CI=0.67–1.15). Among those who smoked 42 or more years, the adjusted OR was 0.89 (95% CI=0.68–1.15) compared to those who never smoked. For individuals who smoked more than 45 pack-years, the OR was 0.92 (95% CI=0.72–1.19). The results did not differ significantly by gender, although men had considerably greater exposure compared to women. Results also did not differ by colorectal sub-site.CONCLUSIONNo association was found between long-term cigarette smoking and colorectal cancer risk. These results are in accord with studies that followed cohorts throughout the 1950s and 1960s. Methodological limitations, such as missing data on covariates and the higher incidence of smoking-related illness in a hospital setting, may have contributed to the null results found in this study. Prolonged population exposure to cigarettes and perhaps a changing product may explain why more recent studies have reported a positive association between smoking and colorectal cancer.
Cigarette Smoking and Colorectal Cancer Risk: A Burning Issue
Gastroenterology, 2008
Cigarette smoking is an established risk factor for colorectal cancer. Because colorectal carcinogenesis is a heterogeneous process, we investigated whether cigarette smoking is differentially associated with molecularly defined subtypes of colorectal cancer.
Long-term tobacco smoking and colorectal cancer in a prospective cohort study
International Journal of Cancer, 2001
Tobacco smoking has consistently been associated with colorectal adenomas, precursors of cancer, but the association with colorectal cancer itself has not been consistent. If colorectal cancer emerges only after a 35-year induction period, an association would unlikely be detected in studies where exposure assessment is of shorter duration. Most previous studies do not examine smoking of such duration and therefore do not account for the hypothesized 35-year induction period. By using the Cox proportional hazards models to estimate relative risks, we studied the association of longterm smoking and colorectal cancer risk in a populationbased prospective cohort of 17,118 Swedish twins with up to 30 years of follow-up and information on smoking habits prior to baseline exposure assessment. Long-term heavy smoking was associated with a statistically significant 3-fold increased risk of colorectal cancer compared with never smoking (relative risk 3.1, 95% CI 1.4 -7.1). Examining colorectal cancer sub-sites separately, a non-significant 60% increased risk of colon cancer was observed only for heavy smokers and a statistically significant 5-fold increased risk was observed for rectal cancer. Our data lend some support to the hypothesis that heavy long-term cigarette smoking is associated with increased risk of colorectal cancer. Further elucidation of this association would be valuable from both etiologic and public health perspectives.
Prospective cohort study of cigarette smoking and colorectal cancer risk in women
International Journal of Cancer, 2002
Epidemiological studies have consistently found a positive association between cigarette smoking and risk of colorectal adenomas, so the absence of a clear association between smoking and colorectal cancer risk may seem paradoxical. However, if colorectal cancer develops only after an induction period of about 35 years, as has been proposed recently, then studies in which all subjects have fewer than about 35 years between smoking commencement and assessment of outcome would be unlikely to detect this association. Few studies have examined smoking of several decades' duration among women. Therefore, in the cohort study reported here, we used proportional hazards models to estimate hazard ratios relating cigarette smoking to colorectal cancer risk among 89,835 women aged 40 -59 years at recruitment into the Canadian National Breast Screening Study, a randomized controlled trial of mammography screening for breast cancer. During an average 10.6 years of follow-up (936,433 person-years), a total of 527 women were diagnosed with incident colorectal cancer (363 colon and 164 rectal). We found that smoking was associated with increased risk of rectal cancer 30 years or more after commencement, and especially with smoking of 40 years' duration or longer (hazard ratio,41.3؍ 95% CI.)24.7-33.1؍ There was little evidence for altered risk of colon cancer. These results, along with those of other recent studies, support the hypothesis that tobacco smoking is an initiator, rather than a promoter, of rectal cancer. However, the results do not support an association with colon cancer risk, even with smoking of very long duration and high intensity.
Smoking and Colorectal Cancer: A Meta-analysis
Jama-journal of The American Medical Association, 2008
Context Colorectal cancer is the third most common form of cancer and the fourth most frequent cause of cancer deaths worldwide. The association between cigarette smoking and colorectal cancer has been inconsistent among studies.
Cigarette Smoking and Colorectal Cancer: From Epidemiology to Bench
Journal of Experimental & Clinical Medicine, 2011
Colorectal cancer is the third most commonly diagnosed malignancy in the world. The risk factors include inherited genetic mutations and environmental elements such as a high-fat diet, low-fiber diet and sedentary lifestyle. Cigarette smoking is a serious worldwide health problem and the leading cause of preventable death. Although smoking increases the risk of cardiovascular disease and various cancers such as lung, oral and some gastrointestinal cancers, smoking is currently not recognized as a risk factor of colorectal cancer by either the International Agency for Research on Cancer (IARC) or the US Surgeon General. Accumulating epidemiological studies indicate that cigarette smoking is positively correlated to colorectal adenomatous polyps, and positive associations between cigarette smoking and colorectal cancer risk have been reported. Long-term cigarette smoking increases the risk of colorectal cancer mortality and the likelihood of a mutation occurring in the adenomatous polyposis coli (APC) tumor suppressor gene, which has a "gatekeeper" function in the colonic mucosa. Heavy smoking is associated with an increased risk of obtaining a mutation in BRAF, but not KRAS. Current and long-term smokers are at elevated risk of microsatellite instability high (MSI-H) colorectal cancers and an estimated one in five MSI-H colorectal cancers is attributable to cigarette smoking. Nicotine and its metabolite, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), are two of the most causal elements for smoking-related cancers. Nicotine and NNK have been shown to induce colon cancer growth and even enhance the migration of colon cancer cells, which is a major cause of cancer death. In conclusion, cigarette smoking should be considered a risk factor of colorectal cancer.
The Role of Smoking in the Development of Colorectal Cancer
Acta Medica Marisiensis, 2016
Introduction. Smoking is an important public health issue nowadays. It causes a lot of diseases and represents also a source of carcinogenic substances. Recent studies showed an increased incidence of colorectal cancer in smokers. The aim of our study is to assess the association between smoking and colorectal cancer and to establish the prevalence of heavy smokers among the patients operated on for colorectal cancer. Methodology. We run a retrospective study of the charts belonging to the patients diagnosed with colorectal cancer and operated on in our department between 2004 and 2013. The patients were classified in smokers, former smokers and nonsmokers. The amount of tobacco was evaluated according to the number of smoked cigarettes per day, the smoking period, respectively the pack-years. The data were corroborated with the location of the tumor and analyzed using the online version of Graphpad. Results. From 982 patients diagnosed with colorectal cancer, we found 297 smokers (30.24%). Among these, 106 patients (35.69%) have smoked for over 30 years, at least 20 cigarettes per day, more than 30 pack-years. The number of heavy smokers was significantly greater (p=0.0001) in the group with rectal cancer compared to the group with colon cancer. The association of smoking with rectal cancer was also important (p=0.0015) among the former smokers. Conclusions. Smoking is related to higher incidence of colorectal cancer. Our data sustain the hypothesis of increased risk of developing rectal cancer in heavy smokers. We recommend the screening for colorectal cancer among the heavy smoker population.
Cancer Causes & Control, 2010
Background-Studies published prior to 1980 failed to find an association between smoking and colorectal cancer, while subsequent studies reported an association after accounting for a three to four decade initiation period. The aims of this study were to determine the effect of accounting for secondhand smoke (SHS) exposure on the association between smoking and colorectal cancer and to determine the association between SHS and colorectal cancer.