Who Has the Greatest Risk for Colorectal Cancer?

Men and smokers have the greatest risk for developing colorectal neoplasms—even more than people with a family history of this cancer—according to Michael Hoffmeister et al. in the October issue of Clinical Gastroenterology and Hepatology.

Current guidelines recommend that individuals with a family history of colorectal cancer (CRC), inflammatory bowel disease, or rare genetic syndromes be screened for colorectal cancer. Hoffmeister et al. looked for other factors that might contribute to risk, performing colonoscopies on 3349 individuals that had not previously received this type of screening. They investigated whether different types of polyps were associated with age, sex, education, body mass index, family history of cancer, or smoking.

They found that the population-attributable fraction of non-advanced and advanced neoplasias was highest for male sex (23%), followed by history of smoking (8%)—greater than for family history of CRC (3%). The prevalence of neoplasia was higher among non-smoking men than even women who smoke.

It is not clear why men have a much greater risk for colorectal neoplasia than women; the authors propose that differences in general health behavior and nutrition, in addition to biologic factors, might contribute.

CRC screening guidelines are already complex, but it is clear that sex and smoking history should be included as important determinants.

More Information on CRC:

• The National Cancer Institute’s Colorectal Cancer Screening Fact Sheet
• Screening Guidelines Published in Gastroenterology

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Read the article online:
Hoffmeister M, Schmitz S, Karmrodt E, et al. Male sex and smoking have a larger impact on the prevalence of colorectal neoplasia than family history of colorectal cancer. Clin Gastroenterol and Hepatol 2010;10:870-876.