Smoking, alcohol among factors linked to risk for serrated colorectal polyps
A number of lifestyle factors, particularly tobacco smoking and alcohol consumption, were associated with the risk for developing potentially malignant serrated colorectal polyps in a recent systematic review and meta-analysis.
“Although lifestyle risk factors have long been associated with the risk of colorectal cancer and conventional adenomas, their association with serrated colorectal polyps remained unclear as no large-scale review of evidence had been conducted,” Helen G. Coleman, PhD, of the Cancer Epidemiology and Health Services Group in the Center for Public Health at Queens University Belfast in Northern Ireland, told Healio Gastroenterology. “This is particularly relevant due to recent findings that certain subtypes of these serrated polyps, notably sessile serrated adenomas, can develop into serrated pathway colorectal cancers. Prior to 2010, most serrated polyps were classified as benign hyperplastic polyps.”
Coleman and colleagues reviewed relevant literature published up to March 2016 and ultimately included 43 studies of associations between serrated polyp risk and seven lifestyle factors in their analysis. These included tobacco smoking, alcohol consumption, body fat, diet, physical activity, medication and/or hormone replacement therapy.
After comparing the highest vs. lowest exposures, they found that smoking (RR = 2.47; 95% CI, 2.12-2.87), alcohol (RR = 1.33; 95% CI, 1.17-1.52), BMI (RR = 1.4; 95% CI, 1.22-1.61) and high consumption of fat (RR = 1.25; 95% CI, 1.1-1.41) and red meat (RR = 1.23; 95% CI, 1.07-1.41) were significantly associated with an increased risk for developing serrated polyps. Smoking and alcohol tended to have stronger associations with risk for sessile serrated adenomas and polyps vs. hyperplastic polyps.
In addition, NSAID use (RR = 0.77; 95% CI, 0.65-0.92) aspirin use (RR = 0.81; 95% CI, 0.67-0.99) and high folate consumption (RR = 0.65; 95% CI, 0.49-0.85) were significantly associated with a reduced risk for developing serrated polyps. Calcium and fiber consumption were also associated with a reduced risk for serrated polyps, but these did not reach statistical significance.
“Our systematic review indicates that serrated polyps (and particularly sessile serrated adenomas) were strongly associated with a wide range of modifiable risk factors, and therefore individuals with these polyps detected at colonoscopy should probably receive the same preventative lifestyle advice as those with conventional colorectal adenomas, i.e. to stop smoking, limit alcohol consumption, maintain a normal body weight and eat a healthy diet, in order to reduce their risk of developing future colorectal polyps or cancer,” Coleman said. – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.