Association between Risk Factors for Colorectal Cancer and Risk of Serrated Polyps
      and Conventional Adenomas

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Abstract

Background & Aims

Serrated polyps (SPs) and conventional adenomas are precursor lesions for colorectal cancer (CRC) but believed to arise via distinct pathways. We characterized risk factor profiles for SPs and conventional adenomas in a post-hoc analysis of data from 3 large prospective studies.

Methods

We collected data from the Nurses’ Health Study (NHS), the NHS2, and the Health Professionals Follow-up Study (HPFS) on subjects who developed SPs or conventional adenomas. Our analysis comprised 141,143 participants who had undergone lower gastrointestinal endoscopy, provided updated diet and lifestyle data every 2–4 years, and were followed until diagnosis of a first polyp. We assessed 13 risk factors for CRC in patients with SPs or conventional adenomas, and examined the associations according to histopathology features.

Results

We documented 7945 SPs, 9212 conventional adenomas, and 2382 synchronous SPs and conventional adenomas during 18–20 years of follow up. Smoking, body mass index, alcohol intake, family history of CRC, and height were associated with higher risk of SPs and conventional adenomas, whereas higher intake of vitamin D and marine omega-3 fatty acid were associated with lower risk. The associations tended to be stronger for synchronous SPs and conventional adenomas. Smoking, body mass index, and alcohol intake were more strongly associated with SPs than conventional adenomas ( P for heterogeneity <.05), whereas physical activity and intake of total folate and calcium were inversely associated with conventional adenomas but not SPs. For SPs and conventional adenomas, the associations tended to be stronger for polyps in the distal colon and rectum, larger than 10 mm, or with advanced histology.

Conclusions

In an analysis of data from 3 large prospective studies, we found that although SPs and conventional adenomas share many risk factors, some factors are more strongly associated with 1 type of lesion than the other. These findings provide support for the etiologic heterogeneity of colorectal neoplasia.

Graphical abstract

Colorectal cancer risk factors and risk of serrated polyp and conventional adenoma

*Smoking : current smokers with ≥30 pack-years versus never smokers; Body mass index: ≥35 versus <25 kg/m ²; Alcohol intake: ≥14 g/d versus never for men, ≥7 g/d versus never for women; Physical activity: ≥60 versus <7.5 metabolic equivalent task-hours/week versus; Dietary factors: highest quartile versus lowest quartile.

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Author and article information

Journal

Journal ID (nlm-journal-id): 0374630

Journal ID (pubmed-jr-id): 3841

Journal ID (nlm-ta): Gastroenterology

Journal ID (iso-abbrev): Gastroenterology

Title: Gastroenterology

ISSN (Print): 0016-5085

ISSN (Electronic): 1528-0012

Publication date Nihms-submitted: 24 April 2018

Publication date (Electronic): 24 April 2018

Publication date (Print): August 2018

Publication date PMC-release: 01 August 2019

Volume: 155

Issue: 2

Pages: 355-373.e18

Affiliations

[1 ]Research fellow. Department of Colorectal Surgery, the Six Affiliated Hospital, Sun Yat-sen University, Guangzhou, P.R. China; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

[2 ]Principal Research Scientist. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA

[3 ]Professor of Medicine. Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Program in MPE Molecular Pathological Epidemiology, Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School Boston, MA, USA; Department of Oncologic Pathology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA

[4 ]Professor of Epidemiology and Nutrition. Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

[5 ]Professor of Medicine. Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA; Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA

[6 ]Instructor in Medicine. Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA

Author notes

Corresponding author: Mingyang Song, MD, ScD, Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, 100 Cambridge Street, Room1576, Boston, MA 02114, Telephone: 617- 643-4464; Fax: 617-432-2435, msong2@ 123456mgh.harvard.edu

[*]

M.S. and A.T.C. contributed equally.

Article

Accession ID: PMC6067965 Pmcid ID: PMC6067965 Pmc-uid ID: 6067965 Manuscript ID: nihpa962640

DOI: 10.1053/j.gastro.2018.04.019

PMC ID: 6067965

PubMed ID: 29702117

SO-VID: c6020d37-4800-40a0-b7ff-0b7ee9b71f98

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Association between Risk Factors for Colorectal Cancer and Risk of Serrated Polyps and Conventional Adenomas

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