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Smoking and Other Risk Factors in Individuals With Synchronous Conventional High-Risk Adenomas and Clinically Significant Serrated Polyps

Anderson, Joseph C. MD1,2; Calderwood, Audrey H. MD, MS2,3; Christensen, Brock C. PhD4; Robinson, Christina M. MS3; Amos, Christopher I. PhD4,5; Butterly, Lynn MD2,3

American Journal of Gastroenterology: December 2018 - Volume 113 - Issue 12 - p 1828–1835
doi: 10.1038/s41395-018-0393-0

BACKGROUND AND AIMS: Serrated polyps (SPs) and conventional high-risk adenomas (HRAs) derive from two distinct biological pathways but can also occur synchronously. Adults with synchronous SPs and adenomas have been shown to be a high-risk group and may have a unique risk factor profile that differs from adults with conventional HRAs alone. We used the population-based New Hampshire Colonoscopy Registry (NHCR) to examine the risk profile of individuals with synchronous conventional HRAs and SPs.

METHODS: Our study population included 20,281 first time screening colonoscopies from asymptomatic NHCR participants 40 years or older between 2004-15. Exams were categorized by findings: (1) normal, (2) HRA only (adenomas ≥ 1 cm, villous, high grade dysplasia, multiple adenomas (> 2) and adenocarcinoma), (3) clinically significant SP (CSSP) only (any hyperplastic polyp ≥ 1 cm, sessile serrated adenomas/polyps or traditional serrated adenomas), and (4) synchronous HRA + CSSP. Risk factors examined included exposure of interest, smoking (never, past, and current/pack years), as well as age, sex, alcohol, education, and family history of colorectal cancer (CRC). Multivariable unconditional logistic regression tested the relation of risk factors with having synchronous HRA + CSSP versus having a normal exam or HRA alone.

RESULTS: Among NHCR participants with 18,354 screening colonoscopies (with complete smoking, sex, bowel preparation data, and adequate preparation) there were 16,495 normal; 1309 HRA alone; 461 CSSP alone, and 89 synchronous HRA + CSSP. Current smoking was associated with an almost threefold increased risk for HRA or CSSP, and an eightfold risk for synchronous HRA + CSSP (aOR = 8.66; 95% CI: 4.73-15.86) compared to normal exams. Adults with synchronous HRA + CSSP were threefold more likely to be current smokers than those with HRA alone (aOR = 3.27; 95% CI:1.74-6.16).

CONCLUSIONS: Our data suggest that current smokers may be at a higher risk for synchronous CSSP + HRA even when compared to having HRA alone.

1Department of Veterans Affairs Medical Center, White River Junction, Hartford, VT, USA. 2The Geisel School of Medicine at Dartmouth, Hanover, NH, USA. 3Section of Gastroenterology, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA. 4Department of Community and Family Medicine, The Geisel School of Medicine at Dartmouth, Hanover, NH, USA. 5Baylor College of Medicine, Houston, TX, USA. Lynn Butterly is the senior author on the paper and the Director of the New Hampshire Colonoscopy Registry

Correspondence: J.C.A. (email:

Received 29 April 2018; accepted 3 October 2018; Published online 1 November 2018

© The American College of Gastroenterology 2018. All Rights Reserved.
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