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Risk Factors for Sessile Serrated Adenomas

Anderson, Joseph Carl MD*; Rangasamy, Priya MD*; Rustagi, Tarun MD; Myers, Matthew MD*; Sanders, Melinda MD; Vaziri, Haleh MD*; Wu, George MD*; Birk, John W. MD*; Protiva, Petr MD§

Journal of Clinical Gastroenterology: September 2011 - Volume 45 - Issue 8 - p 694–699
doi: 10.1097/MCG.0b013e318207f3cf
ALIMENTARY TRACT: Original Articles

Background Although sessile serrated adenomas (SSAs) may represent a separate and important pathway for colorectal cancer (CRC), little is known about the risk factors for these lesions. Molecular abnormalities such as BRAF have been observed in SSA and smokers. Our hypothesis is that smoking may be associated with these lesions.

Methods All patients diagnosed with an SSA from January 2007 to September 2010 were identified retrospectively based on a pathology database query. There were 2 sets of controls. One group had no adenomas, whereas another group had tubular adenomas. These groups were randomly identified from 2007 to 2010. Data collected included age, sex, ethnicity, height, weight, family history of CRC, diabetes mellitus, use of aspirin, statins, and calcium, and serum trigylcerides and cholesterol. We defined smokers as those patients who smoked at least 20 pack-years.

Results We identified 90 patients with an SSA of any size, 90 patients with tubular adenomas, and 200 controls with no adenomas. Of the 90 SSAs, 42 were 6 mm or larger and 19 of them were ≥1 cm. Most of the SSAs was flat (76/90; 84.4%). After multivariate analyses, smokers with at least 20 pack-year exposure were found to have an increased risk [adjusted odds ratio (OR)=7.31; 95% confidence interval (CI), 3.92-13.63] of having any SSAs, SSAs ≥6 mm (adjusted OR=7.77; 95% CI, 3.48-17.35), and large SSAs (adjusted OR=10.20; 95% CI, 3.31-31.41) compared with nonsmokers. We also observed this relationship when comparing patients with SSAs to those with tubular adenomas.

Conclusions Our data suggest that smoking at least 20 pack-years is strongly associated with any and large SSAs. In addition, diabetes mellitus and obesity seem to be associated with SSAs as well. Our data has implications for CRC screening.

Departments of *Gastroenterology

Internal Medicine

Pathology, University of Connecticut Health Center, Farmington

§Department of Gastroenterology, VA Hospital, Yale School of Medicine, New Haven, CT

Financial Support: None.

Reprints: Joseph Carl Anderson, MD, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-1845 (e-mail:

Received June 12, 2010

Accepted November 18, 2010

© 2011 Lippincott Williams & Wilkins, Inc.