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Smoking Linked to Higher Risk of Flat Colorectal Adenomas

Smokers have more than double the risk of flat adenoma found on high-definition colonoscopy

FRIDAY, June 18 (HealthDay News) -- Smoking appears to be an important risk factor for flat colorectal adenomas, which may explain the earlier onset and advanced stage at presentation of colorectal cancer in smokers, according to research published in the June issue of Gastrointestinal Endoscopy.

Joseph C. Anderson, M.D., of the University of Connecticut in Farmington, and colleagues analyzed data from 600 asymptomatic participants screened with a high-definition, wide-angle colonoscope. Polyp morphology was classified using the Japanese Research Society Classification.

The researchers found that smoking was associated with a greater risk of having a flat adenoma of any size (adjusted odds ratio [aOR], 2.53), having only flat adenomas of at least 6 mm in diameter (aOR, 3.84), and having flat advanced adenomas (aOR, 2.81). They also found a dose-dependent relationship between smoking and having any flat adenoma or only flat adenomas of at least 6 mm.

"The present findings may explain the observation that smokers often present with colorectal cancer at a younger age and at a more advanced stage than nonsmokers. If flat polyps are associated with de novo cancers, the findings of an earlier onset and progression in smokers may be due to their association with flat adenomas," the authors write. "These polyps, especially the larger adenomas, are important precursors to colorectal cancer. Their morphology may make them difficult to detect; therefore, identifying a risk factor that may increase a patient's predilection for them is clinically important."

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