title: Hyperplastic polyposis syndrome is associated with cigarette smoking, which may be a modifiable risk factor.
abstract: OBJECTIVE
  Hyperplastic polyposis syndrome (HPS) confers an increased risk of colorectal cancer and is difficult to manage clinically. Because both polyps and resultant cancers display the CpG island methylator phenotype and mutation of the BRAF oncogene, and because sporadic cancers with these characteristics are associated with cigarette smoking, we hypothesized that cigarette smoking may predispose to the development of HPS.
  
  
  METHODS
  This was a case-control study with two independent control series conducted at a tertiary hospital in Brisbane, Queensland, Australia. Cases comprised patients with HPS (n=32) recruited through the database of the Queensland Familial Bowel Registry, who satisfied the World Health Organization international classification for HPS. Cases were compared with colonoscopy controls (n=298) defined as consecutive patients undergoing colonoscopy for clinical indications, who were free from polyps. We also compared cases with a second set of population controls (n=645) selected at random from a population register serving the catchment area for cases. This was an observational study, and all participants completed a questionnaire to obtain a comprehensive smoking history.
  
  
  RESULTS
  The prevalence rate of current smoking was 47% in HPS patients, 17% in colonoscopy controls, and 12% in population controls. HPS patients were significantly more likely to be current smokers than were either colonoscopy controls (odds ratio (OR)=8.3, 95% confidence interval (CI): 3.0-22.9) or population controls (OR=12.7, 95% CI: 4.9-33.1).
  
  
  CONCLUSIONS
  Cigarette smoking is strongly associated with HPS, thus suggesting that smoking exposure may increase the expression of this condition. Further studies should examine the possible benefits of quitting smoking in HPS patients.
authors.affiliation: Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: R Griff
authors.initials: RG
authors.lastname: Walker
authors.forename: Juergen K
authors.initials: JK
authors.lastname: Landmann
authors.forename: David G
authors.initials: DG
authors.lastname: Hewett
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Worthley
authors.forename: Ron L
authors.initials: RL
authors.lastname: Buttenshaw
authors.forename: Ngaire
authors.initials: N
authors.lastname: Knight
authors.forename: Penny M
authors.initials: PM
authors.lastname: Webb
authors.forename: David C
authors.initials: DC
authors.lastname: Whiteman
authors.forename: Vicki L
authors.initials: VL
authors.lastname: Whitehall
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Leggett
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003111:Colonic Polyps / Q000453:epidemiology / Q000209:etiology*; D003113:Colonoscopy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011793:Queensland / Q000453:epidemiology; D012042:Registries; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013577:Syndrome