title: Male sex and smoking have a larger impact on the prevalence of colorectal neoplasia than family history of colorectal cancer.
abstract: OBJECTIVE
  Screening recommendations for colorectal cancer (CRC) commonly take family history but no other risk factors into account. We compared and assessed risk factors of colorectal polyps in a large population undergoing screening colonoscopy.
  
  
  METHODS
  We conducted a population-based cross-sectional study that included 3349 subjects, 55 years or older (mean ages of men and women, 63.6 and 63.4 years, respectively), who underwent colonoscopy for the first time within the nationwide colonoscopy screening program in Germany. We calculated prevalences of colorectal polyps and estimated multivariate prevalence ratios (PRs) and population attributable fractions (PAFs).
  
  
  RESULTS
  Overall, 654 subjects had hyperplastic polyps (20%), 675 had non-advanced adenomas (20%), 343 had advanced adenomas (10%), and 40 had CRC (1%). Risk factor prevalences and adjusted PRs were higher for male gender and smoking than for family history of CRC. PAFs for prevalence of non-advanced and advanced neoplasia were highest for male gender (23% and 23%, respectively), followed by smoking (7% and 9%, respectively), and family history of CRC (2% and 4%, respectively).
  
  
  CONCLUSIONS
  Male gender and smoking have a larger impact on the prevalence of colorectal neoplasia than family history, suggesting an extensive evaluation of additional risk stratification in population-based screening, particularly by sex.
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany. m.hoffmeister@dkfz.de
authors.forename: Michael
authors.initials: M
authors.lastname: Hoffmeister
authors.forename: Stephanie
authors.initials: S
authors.lastname: Schmitz
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Karmrodt
authors.forename: Christa
authors.initials: C
authors.lastname: Stegmaier
authors.forename: Ulrike
authors.initials: U
authors.lastname: Haug
authors.forename: Volker
authors.initials: V
authors.lastname: Arndt
authors.forename: Hermann
authors.initials: H
authors.lastname: Brenner
mesh_terms: D000236:Adenoma / Q000453:epidemiology*; D000368:Aged; D000369:Aged, 80 and over; D003111:Colonic Polyps / Q000453:epidemiology*; D015179:Colorectal Neoplasms / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005192:Family Health; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects