Male sex and smoking have a larger impact on the prevalence of colorectal neoplasia than family history of colorectal cancer.
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.
Hoffmeister
Michael
M
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany. m.hoffmeister@dkfz.de
Schmitz
Stephanie
S
Karmrodt
Elisabeth
E
Stegmaier
Christa
C
Haug
Ulrike
U
Arndt
Volker
V
Brenner
Hermann
H
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