title: A prospective evaluation of C-reactive protein levels and colorectal adenoma development.
abstract: BACKGROUND
  Inflammation is hypothesized to play a role in colorectal tumorigenesis. Circulating levels of C-reactive protein (CRP), a serologic marker of the inflammatory response, have been positively associated with colorectal cancer development in some studies; however, there are limited data on the relation of CRP with colorectal adenomas, established precursors of colorectal cancer.
  
  
  METHODS
  A nested case-control investigation of CRP levels and incident colorectal adenoma was conducted in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, a randomized trial of 154,942 individuals designed to test the efficacy of flexible sigmoidoscopy on colorectal cancer mortality when performed once, and then repeated 3 to 5 years later. Serum CRP levels were measured in baseline blood specimens from participants who were free of polyps in the left-sided colorectum at the baseline screening procedure, but who were found at the subsequent screen to have at least one colorectal adenoma (n=356), and in a set of polyp-free, frequency-matched controls (n=396).
  
  
  RESULTS
  In a multivariable logistic regression model that included established colorectal adenoma risk factors, a 1-unit increase in log CRP level was associated with a 15% reduction in risk of developing colorectal adenoma (OR=0.85, 95% CI, 0.75-0.98, Ptrend=0.01). This association did not differ according to body size, smoking behavior, gender, use of nonsteroidal antiinflammatory drugs, or adenoma location.
  
  
  CONCLUSIONS
  High circulating CRP levels may be protective against colorectal adenoma development.
  
  
  CONCLUSIONS
  Though at contrast with mechanistic data on inflammation and colorectal tumorigenesis, this finding is not inconsistent with prior results on CRP and colorectal adenoma and warrants further investigation.
authors.affiliation: Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, New York, NY 10461, USA. marc.gunter@einstein.yu.edu
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Gunter
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Cross
authors.forename: Wen-Yi
authors.initials: WY
authors.lastname: Huang
authors.forename: Frank Z
authors.initials: FZ
authors.lastname: Stanczyk
authors.forename: Mark
authors.initials: M
authors.lastname: Purdue
authors.forename: Xiaonan
authors.initials: X
authors.lastname: Xue
authors.forename: Robert
authors.initials: R
authors.lastname: Schoen
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Limburg
authors.forename: Arthur
authors.initials: A
authors.lastname: Schatzkin
authors.forename: Rashmi
authors.initials: R
authors.lastname: Sinha
authors.forename: Richard B
authors.initials: RB
authors.lastname: Hayes
mesh_terms: D000236:Adenoma / Q000097:blood* / Q000175:diagnosis; D002097:C-Reactive Protein / Q000378:metabolism*; D016022:Case-Control Studies; D015179:Colorectal Neoplasms / Q000097:blood* / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012812:Sigmoidoscopy
chemical_list: D002097:C-Reactive Protein