title: Association of tobacco and alcohol use with earlier development of colorectal pathology: should screening guidelines be modified to include these risk factors?
abstract: BACKGROUND
  Current guidelines for colorectal cancer (CRC) screening recommend initial screening at 50 years of age for normal-risk patients. Alcohol and tobacco use can be associated with an earlier onset of CRC and possibly polyps.
  
  
  METHODS
  We reviewed all colonoscopies performed at our institution from January to December 2007. Patient data were collected on age, sex, tobacco and alcohol history, and the presence of colon lesions.
  
  
  RESULTS
  Our data included 663 patients (643 men and 20 women) with a mean age of 60.7 years (range 23-89 years); 68.5% were current/former tobacco users, 53.7% were current/former alcohol users, 37.6% had used both, and 21.7% had used neither. Colonoscopy findings were as follows 64% of patients had no lesions, 30.6% had tubular polyps, 3.5% had villous polyps, and 2% had cancer. The current use of tobacco, alcohol, or both was associated with the early development of colon pathology (ie, 66.9 years, 61.1 years, and 59.2 years [P < .05], respectively). In nonusers, the mean age was 67.7 years.
  
  
  CONCLUSIONS
  Our work confirms that the use of alcohol and tobacco is associated with an earlier onset of colon pathology. Consideration should be given to modifying screening guidelines to include these habits as "high-risk" factors.
authors.affiliation: Department of Surgery, Central Arkansas Veterans Healthcare System, 4300 W 7th Street, 112/LR, Little Rock, AR 72205, USA.
authors.forename: Mario
authors.initials: M
authors.lastname: Rueda
authors.forename: Yara
authors.initials: Y
authors.lastname: Robertson
authors.forename: Alison
authors.initials: A
authors.lastname: Acott
authors.forename: Steven
authors.initials: S
authors.lastname: Rueda
authors.forename: Aaron
authors.initials: A
authors.lastname: Keikhoff
authors.forename: Whitney
authors.initials: W
authors.lastname: Guerrero
authors.forename: Anne T
authors.initials: AT
authors.lastname: Mancino
mesh_terms: D018256:Adenomatous Polyps / Q000175:diagnosis / Q000209:etiology*; D000328:Adult; D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects*; D003113:Colonoscopy / Q000592:standards*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D055088:Early Detection of Cancer / Q000592:standards*; D005260:Female; D006801:Humans; D007417:Intestinal Polyps / Q000175:diagnosis / Q000209:etiology*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D062789:Tobacco Products / Q000009:adverse effects