title: Factors associated with the risk of adenoma recurrence in distal and proximal colon.
abstract: OBJECTIVE
  Colonoscopy may be less effective in preventing cancer in the proximal colon. We evaluated whether risk factors for adenoma recurrence exhibit differential effect on adenoma recurrence by colon subsite.
  
  
  METHODS
  We examined the association of age, sex, body mass index, smoking status and use of nonsteroidal anti-inflammatory drugs (NSAIDs) on proximal and distal adenoma recurrence among 1,864 participants in the Polyp Prevention Trial. We used multinomial logistic regression models to calculate the relative risk ratios (RRR) and 95% CI.
  
  
  RESULTS
  733 (39.3%) participants had adenoma recurrence (228 distal only, 369 proximal only and 136 synchronous proximal and distal adenoma). When compared to participants without adenoma recurrence, no factor was associated with an increased risk of distal only adenoma recurrence. Age 65-69 years (RRR = 1.47, 95% CI 1.00-2.16), age ≥70 years (RRR = 2.24, 95% CI 1.57-3.20), and male sex (RRR = 1.73, 95% CI 1.32-2.27) were positively associated with proximal only adenoma recurrence. NSAIDs use was associated with a reduced risk of adenoma recurrence by similar magnitude in distal (RRR = 0.78, 95% CI 0.58-1.07) and proximal colon (RRR = 0.77, 95% CI 0.60-1.00).
  
  
  CONCLUSIONS
  We did not find any modifiable risk factor that differentially increases proximal as compared to distal adenoma recurrence to be clinically useful for targeted intervention.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Howard University College of Medicine, Washington, DC 20060, USA. adeyinka.laiyemo@howard.edu
authors.forename: Adeyinka O
authors.initials: AO
authors.lastname: Laiyemo
authors.forename: Chyke
authors.initials: C
authors.lastname: Doubeni
authors.forename: Paul F
authors.initials: PF
authors.lastname: Pinsky
authors.forename: V Paul
authors.initials: VP
authors.lastname: Doria-Rose
authors.forename: Pamela M
authors.initials: PM
authors.lastname: Marcus
authors.forename: Robert E
authors.initials: RE
authors.lastname: Schoen
authors.forename: Elaine
authors.initials: E
authors.lastname: Lanza
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Cross
mesh_terms: D000236:Adenoma / Q000453:epidemiology* / Q000473:pathology; D000368:Aged; D003106:Colon / Q000473:pathology*; D003110:Colonic Neoplasms / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology; D016032:Randomized Controlled Trials as Topic; D014481:United States / Q000453:epidemiology
references.citation: Gastrointest Endosc. 2011 Aug;74(2):253-61
references.pmid: 21549375
references.citation: Cancer Epidemiol Biomarkers Prev. 1996 May;5(5):375-83
references.pmid: 9162304
references.citation: Arch Intern Med. 1999 Jan 25;159(2):161-6
references.pmid: 9927099
references.citation: Cancer Epidemiol Biomarkers Prev. 2005 Feb;14(2):409-16
references.pmid: 15734966
references.citation: Clin Gastroenterol Hepatol. 2008 Oct;6(10):1117-21; quiz 1064
references.pmid: 18691942
references.citation: JAMA. 2005 Aug 24;294(8):914-23
references.pmid: 16118381
references.citation: Cancer Epidemiol Biomarkers Prev. 1996 May;5(5):385-92
references.pmid: 9162305
references.citation: Ann Intern Med. 2011 Jan 4;154(1):22-30
references.pmid: 21200035
references.citation: Dis Colon Rectum. 2001 Feb;44(2):251-8
references.pmid: 11227943
references.citation: J Pathol. 2008 Apr;214(5):594-602
references.pmid: 18241079
references.citation: Ann Intern Med. 2008 Mar 18;148(6):419-26
references.pmid: 18347350
references.citation: Ann Intern Med. 2009 Jan 6;150(1):1-8
references.pmid: 19075198
references.citation: N Engl J Med. 2006 Aug 31;355(9):885-95
references.pmid: 16943401
references.citation: Am J Epidemiol. 2009 Mar 15;169(6):657-66
references.pmid: 19147743
references.citation: Gastroenterology. 2010 Oct;139(4):1128-37
references.pmid: 20600026
references.citation: Ann Intern Med. 2007 Mar 6;146(5):376-89
references.pmid: 17339623
references.citation: Cancer. 1997 Jul 15;80(2):193-7
references.pmid: 9217029
references.citation: N Engl J Med. 2006 Aug 31;355(9):873-84
references.pmid: 16943400
references.citation: Gastroenterology. 2006 Dec;131(6):1674-82
references.pmid: 17087947
references.citation: Cancer Epidemiol Biomarkers Prev. 2009 Aug;18(8):2170-5
references.pmid: 19622721
references.citation: Clin Gastroenterol Hepatol. 2008 May;6(5):506-14
references.pmid: 18455696
references.citation: JAMA. 2006 May 24;295(20):2366-73
references.pmid: 16720822
references.citation: N Engl J Med. 2000 Apr 20;342(16):1149-55
references.pmid: 10770979
references.citation: Eur J Cancer. 2008 Jun;44(9):1290-301
references.pmid: 18486467