Markus D Knudsen1, Edoardo Botteri2, Øyvind Holme3, Anette Hjartåker4, Mingyang Song5, Espen Thiis-Evensen6, Espen R Norvard7, Anna L Schult8, Kristin R Randel9, Geir Hoff10, Paula Berstad11. 1. Section for colorectal cancer screening, Cancer Registry of Norway, P.O. Box 5313, Majorstuen, 0304 Oslo, Norway; Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Norwegian PSC Research Center, Oslo University Hospital, Rikshospitalet, P.O. Box 4950 Nydalen, 0424 Oslo, Norway; Departments of Epidemiology and Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA. 2. Section for colorectal cancer screening, Cancer Registry of Norway, P.O. Box 5313, Majorstuen, 0304 Oslo, Norway. 3. Section for colorectal cancer screening, Cancer Registry of Norway, P.O. Box 5313, Majorstuen, 0304 Oslo, Norway; Department of Medicine, Sørlandet Hospital Kristiansand, P.O. Box 416 Lundsiden, 4604 Kristiansand, Norway; Department of Health Management and Health Economis, Institute of Health and Society, University of Oslo, P.O. Box 1089 Blindern, 0317 Oslo, Norway. 4. Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, P.O.Box 1046 Blindern, 0317 Oslo, Norway. 5. Departments of Epidemiology and Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA. 6. Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Norwegian PSC Research Center, Oslo University Hospital, Rikshospitalet, P.O. Box 4950 Nydalen, 0424 Oslo, Norway. 7. Department of Pathology, Vestre Viken Hospital Trust Drammen, P.O. Box 800, 3004 Drammen, Norway. 8. Section for colorectal cancer screening, Cancer Registry of Norway, P.O. Box 5313, Majorstuen, 0304 Oslo, Norway; Department of Medicine, Vestre Viken Hospital Trust Bærum, P.O. Box 800, 3004 Drammen, Norway; Institute of Clinical Medicine, University of Oslo, Rikshospitalet, P.O. Box 4950 Nydalen, 0424 Oslo, Norway. 9. Section for colorectal cancer screening, Cancer Registry of Norway, P.O. Box 5313, Majorstuen, 0304 Oslo, Norway; Department of Health Management and Health Economis, Institute of Health and Society, University of Oslo, P.O. Box 1089 Blindern, 0317 Oslo, Norway; Department of Research and Development, Telemark Hospital Trust, Ulefossvegen 55, 3710 Skien, Norway. 10. Section for colorectal cancer screening, Cancer Registry of Norway, P.O. Box 5313, Majorstuen, 0304 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Rikshospitalet, P.O. Box 4950 Nydalen, 0424 Oslo, Norway; Department of Research and Development, Telemark Hospital Trust, Ulefossvegen 55, 3710 Skien, Norway. 11. Section for colorectal cancer screening, Cancer Registry of Norway, P.O. Box 5313, Majorstuen, 0304 Oslo, Norway. Electronic address: paula.berstad@kreftregisteret.no.
Abstract
BACKGROUND: Lifestyle factors may help to identify individuals at high-risk for colorectal cancer (CRC). AIMS: To examine the association between lifestyle, referral for follow-up colonoscopy and proximal neoplasia detection in CRC screening. METHODS: In this observational study, 14,832 individuals aged 50-74 years were invited to faecal immunochemical test (FIT) or sigmoidoscopy screening. Advanced lesions (AL), including advanced adenomas, advanced serrated lesions and CRC were divided according to location: distal-only, or proximal with or without distal AL. We collected information on smoking habit, body mass index and alcohol intake through a questionnaire. RESULTS: Out of 3,318 FIT and 2,988 sigmoidoscopy participants, 516 (16%) and 338 (11%), respectively, were referred for follow-up colonoscopy after a positive screening test. Two-hundred-and-fifty-six (4%) had distal-only and 119 (2%) proximal AL. In FIT participants, obesity and high alcohol intake were associated with proximal AL; odds ratio (95% confidence interval) 2.68 (1.36-5.26) and 2.16 (1.08-4.30), respectively. In sigmoidoscopy participants, current smoking was associated with proximal AL; 4.58 (2.24-9.38), and current smoking and obesity were associated with referral for colonoscopy; 2.80 (2.02-3.89) and 1.42 (1.01-2.00), respectively. CONCLUSION: Current smoking, obesity and high alcohol intake were associated with screen-detected proximal colorectal AL. Current smoking and obesity were associated with referral for follow-up colonoscopy in sigmoidoscopy screening.
BACKGROUND: Lifestyle factors may help to identify individuals at high-risk for colorectal cancer (CRC). AIMS: To examine the association between lifestyle, referral for follow-up colonoscopy and proximal neoplasia detection in CRC screening. METHODS: In this observational study, 14,832 individuals aged 50-74 years were invited to faecal immunochemical test (FIT) or sigmoidoscopy screening. Advanced lesions (AL), including advanced adenomas, advanced serrated lesions and CRC were divided according to location: distal-only, or proximal with or without distal AL. We collected information on smoking habit, body mass index and alcohol intake through a questionnaire. RESULTS: Out of 3,318 FIT and 2,988 sigmoidoscopy participants, 516 (16%) and 338 (11%), respectively, were referred for follow-up colonoscopy after a positive screening test. Two-hundred-and-fifty-six (4%) had distal-only and 119 (2%) proximal AL. In FIT participants, obesity and high alcohol intake were associated with proximal AL; odds ratio (95% confidence interval) 2.68 (1.36-5.26) and 2.16 (1.08-4.30), respectively. In sigmoidoscopy participants, current smoking was associated with proximal AL; 4.58 (2.24-9.38), and current smoking and obesity were associated with referral for colonoscopy; 2.80 (2.02-3.89) and 1.42 (1.01-2.00), respectively. CONCLUSION: Current smoking, obesity and high alcohol intake were associated with screen-detected proximal colorectal AL. Current smoking and obesity were associated with referral for follow-up colonoscopy in sigmoidoscopy screening.