Association between lifestyle and site-specific advanced colorectal lesions in screening with faecal immunochemical test and sigmoidoscopy

Abstract

BackgroundLifestyle factors may help to identify individuals at high-risk for colorectal cancer (CRC). AimsTo examine the association between lifestyle, referral for follow-up colonoscopy and proximal neoplasia detection in CRC screening. MethodsIn 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. ResultsOut 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. ConclusionCurrent 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.