Association of Smoking, Alcohol Use, COPD and Colorectal Adenomas in Initial Colonoscopies

Abstract

Introduction: Smoking is a strong risk factor for colorectal carcinoma (CRC), while the link between alcohol and CRC development is not as robust. Chronic Obstructive Pulmonary Disease (COPD) has been implicated as a risk factor for various malignancies, primarily due to its association with smoking. However, a clear link between COPD and precancerous (PC) polyps has not been established. Therefore, we explored the impact of smoking, alcohol abuse, and COPD, on PC polyps. Methods: This retrospective study assessed the association of modifiable risk factors in 1442 patients. Data were collected on 4200 patients at the Louisville, KY VAMC, 2758 were excluded based on exclusion criteria: history of IBD, malignancy, insufficient data, poor bowel preparation, and birth prior to 1948. After exclusion, 1442 patients (89% male, 74% white, mean age 54) were included. Data were further abstracted based on comorbidities: smokers were stratified into current and former, with and without history of COPD; and patients were also stratified by current or former history of alcohol use. A Poisson regression was used for analysis. P 0.05 was deemed statistically significant. Results: A total of 846 patients had a smoking history, and current smokers demonstrated a statistically significant increase in relative risk (RR) of PC polyps (P=0.003), while former smokers did not (Table 1). Diagnosis of COPD (n=166) showed an insignificant increase in the RR of PC polyps (P=0.102). Analysis of alcohol use, showed neither former (n=209) or current alcohol users (n=220) had a statistically significant increase in PC polyps.Table: Table. Modifiable risk factors and risk of precancerous colonic polypsConclusion: The presence of COPD, irrespective of smoking status did not carry a significant impact on PC polyps. Moreover, alcohol users did not have an increased RR of PC polyps. Consistent with previous reports, we found that current smokers have an increased RR of developing PC polyps, while former smokers do not. Therefore, although smoking enhances adenoma formation, smoking cessation can mitigate that risk and provide clear benefit in CRC prevention. Further quantitative analysis to assess the association between degree of tobacco exposure and PC polyps are indicated.