Adenomas In Subjects Research Articles

Usefulness of the fecal immunochemical test in the detection of advanced adenomas in subjects at average risk for colorectal cancer

Fecal immunochemical test (FIT) is a screening tool for detecting neoplastic lesions in asymptomatic patients. Colonoscopy is indicated in levels of FIT >100ngHb/ml. AimCompare the frequency of advanced adenomas (AA) in colonoscopy between asymptomatic subjects with FIT+ vs. symptomatic patients. Evaluate the level of bleeding of AA. Material and methodologyCross-sectional, observational study of 2829 consecutive patientes referred for colonoscopy. We collected clinic-demographic information, AA (size, topography, and histology) and FIT quantification. We included 2829 subjects who underwent colonoscopy. Statisticsχ2, Student's t-tests (0.05), one-way ANOVA and ANCOVA were performed for adjusted contrasts among lesions, gender, positive left colonic findings and age. ResultsGlobal rate of AA was 7.2%. Detection of AA was higher in average-risk asymptomatic subjects than in symptomatic (8.9 vs. 4.35%); no differences in age, sex or site of lesion was find. Group 1: (n=902). 105 AA (alone: 80.2%; ≤9mm: 27.2%; 10–15mm: 62.9% and ≥16mm: 9.9%) were detected in 81 patients (females: 38.2%; mean age: 64.1±8.4 years). Group 2: (n=1927). AA 105 in 84 (5.1%) in symptomatic patients.Quantitative FIT showed a correlation between AA size and bleeding level. For each mm that increased the size of the AA, the bleeding level increased 35±9ngHb with a stop limit of 15mm. ConclusionsDetection was higher in average-risk asymptomatic subjects with FIT+ than in symptomatic patients. Quantitative FIT showed a correlation between adenoma size and bleeding level.

Mo1197 Simple Clues for Colorectal Carcinoma and Adenoma

Introduction: Diabetes mellitus type II (DM), is associated with increased risk of colorectal neoplasia. Yet, it is unclear if diabetes impacts initiation of colorectal neoplasia in subjects younger than the recommended average risk screening age. Aim: To determine if DM type II is associated with increased risk of developing colorectal adenomas in subjects 40-49 years of age in a VA population. Methods: We performed a retrospective review of consecutive patients who underwent inpatient and outpatient colonoscopy procedures between January 2005 and December 2010 to compare the adenoma detection rate (ADR) and advanced adenoma detection rate (AADR) in the following 3 cohorts: 1) ages 40-49 with DM, 2) ages 40-49 without DM, and 3) ages 50-59 without DM. Inclusion criteria included index (first) colonoscopy; complete to cecum; good or excellent bowel prep. Patients with an incomplete colonoscopy, fair or poor bowel prep, history of prior colonoscopy, IBD, polyposis, colectomy, or CRC in self or first degree relative were excluded. Analyses were adjusted for gender, indication, race, hypertension, hyperlipidemia, tobacco, alcohol, ASA/NSAIDs, and BMI. Results: A total of 13,428 colonoscopies were performed during the 6 year period. 573 patients met eligibility criteria, 63 of which were between 40-49 years of age and had DM. The average HbA1C was 7.2%. The adenoma detection rate (ADR) was 17.2% in those ages 40-49 with DM, 19.6% in those ages 40-49 without DM and 26.8% in those ages 50-59 without DM. The advanced adenoma detection rate (AADR), defined as an adenoma ≥ 1 cm in size, high grade dysplasia, or villous features was 8.6% in those ages 40-49 with DM, 5.6% in those ages 40-49 without DM and 9.3% in those ages 50-59 without DM. Compared to those ages 40-49 with DM, we did not find a significant difference in the ADR ((OR 1.17 [95% CI 0.55-2.47 ]; p=0.68 ); adjusted OR 0.98 [95% CI 0.44-2.2]; p=0.97) or AADR in subjects 40-49 years of age without DM ((OR 0.624 [95% CI 0.22-1.81]; p=0.38); adjusted OR 0.62 p=0.42 [95% CI 0.19-2.0]). However, compared to subjects ages 40-49 with or without DM, those ages 50-59 without DM had a significantly higher ADR (OR 1.54 [95% CI 1.04-2.33]; p=0.032) yet no difference in the AADR (OR 0.63 p=0.15 [95% CI 0.341.19]. Conclusion: DM was not associated with a higher risk of developing colorectal adenomas in this VA patient population ages 40-49. Although previous literature has shown that DM is associated with an increased risk of colorectal neoplasia, we did not find that adenomas developed any earlier in diabetics.

Using gene-environment interaction analyses to clarify the role of well-done meat and heterocyclic amine exposure in the etiology of colorectal polyps

The role of well-done meat intake and meat-derived mutagen heterocyclic amine (HCA) exposure in the risk of colorectal neoplasm has been suggested but not yet established. With the use of gene-environment interaction analyses, we sought to clarify the association of HCA exposure with colorectal polyp risk. In a case-control study including 2057 colorectal polyp patients and 3329 controls, we evaluated 16 functional genetic variants to construct an HCA-metabolizing score. To derive dietary HCA-exposure amount, data were collected regarding dietary intake of meat by cooking method and degree of doneness. A 2-fold elevated risk associated with high red meat intake was found for colorectal polyps or adenomas in subjects with a high HCA-metabolizing risk score, whereas the risk was 1.3- to 1.4-fold among those with a low risk score (P-interaction ≤ 0.05). The interaction was stronger for the risk of advanced or multiple adenomas, in which an OR of 2.8 (95% CI: 1.8, 4.6) was observed for those with both a high HCA-risk score and high red meat intake (P-interaction = 0.01). No statistically significant interaction was found in analyses that used specific HCA exposure derived from dietary data. High red meat intake is associated with an elevated risk of colorectal polyps, and this association may be synergistically modified by genetic factors involved in HCA metabolism.

Antioxidant supplement and long-term reduction of recurrent adenomas of the large bowel. A double-blind randomized trial

Patients who undergo polypectomy are at increased risk of adenoma recurrence. The preventive potential of vitamins (A, C and E) and selenium supplementation represent an interesting opportunity for colorectal cancer prevention. To assess the efficacy of a combination of these micronutrients in reducing the incidence of recurrent adenomas in subjects on post-polypectomy endoscopic follow-up, a double-blind placebo-controlled randomized trial was started in Italy in 1988. A total of 411 patients were randomized to receive either an active compound (200 μg selenium, 30 mg zinc, 2 mg vitamin A, 180 mg vitamin C, 30 mg vitamin E) or a placebo daily for 5 years. Of them, 330 had follow-up colonoscopy (164 in the intervention and 166 in the placebo group). After a median follow-up of 4 years (range 1-15 years), 100 patients had recurrence: 38 in the intervention and 62 in the placebo arm. The 15-year cumulative incidence of recurrence was 48.3% in the intervention and 64.5% in the placebo arm (HR = 0.59; log-rank P = 0.009). A 39% reduction of the risk of recurrence was observed in the intervention compared to the placebo group (adjusted HR = 0.61; 95% CI 0.41-0.92): the risk reduction was similar for small tubular (adjusted HR = 0.61; 95% CI 0.37-0.99) and advanced adenomas (adjusted HR = 0.50; 95% CI 0.24-1.01). Our study showed a statistically significant effect of antioxidant supplementation on adenoma recurrence. Further clinical trials are needed to address the role of antioxidants in subgroups of subjects at increased risk for colorectal cancer.

917 An Interim Analysis of an Asia-Pacific Multicenter Randomized Study Comparing Colonoscopy Using a New High Definition System in Either White Light or Narrow Band Imaging in the Detection of Adenomas in Subjects Undergoing Screening

classification, and scoring 90% accuracy on an NBI test. Results. At a planned interim analysis at 300 patients, both arms were equally balanced in terms of gender, race, indication and other known risk factors. For the primary outcome; the accuracy of DFHD-White light imaging was 83% compared to 77% for HDwhite light. The accuracy for DFHD-NBI was 82% compared with 78% for HDNBI. Sensitivity, specificity and detailed accuracy for each method is shown in Table 1. Conclusions: At the planned interim analysis, dual focus HD imaging with and without NBI appears promising. Accuracy is near threshold levels set by ASGE to consider optical diagnosis without histologic confirmation. Final results will be reported at DDW.

Abstract PR-01: Properties of adenomas in subjects treated with difluoromethylornithine and sulindac for reduction of colorectal adenomas

Abstract Difluoromethyl ornithine (DFMO), an ornithine decarboxylase inhibitor, and sulindac reduced the occurrence of colorectal adenomas by 70% in a phase III randomized placebo controlled clinical trial. The goal of the current study was to compare adenoma location in the colorectum and biomarker expression by immunohistochemistry of formalin fixed paraffin embedded adenomas from treatment and placebo groups in the trial. To take into account the relationship between the locations in the colorectum of multiple adenoma that were removed from individual subjects, the generalized estimation equation (GEE) method was applied for all analyses. The decrease in the reappearance of metachronous adenomas was similar throughout the colorectum in subjects treated with DFMO and sulindac (P = 0.44). For TP53, Ki67, and c-MYC there were no significant differences in the estimated mean percent of cells staining positive between treated and untreated subjects (P>0.5 for all). For BCL-2, LC3B, CEA, sialy1-Tn, cleaved caspase 3 and apoptosis, the proportion of adenoma with expression levels 1+ to 3+ did not differ between subjects treated with DFMO plus sulindac versus those treated with double placebos. For hMSH2, hMSH6, hMLH1 and hPMS2, there was a loss of staining of a greater number of cells on average in adenomas from the control group compared to adenomas from the subjects treated with DFMO and sulindac. For hMSH2, this difference was statistically significant (P = 0.0004). This finding raises the possibility that DFMO and sulindac protect adenomas from loss of DNA mismatch repair protein expression and provides a rationale for further study of the possible role of DFMO and sulindac on DNA mismatch repair protein regulation and chemoprevention in patients at risk for colorectal carcinoma. In conclusion, DFMO decreases the occurrences of adenomas throughout the colorectum, including the right colon, and may have an effect on DNA mismatch repair enzyme expression. These findings provide further rationale for the use of DFMO as a chemopreventative agent for colorectal carcinoma. Citation Information: Cancer Prev Res 2011;4(10 Suppl):PR-01.

The association of serum lipids with the histological pattern of rectosigmoid adenoma in Taiwanese adults.

BackgroundThe mortality rate of colorectal cancer ranks third behind lung and hepatic cancer in Taiwan. Colorectal cancer mostly arises from adenomatous polyps of left colon. The aim of our study was to examine the association of serum lipids with the histological pattern of rectosigmoid adenoma.MethodsThere were 2,506 eligible examinees aged 20 and above who underwent sigmoidoscopy as a screening examination in National Cheng Kung University Hospital between January 2003 and October 2006. They were classified into three groups: tubular adenoma (333 subjects), villous-rich (tubulovillous/villous) adenoma (53 subjects) and normal (2,120 subjects). We defined high total cholesterol (TC) as a level ≧200 mg/dl, low high-density lipoprotein cholesterol (HDL-C) as a level <40 mg/dL, and high triglyceride (TG) as a level ≧200 mg/dl according to the third report of the National Cholesterol Education Program expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. Adenoma histology was classified as tubular, tubulovillous and villous according to the proportion of villous part.ResultsAmong the study population, 333 subjects (13.3%) had tubular adenomas and 53 subjects (2.1%) had villous-rich adenomas. The odds ratio (OR) for villous-rich adenoma in subjects with TG≧200 mg/dL compared to those with TG < 200 mg/dL was 3.20 (95% confidence interval [CI]:1.71-6.01), after adjusting for age, gender, general obesity, central obesity, diabetes, hypertension, smoking, and alcohol consumption. If further taking high TC and low HDL-C into consideration, the OR was 4.42 (95% CI:2.03-9.63).ConclusionsOur study showed that subjects with high serum TG tended to have a higher risk of tubulovillous/villous adenoma in rectosigmoid colon. Therefore, reducing the serum TG level might be one method to prevent the incidence of colorectal cancer.

Prevalence and risk of colorectal neoplasms in asymptomatic, average-risk screenees 40 to 49 years of age

A paucity of information exists regarding colorectal neoplasm in asymptomatic, average-risk individuals 40 to 49 years of age. To evaluate the prevalence and risk factors of colorectal neoplasms in those in their 40s. Cross-sectional study. Results offered to subjects of a health care provider that offers screening services as part of an employer-provided wellness program. A consecutive series of 1761 asymptomatic, average-risk screenees 40 to 59 years of age. First screening colonoscopy. The prevalence of overall colorectal neoplasm in subjects of ages 40 to 44 years, 45 to 49 years, 50 to 54 years, and 55 to 59 years increased significantly with increasing age (13.7%, 20.2%, 21.0%, and 23.8%, respectively; P < .001). The prevalence of advanced adenomas in subjects of ages 40 to 44 years, 45 to 49 years, 50 to 54 years, and 55 to 59 years increased significantly with age (1.9%, 3.0%, 3.2%, and 5.9%, respectively; P = .004). Multivariate analysis of data from the 40- to 49-year age group identified an increased risk of colorectal neoplasm associated with ages 45 years and older (odds ratio [OR], 1.68; 95% CI, 1.20-2.35), male sex (OR, 1.76; 95% CI, 1.15-2.69), presence of abdominal obesity (OR, 1.57; 95% CI, 1.12-2.21), and metabolic syndrome (OR, 1.56; 95% CI, 1.03-2.35), whereas for advanced adenomas, abdominal obesity (OR, 2.37; 95% CI, 1.06-5.27) and metabolic syndrome (OR, 2.83; 95% CI, 1.23-6.53) were the independent risk factors. Single-center study and the cohort composed of ethnic Korean subjects who lived in the same geographic region. In average-risk individuals 40 to 49 years of age, men with abdominal obesity or metabolic syndrome might benefit from screening colonoscopy starting at 45 years of age to detect colorectal neoplasm.

Prévention par l’acide folique des défauts de fermeture du tube neural : la question n’est toujours pas réglée

Between 1981 and 1996, several interventional studies proved the efficacy of periconceptional folic acid supplementation in the prevention of neural tube closure defects (NTCD), first in women at risk (with a previous case of NTCD) and also in women of the general population in age to become pregnant. The poor observance of this supplementation led several countries (USA, Canada, Chile...) to decide mandatory folic acid fortification of cereals, which permitted a 30% (USA) to 46% (Canada) reduction in the incidence of NTCD. Moreover, this benefit was accompanied by a diminished incidence of several other malformations and of stroke and coronary accidents in elderly people. However, several papers drew attention to an increased risk of colorectal and breast cancer in relation with high blood folate levels and the use of folic acid supplements. A controlled interventional study showed a higher rate of recurrence of colic adenomas and a higher percentage of advanced adenomas in subjects receiving 1mg/day of folic acid. A recent study demonstrated an abrupt reversal of the downward trend in colorectal cancer 1 year after the beginning of cereal folic acid fortification in the USA and Canada. Two studies also reported impaired cognitive functions in elder persons with defective vitamin B(12) status. Taken in aggregate, these studies question the wisdom of a nationwide, mandatory, folic acid fortification of cereals. As of today, despite their limited preventive efficacy, a safe approach is to keep our current French recommendations and to increase the awareness of all caregivers, so as to improve the observance of these recommendations.

Impact of Having a Second Degree Relative with Colorectal Cancer on the Risks of Developing Adenomas

Impact of Having a Second Degree Relative with Colorectal Cancer on the Risks of Developing Adenomas Kenny Chiu, Hyung Cho, Sharon Bayuga, Tim Church, Margaret Mandelson, Andrew Feld, John Allen, Glenn Mills, Paul Jordan, Michael O’Brien, Ann Zauber, Sidney Winawer Colon cancer screening studies have concentrated on studying the risks of 1 degree relatives (FDR) with colon cancer and under current screening guidelines, having affected 2 degree relatives (SDR) place a person in the average risk category. However, there is a small increase in colon cancer risks from having an affected SDR. The aim of this study is to evaluate how an affected SDR or FDR affect the prevalence of adenomas and advanced adenomas in a multicenter colon cancer screening trial. As part of the National Colonoscopy Study (NCS), 622 subjects enrolled from 1999 to 2002 underwent a screening colonoscopy. The presence of adenomas, their number, size, and location were recorded. All histologies were confirmed by an independent pathologist. The subjects were categorized as having an affected FDR, SDR, or neither. The endoscopists determined that 99.4% had a good preparation and the cecum was reached in 98.9%. Subjects with an affected FDR and those with an affected SDR show a similar trend towards an increased risk for adenomas. Having either an affected FDR or SDR increases the risk for adenomas when compared to those with neither (p Z 0.03). There was no difference in the ratio of right vs left sided adenomas or in their multiplicity based on family history. In conclusion, subjects with an affected SDR show a trend towards an increased risk for adenomas similar to those with an affected FDR. There is a statistically significant increase in the risk for adenomas in subjects with either an affected FDR or SDR. The number of advanced adenomas is too few to show a trend. The NCS is ongoing and will accrue a larger cohort to further evaluate the role of SDR’s in the risk of advanced adenomas. The impact of family histories is still being explored and with further studies, the presence of an affected SDR may place individuals in a higher risk screening category.

Serum fructosamine and colorectal adenomas.

The relationship of glucose in the blood with colorectal adenoma or cancer is not clear. Fructosamine, equivalent to total serum glycated proteins, is a marker of blood glucose levels in the previous 3 weeks. We evaluated in a case-control study the association between fructosamine and colorectal adenoma, a precursor of colorectal cancer. Cases were subjects with the first occurrence of one or more histologically confirmed colorectal adenomatous polyps removed after a complete colonoscopy (153 cases), and controls were subjects with normal colonoscopy performed in the same endoscopy units during the same period (84 controls). Serum fructosamine was measured by a colorimetric method. Unconditional multiple logistic regression was used for statistical analysis. We found that in non-diabetic subjects the risk of colorectal adenoma increased with the level of fructosamine, and the odds ratio of colorectal adenoma in subjects with fructosamine levels higher than the median (270 microg/100 ml), in comparison with subjects with fructosamine lower than the median, was 2.3 (95% CI: 1.1-4.8). The risk of colorectal adenoma increased also with increasing levels of serum triglycerides and cholesterol, and decreased with increasing levels of fasting serum insulin. The results of this study show that the risk of colorectal adenoma increases with the level of fructosamine, an indicator of the level of glucose in the blood more sensitive to foods with a high glycemic index.

Serum selenium and risk of large size colorectal adenomas in a geographical area with a low selenium status

OBJECTIVE: Selenium is a fundamental nutrient to human health that might have anticarcinogenic effects. Previous studies have assessed the possible relationship of selenium status to colorectal adenomas with controversial results. We primarily aimed to assess the relationship of serum selenium status with the presence of large size colorectal adenomas in subjects living in a poor selenium region. The serum selenium status in colorectal cancer was also evaluated. METHODS: Serum selenium levels were measured in 28 patients with large size sporadic adenomatous polyps, 24 patients with colorectal adenocarcinomas, and 35 age-matched healthy individuals. A logistic regression analysis was performed to assess the relationship of serum selenium to colorectal adenomatous polyps after adjusting for confounding variables (age, sex, smoking habit, and alcohol drinking). RESULTS: Among subjects aged ≤60 yr, mean serum selenium levels were significantly lower in both patient groups (adenoma, 57.9 ± 4.3 μg/L; cancer, 43.7 ± 6.6 μg/L) than in healthy controls (88.9 ± 8 μg/L) ( p = 0.0001). There were no difference among subjects >60 yr old. A significant inverse association between selenium status and the diagnosis of large size adenomatous polyps after adjusting for confounding variables was found (adjusted p = 0.029). Subjects with higher selenium status (≥75th percentile value of 82.11 μg/L) had a lower probability (OR = 0.17, 95% CI = 0.03–0.84) to be in the adenoma group than subjects with lower selenium status (<82.11 μg/L). This association was more marked in subjects aged ≤60 yr (adjusted p value = 0.04, OR = 0.08, 95% CI = 0.007–0.91), and was not significant in older subjects. CONCLUSIONS: Results suggest that high selenium status may decrease the risk of large size adenomas in a low selenium region, and that this preventive effect seems to be exclusive to subjects ≤60 yr. These results will need to be confirmed in additional epidemiological studies before recommending selenium supplementation in patients with colon adenomas.

Serum selenium and risk of large size colorectal adenomas in a geographical area with a low selenium status.

Selenium is a fundamental nutrient to human health that might have anticarcinogenic effects. Previous studies have assessed the possible relationship of selenium status to colorectal adenomas with controversial results. We primarily aimed to assess the relationship of serum selenium status with the presence of large size colorectal adenomas in subjects living in a poor selenium region. The serum selenium status in colorectal cancer was also evaluated. Serum selenium levels were measured in 28 patients with large size sporadic adenomatous polyps, 24 patients with colorectal adenocarcinomas, and 35 age-matched healthy individuals. A logistic regression analysis was performed to assess the relationship of serum selenium to colorectal adenomatous polyps after adjusting for confounding variables (age, sex, smoking habit, and alcohol drinking). Among subjects aged < or = 60 yr, mean serum selenium levels were significantly lower in both patient groups (adenoma, 57.9 +/- 4.3 microg/L; cancer, 43.7 +/- 6.6 microg/L) than in healthy controls (88.9 +/- 8 microg/L) (p = 0.0001). There were no difference among subjects > 60 yr old. A significant inverse association between selenium status and the diagnosis of large size adenomatous polyps after adjusting for confounding variables was found (adjusted p = 0.029). Subjects with higher selenium status (> or = 75th percentile value of 82.11 microg/L) had a lower probability (OR = 0.17, 95% CI = 0.03-0.84) to be in the adenoma group than subjects with lower selenium status (< 82.11 microg/L). This association was more marked in subjects aged < or = 60 yr (adjusted p value = 0.04, OR = 0.08, 95% CI = 0.007-0.91), and was not significant in older subjects. Results suggest that high selenium status may decrease the risk of large size adenomas in a low selenium region, and that this preventive effect seems to be exclusive to subjects < or = 60 yr. These results will need to be confirmed in additional epidemiological studies before recommending selenium supplementation in patients with colon adenomas.

DNA microsatellite instability and mismatch repair protein loss in adenomas presenting in hereditary non-polyposis colorectal cancer

BACKGROUND AND AIMHereditary non-polyposis colorectal cancer (HNPCC), as its name implies, is associated with few adenomas, and the early evolution of colorectal neoplasia is poorly understood. In this study our...

146 P - Familiarity and counselling in hereditary colorectal cancer

The 25% of colorectal cancer (CRC) are correlated with a familiarity. The 5% of familial colorectal cancer are HNPCC and the1% are FAP. We present two research projects. The first one is on a prevalence of colorectal adenomas in subjects with at list two first grade relatives affected by CRC. These subjects aged 55–64 yrs are detected from questionnaires filled up for Trial "once only sigmoidoscopy". A colonscopy will be proposed instead of rectosigmoidoscopy. The data will be correlated with those of a standard CRC risk control group. The second project is on familiarity and couselling of less than 55 yrs colorectal cancer patients. The aim is to control families with a high risk of hereditary CRC. General Practitioners contact probands and build a nuclear genealogic tree. In case of doubt or clear HNPCC, the genealogic tree will be expanded by specialized group. A personalized programme of sourveillance and follow-up will be provided to the probands and their family.

Distal colonic hyperplastic polyps do not predict proximal adenomas in asymptomatic average-risk subjects

The significance of distal colonic hyperplastic polyps was investigated in 482 asymptomatic average-risk subjects, aged 50–75 years, in whom fecal occult blood test results were negative and who underwent screening colonoscopy. The incidence of adenomas in the colon proximal to the sigmoid-descending colon junction in subjects with hyperplastic polyps distal to that point was 18% and was similar to the incidence of proximal colonic adenomas in subjects with no distal colonic polyps (15%). The incidence of proximal colonic adenomas in subjects with distal colonic adenomas was 38% and was significantly greater than the incidence found in individuals with no distal colonic polyps or only hyperplastic polyps. Our data do not support distal colonic hyperplastic polyps as markers for proximal colonic adenomas in asymptomatic average-risk subjects.

Relation between the frequency of colorectal adenoma and the serum cholesterol level.

Several investigators have reported an association between low serum cholesterol levels and an increased frequency of colorectal cancer. Because low cholesterol levels may be a result of an established cancer, we have investigated the relation between serum cholesterol levels and the frequency of colorectal adenomas, which are thought to be precursors of colon cancer. We prospectively studied 1083 consecutive patients who underwent colonoscopy (241 of whom were excluded because of malignant disease, chronic inflammatory bowel disease, familial polyposis, or partial colectomy). In the remaining 842 patients, analysis of covariance was performed to evaluate the contribution of serum cholesterol to the risk of colorectal adenoma. Serum cholesterol levels were significantly and positively associated with the frequency of colorectal adenoma in subjects of both sexes. After adjustment for age and body-mass index, this positive association remained significant between the top quintile and the lowest quintile for serum cholesterol, with regard to the total study group (odds ratio, 2.0; 95 percent confidence limits, 1.1 and 3.6) and men only (odds ratio, 2.2; 95 percent confidence limits, 1.0 and 4.8). We conclude that there is not an inverse correlation between serum cholesterol levels and the risk of colorectal adenomas; on the contrary, there appears to be a small positive association.