Smoking Increases the Risk for Colorectal Adenomas in Patients With Lynch Syndrome

Winkels, Renate M.; Botma, Akke; Duijnhoven, Fränzel J.B. van; Nagengast, Fokko M.; Kleibeuker, Jan H.; Vasen, Hans F. A.; Kampman, Ellen

doi:10.1053/j.gastro.2011.10.033

Cited by 45 publications

(28 citation statements)

References 33 publications

(52 reference statements)

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“…In a prospective cohort study of 386 MMR gene mutation carriers (58 diagnosed with colorectal adenoma over a median follow-up of 10 months), Winkels et al reported an HR of 1.56 (95% CI, 0.71 – 3.43) for the association between highest vs. lowest tertiles of alcohol consumption and the risk of colorectal adenoma. This is similar to our estimate from analysis in which the outcome was defined as either colorectal polyp or cancer (HR >28 grams/day vs. abstention, 1.60; 95% CI, 1.16 – 2.20) (21). The smaller sample sizes of those studies relative to ours could explain their lack of evidence for associations between alcohol consumption and the risk of colorectal polyp or cancer.…”

Section: Discussionsupporting

confidence: 85%

“…A few previous studies have investigated the association between alcohol consumption and the risk of colorectal cancer (19), colorectal polyp or cancer (20), and colorectal adenoma (21), for MMR gene mutation carriers. In a retrospective cohort study of 271 MMR gene mutation carriers, Watson et al reported no evidence for an association between alcohol use and colorectal cancer risk ( P >0.4; estimates not reported) (19).…”

Section: Discussionmentioning

confidence: 99%

“…For MMR gene mutation carriers, only a few studies have investigated the association between alcohol consumption and colorectal cancer risk and their findings have been inconclusive (19–21). All these studies had small sample sizes, different selection criteria for participants (confirmed mutation carriers, those who met clinical criteria for HNPCC), different outcome measures (colorectal cancer, polyps, or both), and none investigated the association between lifetime alcohol consumption and colorectal cancer risk.…”

Section: Introductionmentioning

confidence: 99%

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Alcohol Consumption and the Risk of Colorectal Cancer for Mismatch Repair Gene Mutation Carriers

Dashti

Buchanan

Jayasekara

et al. 2017

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background People with germline mutation in one of the DNA mismatch repair (MMR) genes have increased colorectal cancer risk. For these high-risk people, study findings of the relationship between alcohol consumption and colorectal cancer risk have been inconclusive. Methods 1,925 MMR gene mutations carriers recruited into the Colon Cancer Family Registry who had completed a questionnaire on lifestyle factors were included. Weighted Cox proportional hazard regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between alcohol consumption and colorectal cancer. Results Colorectal cancer was diagnosed in 769 carriers (40%) at a mean (standard deviation) age of 42.6 (10.3) years. Compared with abstention, ethanol consumption from any alcoholic beverage up to 14 grams/day and >28 grams/day were associated with increased colorectal cancer risk (HR, 1.50; 95%CI, 1.09–2.07 and 1.69; 95%CI, 1.07–2.65 respectively; P-trend=0.05), and colon cancer risk (HR, 1.78; 95%CI, 1.27–2.49 and 1.94; 95%CI, 1.19–3.18 respectively; P-trend=0.02). However, there was no clear evidence for an association with rectal cancer risk. Also, there was no evidence for associations between consumption of individual alcoholic beverage types (beer, wine, spirits) and colorectal, colon, or rectal cancer risk. Conclusion Our data suggests that alcohol consumption, particularly more than 28 grams/day of ethanol (~2 standard drinks of alcohol in the US), is associated with increased colorectal cancer risk for MMR gene mutation carriers. Impact Although these data suggested that alcohol consumption in MMR carriers was associated with increased colorectal cancer risk, there was no evidence of a dose-response, and not all types of alcohol consumption were associated with increased risk.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Alcohol Consumption and the Risk of Colorectal Cancer for Mismatch Repair Gene Mutation Carriers

Dashti

Buchanan

Jayasekara

et al. 2017

Cancer Epidemiology, Biomarkers &Amp; Prevention

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“…A prospective analysis of 386 patients with LS undergoing surveillance revealed that current smokers had an increased risk of colorectal adenomas compared with past smokers and never smokers (hazard ratio of 6.1 vs. 3.0 vs. 1, respectively (77). Excess body weight (body mass index >25 kg/m 2 ) has been shown to be associated with an elevated risk (hazard ratio of 8.7 compared with normal weight) of colorectal adenomas in men with LS in the same cohort; an elevated risk was not found in women with a high body mass index (78).…”

Section: Lynch Syndrome (Ls)mentioning

confidence: 99%

ACG Clinical Guideline: Genetic Testing and Management of Hereditary Gastrointestinal Cancer Syndromes

Syngal

Brand

Church

et al. 2015

American Journal of Gastroenterology

1,256

1,349

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This guideline presents recommendations for the management of patients with hereditary gastrointestinal cancer syndromes. The initial assessment is the collection of a family history of cancers and premalignant gastrointestinal conditions and should provide enough information to develop a preliminary determination of the risk of a familial predisposition to cancer. Age at diagnosis and lineage (maternal and/or paternal) should be documented for all diagnoses, especially in first- and second-degree relatives. When indicated, genetic testing for a germline mutation should be done on the most informative candidate(s) identified through the family history evaluation and/or tumor analysis to confirm a diagnosis and allow for predictive testing of at-risk relatives. Genetic testing should be conducted in the context of pre- and post-test genetic counseling to ensure the patient's informed decision making. Patients who meet clinical criteria for a syndrome as well as those with identified pathogenic germline mutations should receive appropriate surveillance measures in order to minimize their overall risk of developing syndrome-specific cancers. This guideline specifically discusses genetic testing and management of Lynch syndrome, familial adenomatous polyposis (FAP), attenuated familial adenomatous polyposis (AFAP), MUTYH-associated polyposis (MAP), Peutz–Jeghers syndrome, juvenile polyposis syndrome, Cowden syndrome, serrated (hyperplastic) polyposis syndrome, hereditary pancreatic cancer, and hereditary gastric cancer.

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“…Cigarette smoking is a known risk factor for colorectal [31, 32] and other cancers, including those for which FAP also increases risk. Although the relationship between cigarette smoking and malignancy has not yet been investigated in FAP, studies of other inherited CRC syndromes have shown increased risk for polyps [33] or CRC [34] associated with smoking cigarettes. Thus, the seemingly high rate of cigarette smoking is concerning despite our small sample; such findings merit future investigation with larger FAP samples and biologic measurement.…”

Section: Discussionmentioning

confidence: 99%

Screening and Health Behaviors among Persons Diagnosed with Familial Adenomatous Polyposis and Their Relatives

James

Chisholm

Wolin

et al. 2012

Journal of Cancer Epidemiology

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Familial Adenomatous Polyposis (FAP) is a rare autosomal dominantly inherited colorectal cancer syndrome. Individuals with FAP often undergo colectomy and are recommended to follow several surveillance protocols. Biological relatives of persons with FAP may also be at risk and thus should undergo genetic counseling. Screening adherence, genetic testing, and other health behaviors among individuals with FAP and their relatives are not well characterized. We conducted a cross-sectional self-report survey with individuals who have FAP (n = 35) and their biological relatives (n = 15). Respondents were recruited through a cancer center registry for inherited colon cancers. Most relatives had undergone colon cancer screening; 40% had undergone genetic testing. One fifth of respondents with FAP had not undergone an upper endoscopy, contrary to usual recommendations. Cigarette smoking rates were above average and were higher among FAP respondents. Use of vitamin supplements was fairly common, more so among those with FAP. Although most people had been screened, there are areas for improvement, notably for upper endoscopy among individuals with FAP and genetic testing among family members. Several other health-risk behaviors and health concerns other than FAP were identified. Further research into factors contributing to screening rates and other health behaviors in this high-risk population is warranted.

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Smoking Increases the Risk for Colorectal Adenomas in Patients With Lynch Syndrome

Cited by 45 publications

References 33 publications

Alcohol Consumption and the Risk of Colorectal Cancer for Mismatch Repair Gene Mutation Carriers

Alcohol Consumption and the Risk of Colorectal Cancer for Mismatch Repair Gene Mutation Carriers

ACG Clinical Guideline: Genetic Testing and Management of Hereditary Gastrointestinal Cancer Syndromes

Screening and Health Behaviors among Persons Diagnosed with Familial Adenomatous Polyposis and Their Relatives

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