Epidemiological and animal studies have suggested that a high ratio of n-3 fish fatty acids to arachidonic acid (AA), might protect against colorectal carcinogenesis. Competition of n-3 and n-6 fatty acids, especially AA, for the enzyme cyclooxygenase-2 may be responsible for this effect. To examine the relation between fish intake and colorectal adenomas, data from a Dutch case-control study were analysed. All 52 cases and 57 controls filled out a food questionnaire, underwent a full colonic examination and have had a fat biopsy from the buttock. Intake of fish and fish fatty acids was inversely associated with colorectal adenomas although not statistically significant. For the ratio of fish fatty acids to AA, the ORs in the second and third tertile were 1.2 and 0.8 (p-trend = 0.78). Tissue levels of fish fatty acids were inversely associated and tissue levels of AA were positively associated with adenomas, although not statistically significant. However, the OR for the ratio of fish fatty acids to AA was 0.2 in the second and third tertile (p-trend = 0.002). In line with the hypothesis, a high ratio of fish fatty acids to AA in adipose tissue was associated with a lower risk of colorectal adenomas.