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

Markus D Knudsen; Edoardo Botteri; Øyvind Holme; Anette Hjartåker; Mingyang Song; Espen Thiis-Evensen; Espen R Norvard; Anna L Schult; Kristin R Randel; Geir Hoff; Paula Berstad

doi:10.1016/j.dld.2020.11.021

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

Dig Liver Dis. 2021 Mar;53(3):353-359. doi: 10.1016/j.dld.2020.11.021. Epub 2020 Dec 10.

Authors

Affiliations

¹ Section for colorectal cancer screening, Cancer Registry of Norway, P.O. Box 5313, Majorstuen, 0304 Oslo, Norway; Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Norwegian PSC Research Center, Oslo University Hospital, Rikshospitalet, P.O. Box 4950 Nydalen, 0424 Oslo, Norway; Departments of Epidemiology and Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
² Section for colorectal cancer screening, Cancer Registry of Norway, P.O. Box 5313, Majorstuen, 0304 Oslo, Norway.
³ Section for colorectal cancer screening, Cancer Registry of Norway, P.O. Box 5313, Majorstuen, 0304 Oslo, Norway; Department of Medicine, Sørlandet Hospital Kristiansand, P.O. Box 416 Lundsiden, 4604 Kristiansand, Norway; Department of Health Management and Health Economis, Institute of Health and Society, University of Oslo, P.O. Box 1089 Blindern, 0317 Oslo, Norway.
⁴ Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, P.O.Box 1046 Blindern, 0317 Oslo, Norway.
⁵ Departments of Epidemiology and Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA; Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
⁶ Department of Transplantation Medicine, Division of Surgery, Inflammatory Diseases and Transplantation, Norwegian PSC Research Center, Oslo University Hospital, Rikshospitalet, P.O. Box 4950 Nydalen, 0424 Oslo, Norway.
⁷ Department of Pathology, Vestre Viken Hospital Trust Drammen, P.O. Box 800, 3004 Drammen, Norway.
⁸ Section for colorectal cancer screening, Cancer Registry of Norway, P.O. Box 5313, Majorstuen, 0304 Oslo, Norway; Department of Medicine, Vestre Viken Hospital Trust Bærum, P.O. Box 800, 3004 Drammen, Norway; Institute of Clinical Medicine, University of Oslo, Rikshospitalet, P.O. Box 4950 Nydalen, 0424 Oslo, Norway.
⁹ Section for colorectal cancer screening, Cancer Registry of Norway, P.O. Box 5313, Majorstuen, 0304 Oslo, Norway; Department of Health Management and Health Economis, Institute of Health and Society, University of Oslo, P.O. Box 1089 Blindern, 0317 Oslo, Norway; Department of Research and Development, Telemark Hospital Trust, Ulefossvegen 55, 3710 Skien, Norway.
¹⁰ Section for colorectal cancer screening, Cancer Registry of Norway, P.O. Box 5313, Majorstuen, 0304 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Rikshospitalet, P.O. Box 4950 Nydalen, 0424 Oslo, Norway; Department of Research and Development, Telemark Hospital Trust, Ulefossvegen 55, 3710 Skien, Norway.
¹¹ Section for colorectal cancer screening, Cancer Registry of Norway, P.O. Box 5313, Majorstuen, 0304 Oslo, Norway. Electronic address: paula.berstad@kreftregisteret.no.

PMID: 33309513
DOI: 10.1016/j.dld.2020.11.021

Abstract

Background: Lifestyle factors may help to identify individuals at high-risk for colorectal cancer (CRC).

Aims: To examine the association between lifestyle, referral for follow-up colonoscopy and proximal neoplasia detection in CRC screening.

Methods: In 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.

Results: Out 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.

Conclusion: Current 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.

Keywords: Alcohol; Body mass index; CRC screening; Proximal neoplasia; Smoking.

Publication types

Observational Study
Randomized Controlled Trial

MeSH terms

Aged
Alcohol Drinking / epidemiology
Biomarkers, Tumor / analysis
Colorectal Neoplasms / diagnosis*
Female
Humans
Life Style*
Male
Middle Aged
Obesity / epidemiology
Occult Blood*
Referral and Consultation / statistics & numerical data
Sigmoidoscopy / statistics & numerical data*
Smoking / epidemiology
Surveys and Questionnaires

Substances

Biomarkers, Tumor