Association of tobacco and alcohol use with earlier development of colorectal cancer: should we modify screening guidelines?

Background: Current guidelines recommend initial colorectal cancer screening at age 50 years for average-risk patients. Alcohol and tobacco use can be associated with earlier onset of colorectal cancer. We hypothesized an earlier age at diagnosis and/or more advanced stage in patients with these habits.

Methods: We queried our tumor registry for colorectal cancer diagnosed between January 1997 and December 2006. Data were analyzed to evaluate effects of alcohol and tobacco use.

Results: Of 335 colorectal cancer patients, 81% used tobacco, 51% used alcohol, 45% used both, and 14% used neither. Current tobacco and alcohol use were associated with younger ages at onset of colorectal cancer. Thirteen of 332 patients were diagnosed with colorectal cancer before age 50 years. All had exposure to alcohol and tobacco. Fifty-four percent (7/13) of these patients presented at stage 3/4 compared with 34% of the overall population.

Conclusions: Modification of screening guidelines to include these habits as "high-risk" factors may be indicated.