Association of tobacco and alcohol use with earlier development of colorectal pathology: should screening guidelines be modified to include these risk factors?

Background: Current guidelines for colorectal cancer (CRC) screening recommend initial screening at 50 years of age for normal-risk patients. Alcohol and tobacco use can be associated with an earlier onset of CRC and possibly polyps.

Methods: We reviewed all colonoscopies performed at our institution from January to December 2007. Patient data were collected on age, sex, tobacco and alcohol history, and the presence of colon lesions.

Results: Our data included 663 patients (643 men and 20 women) with a mean age of 60.7 years (range 23-89 years); 68.5% were current/former tobacco users, 53.7% were current/former alcohol users, 37.6% had used both, and 21.7% had used neither. Colonoscopy findings were as follows 64% of patients had no lesions, 30.6% had tubular polyps, 3.5% had villous polyps, and 2% had cancer. The current use of tobacco, alcohol, or both was associated with the early development of colon pathology (ie, 66.9 years, 61.1 years, and 59.2 years [P < .05], respectively). In nonusers, the mean age was 67.7 years.

Conclusions: Our work confirms that the use of alcohol and tobacco is associated with an earlier onset of colon pathology. Consideration should be given to modifying screening guidelines to include these habits as "high-risk" factors.