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Smokers, Drinkers and Men Get Colorectal Cancer Much
Sooner
Disease could
strike before they become senior citizens
March 28, 2006 - Non-drinkers and Non-smokers my
get colorectal cancer, the second leading cause of cancer death, but
they are going to have an extra 7.8 years before being stricken than
will their drinking and smoking friends. On average, of the older adults
who currently smoke or drink, women will get the disease at age 63.2 and
men at 62.1.
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on
Health & Medicine |
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Alcohol use, tobacco use and male gender are
associated with an earlier onset of colorectal cancer and also with
location of tumors, findings that could have important implications for
screening, according to a study in the March 27 issue of the Archives of
Internal Medicine, one of the JAMA/Archives journals.
Screening asymptomatic patients is an important
strategy for reducing these deaths, because by the time patients
experience symptoms, the cancer may have progressed beyond the point
where it can be cured.
Generally, physicians recommend that patients begin
screening at age 50 years, the authors write. However, physicians might
recommend that individuals with certain risk factors, including family
history, begin screening at earlier ages.
Screening methods include flexible sigmoidoscopy,
which involves inserting a flexible optical instrument through the
rectum into the lower portion of the large intestine, and colonoscopy,
which involves inserting a longer flexible optical instrument through
the rectum and into the entire colon, is more expensive, has higher
complication rates and usually is performed by a gastroenterologist or
surgeon rather than a primary care physician.
Anna L. Zisman, M.D., and colleagues at
Evanston-Northwestern Healthcare, Feinberg School of Medicine,
Northwestern University, Evanston, Ill., examined the records of 161,172
patients with colorectal cancer to assess whether certain risk factors,
alcohol and tobacco use, should also be considered in screening
decisions.
They analyzed the relationship between use of these
substances and age of onset of colon cancer as well as location of
onset-distal or proximal colon. Distal tumors, including those in the
lower left part of the colon and the rectum, can generally be detected
by flexible sigmoidoscopy, while proximal tumors in the right side of
the colon can be missed by methods other than colonoscopy.
Patients who were classified as alcohol or tobacco
users, defined as those who had smoked or drank alcohol in the previous
year, developed cancer at a younger age than non-drinkers and
non-smokers. Current alcohol and tobacco users developed cancer an
average of 7.8 years earlier (age 63.2 years in women and 62.1 years in
men) than those who had never drank or smoked.
Those who had never smoked but drank or who had
never drank but smoked were each an average of 5.2 years younger at
cancer diagnosis than those who neither smoked nor drank.
Individuals who stopped drinking one year or more
prior to the study and had never smoked developed cancer an average of
2.1 years earlier than those who had never drank or smoked.
The effect of smoking appeared to be particularly
large for women; women who smoke but never drank developed cancer 6.3
years younger than those who never drank or smoked, compared with 3.7
years in men.
In additional, current alcohol and tobacco
consumption was associated with an increased likelihood of distal
colorectal cancer, although women in all categories were less likely to
have distal cancer than men.
These findings suggest that individuals who smoke
and drink should undergo screening for colorectal cancer beginning at a
younger age, the authors write.
In addition, women who do not smoke or drink may be
more prone to proximal cancers and might therefore want to consider
undergoing colonoscopy instead of flexible sigmoidoscopy.
"In the future, we envision the development of risk
scores with exogenous (e.g., alcohol and tobacco use, age, body mass
index, diet and calcium consumption) and hereditary factors to tailor an
individual's colorectal cancer screening program," they conclude.
This study was supported in part by a research
grant from the National Institutes of Health, Bethesda, Md.
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