Consider patients’ smoking history when screening for colorectal cancer

Compared with never smokers, patients with long-term tobacco smoke exposure present with colorectal cancer at a much younger age.

In a case-only study, researchers from the University of Rochester and Roswell Park Cancer Institute in New York studied age at diagnosis in 3,540 patients diagnosed with colorectal cancer between 1957 and 1997. Researchers calculated adjusted linear regression models for smoking exposure.

Current smokers were youngest at the onset of colorectal cancer, compared with never smokers (57.4 years vs. 64.2 years, P<.001), and recent former smokers were aged in between the two groups. Never smokers with previous second-hand smoke exposure were significantly younger at diagnosis than those unexposed.

The researchers conclude that while screening for colorectal cancer is recommended at age 50 years for those at average risk, those with a lifelong history of tobacco smoke exposure should be screened five to 10 years earlier. – by Stacey L. Adams

J Cancer Res Clin Oncol. 2008;doi: 10.1007/s00432-007-0332-8.

This study is another in a long line of reports implicating tobacco use as a cause of cancer. In this case, the cases of colon cancer appear in patients younger than expected. This argues for consideration of a screening paradigm that moves the recommendations for colon cancer screening up five to 10 years for heavy smokers. Better yet, the intervention would be tobacco abstinence.

– Alan Venook, MD

HemOnc Today Editorial Board member