Effect of Cotinine-verified Change in Smoking Status on Risk of Metachronous Colorectal Neoplasia After Polypectomy.

BACKGROUND & AIMS: Previous assessments of colorectal neoplasia (CRN) recurrence after polypectomy used self-report to determine smoking status. We evaluated the association between change in smoking status and metachronous CRN risk after polypectomy using cotinine level in urine to determine tobacco exposure.

METHODS: We performed a retrospective study of participants in the Kangbuk Samsung Health Study, in Korea, who underwent a screening colonoscopy examination and measurement of cotinine in urine samples. Our analysis included 4762 patients who had ≥1 adenoma detected in an index colonoscopy performed between January 2010 and December 2014, and underwent a surveillance colonoscopy, 6 or more months later, until December 2017.

RESULTS: Patients were classified into 4 groups based on the change in cotinine-verified smoking status from index to follow-up colonoscopy (mean interval, 3.2±1.3 years), as follows: remained non-smokers (n=2962; group 1), smokers changed to non-smokers (n=600; group 2), non-smokers changed to smokers (n=138; group 3), and remained smokers (n=1062; group 4). After adjustment for confounding factors, group 4 had significantly higher risk of metachronous CRN than group 1 (hazard ratio [HR], 1.54; 95% CI, 1.36-1.73) and group 2 (HR, 1.63; 95% CI, 1.39-1.99). Group 4 also had a higher risk of metachronous advanced CRN than group 1 (HR, 2.84; 95% CI, 1.79-4.53) and group 2 (HR, 2.10; 95% CI, 1.13-3.89). Group 3 had a higher risk of metachronous CRN than group 1 (HR, 1.50; 95% CI, 1.14-1.97) and group 2 (HR, 1.62; 95% CI, 1.20-2.20).

CONCLUSION: In a retrospective study of individuals with at least one adenoma, we found that cotinine-verified changes in smoking status between index and follow-up colonoscopy are associated with risk of metachronous CRN. Helping patients quit smoking is important to effective prevention of colorectal cancer.