Risk Factors for the Development of Tubular Adenomas and Sessile Serrated Polyps: A Retrospective Case Control Study

Introduction: Colorectal cancer is the 4th most common type of cancer in the United States, and is the 2nd most frequent cause of cancer related deaths.Traditionally, the majority of CRC has been attributed to malignant transformation of adenomatous polyps.Sessile serrated polyps (SSPs) have malignant potential through a pathway distinct from traditional adenomas.The aim of this study was to identify individual risk factors for the development of SSPs as well as for tubular adenomas (TAs).Methods: We identified all patients diagnosed with SSPs or TAs on average risk screening colonoscopy at the University of Vermont Medical Center between July 2009 and October 2013 using a pathology database.All SSPs identified were re-reviewed by 1 of 2 expert GI pathologists to confirm the diagnosis.The control group consisted of patients referred for average risk screening colonoscopy with no polyps identified.Data collected included: demographics, BMI, tobacco use, alcohol consumption, Aspirin use, other NSAID use, statin use, folic acid use, vitamin D use, Type II diabetes (DMII), hyperlipidemia (HLD), and skin cancer.Data on the size and location of the polyps were also recorded.Univariate analyses were performed using chi square and t-tests, multivariate analyses were based on logistic regression.Results: 585 patients were included in this study.429 patients were identified as controls.76 patients with 116 TAs were identified.Of those, 76% were ≤5 mm, 18% were 5-9mm, and 6% were ≥10mm.Multivariate analyses indicated age (odds ratio (OR) =1.27 per 5 year increments; 95% confidence interval (CI) 1.07-1.51),BMI (OR=1.09;95% CI 1.04-1.14),and male sex (OR=1.86;95% CI 1.12-3.08)were associated with an increased risk of TAs.80 patients with 92 SSPs were identified.91.3% were found in the right side of the colon.35% were <5mm, 42% were between 5-9 mm, and 23% were ≥10mm in size.Multivariate analyses indicated age (OR=1.34 per 5 year increments; 95%; CI 1.12-1.59),BMI (OR=1.10;95% CI 1.05-1.15),and current and/ or past alcohol use (OR=3.74;95% CI 1.75-7.97)were associated with an increased risk of SSPs.Current or past Aspirin use (OR=0.38;95% CI, 0.18-0.83)was associated with decreased risk for the development of SSPs.Conclusions: Our results show that advanced age and increased BMI are risk factors for the development of TAs and SSPs.Male sex was found to be an additional risk factor for the development of TAs, which is consistent with previous literature.For SSPs, significant alcohol use was found to be an additional novel risk factor.Aspirin use was found to be protective against the formation of SSPs. Su1586