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We agree with Zisman et al¹ that factors considered when stratifying for colorectal cancer (CRC) screening should be expanded to include risks other than age and family history. Giovannucci² has been a proponent of the concept that people who smoke should be considered to be in a high-risk group. He has stated in a recent article that data were needed that demonstrate that smokers are at risk for CRC at an earlier age. The data provided by Zisman et al¹ demonstrate the earlier onset of CRC in smokers. The relative risks of the different factors can be examined in a screening population. In our sample of asymptomatic patients presenting for screening colonoscopy, we observed that patients who smoke (more than 10 pack-years) had a more than double risk of having significant colorectal neoplasia (SCN) compared with nonsmokers.³ We defined SCN as large (>1 cm in diameter), villous tissue, high-grade dysplasia, . . . [Full Text of this Article]

AUTHOR INFORMATION
Joseph Carl Anderson, MD; Catherine Messina, PhD

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