A 57-year-old woman comes to the primary care physician for a follow-up visit after undergoing a screening colonoscopy. The colonoscopy revealed adenocarcinoma of the ascending colon and 2 well-differentiated, sessile, adenomatous polyps of the sigmoid colon. The patient has a history of mitral valve prolapse and fibromyalgia. She has also had a prior hysterectomy. Her medications include hormone replacement therapy and ibuprofen. The patient eats a high-fiber vegetarian diet and has consumed 3-4 alcoholic beverages per day for the past 30 years. She smoked 1 pack of cigarettes a day for nearly 5 years, but quit 30 years ago. There is no family history of cancer. The patient is very concerned about being diagnosed with colon cancer. Which of the following was her most significant risk factor for developing colon cancer?

Question

A 57-year-old woman comes to the primary care physician for a follow-up visit after undergoing a screening colonoscopy.  The colonoscopy revealed adenocarcinoma of the ascending colon and 2 well-differentiated, sessile, adenomatous polyps of the sigmoid colon.  The patient has a history of mitral valve prolapse and fibromyalgia.  She has also had a prior hysterectomy.  Her medications include hormone replacement therapy and ibuprofen.  The patient eats a high-fiber vegetarian diet and has consumed 3-4 alcoholic beverages per day for the past 30 years.  She smoked 1 pack of cigarettes a day for nearly 5 years, but quit 30 years ago.  There is no family history of cancer.  The patient is very concerned about being diagnosed with colon cancer.  Which of the following was her most significant risk factor for developing colon cancer?

Quizplus · Accepted Answer

Explanation: Risk factors for colorectal cancer (CRC) include family history, polyposis syndromes (eg, familial adenomatous polyposis), inflammatory bowel disease, and African-American race. Other risk factors include alcohol intake, cigarette smoking, and obesity. Several studies have suggested that even moderate alcohol intake (2-3 drinks/day) is associated with increased CRC risk, though the highest risk was seen in heavy drinkers (>4 drinks/day). Alcohol likely interferes with folate absorption, and heavy drinkers may also have decreased folate intake. Cigarette smoking is also associated with increased CRC risk, but the risk is primarily seen in current long-term smokers (eg, >30 years). This patient has a remote history of light tobacco use; her heavy alcohol intake was a more likely contributor to her risk for CRC (Choice E). (Choices B, C, and D) Regular nonsteroidal antiinflammatory drug intake, hormone replacement therapy in postmenopausal women, and a high-fiber diet that is rich in fruits and vegetables are all thought to offer some protection against developing CRC. Educational objective: Risk factors for colorectal cancer include family history, polyposis syndromes (eg, familial adenomatous polyposis), inflammatory bowel disease, and African-American race. Other risk factors include alcohol intake, cigarette smoking, and obesity. Protective factors include a high-fiber diet rich in fruits and vegetables, regular nonsteroidal antiinflammatory drug use, hormone replacement therapy, and regular exercise. References: Alcohol intake and colorectal cancer: a pooled analysis of 8 cohort studies. (http://www.ncbi.nlm.nih.gov/pubmed/15096331) Smoking and colorectal cancer: a meta-analysis. (http://www.ncbi.nlm.nih.gov/pubmed/19088354) Alcohol drinking and colorectal cancer risk: an overall and dose-response meta-analysis of published studies. (http://www.ncbi.nlm.nih.gov/pubmed/21307158)

A 57-Year-Old Woman Comes to the Primary Care Physician for a Follow-Up