Colangelo LA, Gapstur SM, Gann PH, et al: Cigarette smoking and colorectal carcinoma mortality in a cohort with long-term follow-up. Cancer 2004;100(2):288-93.
Colditz GA, Yaus KP: Smoking causes colon carcinoma (editorial). Cancer 2004; 100(2):223-4.
Erlinger TP, Platz EA, Rifai N, et al: C-reactive protein and the risk of incident col-orectal cancer. JAMA 2004; 291(5):585-90.
Pasche B, Serhan CN: Is C-reactive protein an inflammation opsonin that signals colon cancer risk? (editorial) JAMA 2004; 291(5):623-4.
Previous studies revealed an association between cigarette smoking and the development of adenomatous colorectal polyps. Among more than 39,000 men and women in the Chicago Heart Association Detection Project in Industry Study, smokers had a relative risk of death from colorectal carcinoma of 1.87, compared to those who never smoked (95% CI 1.08 to 3.22). The risk for women who smoked more than 20 cigarettes daily compared with those who never smoked was 2.49 (95% CI 0.87 to 7.12). Erlinger and colleagues report the results of a nested case-control study of over 22,000 adults in Washington County, Md., who were followed for 11 years after baseline measurement of C-reactive protein (CRP). Plasma CRP concentrations were higher among cases of colon cancer than among controls (2.69 vs. 1.97 mg/L; P <.0001), but not among cases of rectal cancer (P = .32). The lack of an association with rectal cancer could be a result of reduced opportunity to find a relationship due to small numbers of rectal cancer cases or due to an alternative biologic pathway.
Nurse practitioners can use the knowledge that colorectal cancer is another tobacco-associated disease to counsel patients about the harmful effects of tobacco and to guide individual screening decisions. We know that smokers can reduce CRP levels by quitting. However, whether inflammation should be treated early with nonsteroidal inflammatory drugs such as aspirin to reduce the risk of cancer is not clear.