Association Between Smoking Status and Prevalence of Advanced Outcomes in Patients With and Without Positive Stool...

Our goal was to examine the association between smoking status (current, former, and never) and prevalence of advanced findings in patients with colonoscopy after a positive multi-target stool DNA test (mt-sDNA), patients with colonoscopy after a positive Fecal Immunochemical Test (FIT), and patients with colonoscopy only (no prior stool test).

Our main outcome was prevalence of advanced lesions (any colorectal cancer (CRC), advanced adenoma, or advanced serrated polyp). We also looked at advanced adenomas and advanced serrated polyps separately. We performed logistic regressions comparing findings by smoking status within mt-sDNA + , FIT + , and colonoscopy-only patients, adjusting for age, sex, and CRC risk. We also performed logistic regressions within all current smokers comparing outcome odds between each screening method cohort.

Our sample included 967 mt-sDNA + , 498 FIT + , and 58,682 colonoscopy-only patients. Within the FIT + (OR = 2.46; 95%CI 1.16-5.26) and mt-sDNA + (OR = 1.65; 95%CI 1.05-2.59) groups, current smokers had higher odds of advanced serrated polyps than never-smokers (reference). In addition, FIT + current smokers (OR = 1.97; 95%CI 1.11-3.50) or mt-sDNA (OR = 3.27; 95%CI 2.25-4.74) current smokers had higher odds of advanced lesions than colonoscopy-only smokers (reference).

Within stool-test-positive patients, current smokers have higher odds of advanced serrated polyps than never-smokers, reinforcing the heightened importance of a follow-up colonoscopy in smokers with positive stool tests. We also found higher yields of advanced outcomes in FIT + and mt-sDNA + smokers vs. smokers who underwent colonoscopy without a prior stool test. Endoscopists need to be particularly vigilant in detecting advanced serrated polyps in patients who smoke and have a positive stool test.