Prediagnostic smoking history, alcohol consumption, and colorectal cancer survival

Cancer, 04/15/2011

Phipps AI et al. - In addition to an association with disease risk, smoking is associated with increased mortality after colorectal cancer diagnosis. This association is especially pronounced for colorectal cancer with high microsatellite instability.


  • Men and women diagnosed with incident colorectal cancer between 1998 and 2007 in 13 counties in western Washington State identified by using Surveillance, Epidemiology, and End Results cancer registry
  • Information on smoking history and alcohol consumption collected by telephone interview
  • Follow-up for mortality completed through linkage to National Death Index
  • Cox proportional hazards regression used to estimate HR and 95% CI for associations among smoking, alcohol consumption, and mortality after colorectal cancer diagnosis
  • Stratified analyses conducted by sex, age at diagnosis (<50 years, ≥50 years), tumor site (proximal, distal, rectal), stage (I-II, III-IV), and microsatellite instability status (stable/low, high)


  • Disease-specific and all-cause mortality significantly higher for smokers (HR, 1.30; 95% CI, 1.09-1.74) compared with never-smokers (HR, 1.51; 95% CI, 1.24-1.83)
  • Association most prominent in those with tumors exhibiting high microsatellite instability (HR, 3.83; 95% CI, 1.32-11.11) and did not extend to those with rectal cancer (HR, 1.08; 95% CI, 0.72-1.61) or those diagnosed before age 50 years (HR, 0.99; 95% CI, 0.67-1.48)
  • Alcohol consumption not associated with disease-specific or all-cause mortality, regardless of patient or tumor characteristics

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