Healthy Lifestyle Adherence After Polypectomy Associated With Reduced CRC Risk

Colon cancer
Computer illustration of a malignant (cancerous) tumour (red) in the colon. Risk factors for colorectal cancer are smoking, obesity and lack of physical activity.
Researchers investigated whether adherence to a healthy lifestyle following polypectomy reduced the risk for CRC incidence and mortality.

The following article is a part of conference coverage from the Digestive Disease Week 2021 Annual Meeting , held virtually from May 21 to 23, 2021. The team at Gastroenterology Advisor will be reporting on the latest news and research conducted by leading experts in gastroenterology. Check back for more from DDW 2021.


Adherence to a healthy lifestyle after endoscopic polypectomy may reduce risk for colorectal cancer (CRC) and all-cause mortality, according to study data presented at Digestive Disease Week  2021.

While certain lifestyle factors are known to confer protection against CRC, the role of lifestyle after polypectomy remains unclear. To inform this gap, investigators conducted a prospective study using data from 3 US cohorts: the Nurses’ Health Study, Nurses’ Health Study 2, and Health Professionals Follow-Up Study.

A “healthy lifestyle score” (range: 0-5) was computed using 5 binary criteria. The lifestyle score was incremented up by 1 point for each of the following criteria: (1) body mass index (BMI) >18.5 and <27.5 kg/m2; (2) never smoking; (3) regular vigorous physical activity; (4) none-to-moderate alcohol intake; and (5) healthy diet based on recommendations from the American Institute for Cancer Research.

Cox proportional hazard models were used to estimate the hazard ratios (HRs) for CRC and all-cause mortality based on healthy lifestyle score. Models were adjusted for the relevant covariates, including demographic factors, aspirin use, surveillance endoscopy, and severity of index polyps.

The study cohort consisted of 21,422 patients who underwent polypectomy. Over a median follow-up period of 10 years, 161 CRC cases and 4420 deaths were recorded. Compared against patients with 0-1 healthy lifestyle factors, patients with 3 and 4-5 healthy lifestyle factors had HRs for CRC of 0.53 (95% CI, 0.33-0.85) and 0.55 (95% CI, 0.31-0.99), respectively (P =.003). Patients with 2 healthy lifestyle factors also had a lower HR for CRC compared against patients with 0-1 factors, though the difference was not statistically significant.

All-cause mortality was also significantly reduced in patients with 2 factors (HR, 0.79; 95% CI, 0.72-0.87), 3 factors (HR, 0.62; 95% CI, 0.56-0.69), and 4-5 factors (HR, 0.52; 95% CI, 0.45-0.59) compared against patients with 0-1 factors (P <.0001). These associations persisted in subgroup analyses restricted to patients with conventional adenomas and serrated polyps.

“Adherence to a healthy lifestyle after polypectomy may still confer significant benefit for CRC prevention and reduction in premature death,” investigators concluded.

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Wang L, Knudsen M, Lo CH, et al. Adherence to a healthy lifestyle in relation to colorectal cancer incidence and all-cause mortality after endoscopic polypectomy: a prospective study in three U.S. cohorts. Presented at: Digestive Disease Week Annual Meeting; May 21-23, 2021. Abstract 668.