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Background  The association between colorectal cancer (CRC) and smoking has not been consistent. Incomplete smoking history and association to a specific subset of CRC tumors have been proposed as explanations. The adenomatous polyposis coli ( APC ) gene has been reported to have a "gatekeeper" function in the colonic mucosa.    Methods  To evaluate the hypothesis that cigarette smoking is associated with adenoma and carcinoma development and further to investigate whether this association is due to mutations in the  APC  gene, we used a study population consisting of 133 cases (45 adenomas and 88 carcinomas) and 334 controls. All tumors were sequenced in the mutation cluster region (MCR) of the  APC  gene. Cases and controls were drawn from a homogeneous cohort of Norwegian origin.    Results  The mutational spectra of the  APC  gene revealed no difference in frequencies of mutations in cases based on ever and never smoking status. An overall case-control association was detected for adenomas and "ever smoking" OR = 1.73 (95% CI 0.83–3.58). For CRC cases several smoking parameters for dose and duration were used. We detected an association for all smoking parameters and "duration of smoking > 30 years", yielded a statistically significant OR = 2.86 (1.06–7.7). When cases were divided based on  APC  truncation mutation status, an association was detected in adenomas without  APC  mutation in relation to "ever smoking", with an OR = 3.97 (1.26–12.51). For CRC cases without  APC  mutation "duration of smoking > 30 years", yielded a statistically significant OR = 4.06 (1.20–13.7). The smoking parameter "starting smoking ≥ 40 years ago" was only associated with CRC cases with  APC  mutations, OR = 2.0 (0.34–11.95). A case-case comparison revealed similar findings for this parameter, OR = 2.24 (0.73–6.86).    Conclusion  Our data suggest an association between smoking and adenoma and CRC development. This association was strongest for cases without  APC  truncation mutation. This may implicate other factors in development of these tumors. The association detected between smoking and CRC cases with  APC  mutation was in relationship to the smoking parameter "starting smoking ≥ 40 years ago", a time period long enough to proceed CRC initiation.

Association between cigarette smoking, APCmutations and the risk of developing sporadic colorectal adenomas and carcinomas