Four hundred and fifty-six distal polyps were detected in 160 (53%) of 300 patients over 45 years of age examined by routine proctosigmoidoscopy after July 1, 1965. Sixty-five percent of these lesions were multiple, 97% were 5 mm or less in size, and 75% were located in the middle third segment of the rectocolon visualized. Sixteen proximal polyps were revealed in 8 (3.8%) of 211 patients examined by roentgenogram of the colon. Half of these lesions were less than 1 cm in size. Higher up polyps were roentgenologically demonstrated in patients with distal polyps almost twice as frequently as in those with normal results of endoscopy. A significantly higher incidence of both distal and proximal polyps was found in cigarette smokers and ex-smokers as compared with nonsmokers. Selecting smokers rather than those with distal polyps for subsequent proctologic procedures should efficiently increase the yield of benign adenomatous polyps, at half the cost of similar studies in an unselected population.A previous report concluded that "a controlled study is needed to confirm an expected in¬ crease in frequency of higher polyps in patients with mucosal tags and adenomatous polyps compared with patients in whom no polyp is found by proctosigmoidoscopy. Such a study would also confirm the presumed worth of routine barium enema ex¬ aminations in all patients with mu¬ cosal abnormality."1 Furthermore, al¬ though cigarette smoking has been positively correlated with distal pol¬ yp frequency,2 and heavy smoking with distal polyp multiplicity,2 the smoking characteristics of patients with proximal polyps have not been explored. Finally, careful attention to minute lesions has disclosed poly¬ poid growths in approximately one half of the population over the age of 45 years,2 thus invalidating prior de¬ scriptions of frequency, multiplicity, size, and distribution of distal polyps. To answer these problems, the fol¬ lowing study contrasts roentgenologic findings in distal polyp and nonpolyp populations, relates smoking habits to the presence of higher-up
