Selenium status has been inversely associated with colorectal cancers (CRC) and adenomas. This investigation evaluates the association between selenium supplementation and prevalent and incident colorectal adenomas and CRC detected during the Nutritional Prevention of Cancer trial follow-up. Of the 1,312 randomized to 200 mcg of selenized yeast of matching placebo, 598 participants underwent endoscopic screening (flexible sigmoidoscopy or colonoscopy) for CRC sometime during the follow-up period, which ended in February 1, 1996. There was no colorectal screening performed at baseline. Of those screened, 77% were male (with a mean age of 62.8 years), 42% were former and 25% were current smokers. Adenomas were classified as prevalent (identified at the first endoscopic examination postrandomization during the follow-up period) or incident (identified at the second or subsequent examination). Ninety-nine prevalent and 61 incident adenomas were ascertained. Logistic regression odds ratios (OR) and 95% confidence intervals (CI) were calculated, adjusting for age, gender and smoking status. For prevalent adenomas, there was a suggestive but nonsignificant decrease in risk associated with selenium treatment (OR 5 0.67, 95% CI 5 0.43-1.05). Subjects in the lowest tertile of baseline selenium (OR 5 0.27, 95% CI 5 0.09-0.77) and current smokers (OR 5 0.27, 95% CI 5 0.11-0.66) had significant reductions in risk. The OR for incident adenomas was 0.98 (95% CI 5 0.57-1.68). In addition to being associated with a reduced risk of incident CRC, selenium supplementation was associated with a significantly reduced risk of prevalent adenomas, but only among subjects with either a low baseline selenium level or among current smokers. ' 2005 Wiley-Liss, Inc.Key words: selenium; colorectal cancer; colorectal adenomas The Nutritional Prevention of Cancer (NPC) study 1 was a placebo-controlled, randomized clinical trial designed to prevent the recurrence of nonmelanoma skin cancer (NMSC) in men and women living in the low soil selenium areas of the Eastern Coastal plain of the US. The results indicated that selenium led to a significant increase in the recurrence of squamous cell carcinoma of the skin.2 The secondary endpoints of the trial (total cancer mortality, total cancer incidence, prostate, colon and lung cancer incidence), defined in 1993, were found to be inversely associated with selenium supplementation, with the greatest reduction in risk seen among subjects in the lower third of the distribution of baseline plasma selenium levels. 1,3,4 Since the trial began, patients were interviewed at each clinical visit for new illnesses, tests and new medications. These reports included cancer screening procedures and newly diagnosed colorectal polyps, cancers and other gastrointestinal conditions. Starting in 1989, specific questions were added to the clinical interview on general cancer screening practices and exam results, focusing on breast, cervical, colorectal and prostate cancers. Patients were asked repeatedly about their perso...