Cigarette smoking has been inconsistently associated with colon cancer risk. To evaluate the hypothesis that smoking is primarily linked to a specific colon tumor subgroup(s), we assessed associations between smoking and the occurrence of mutations in the APC, K-ras and p53 genes, p53 overexpression, and microsatellite instability (MSI) in a Dutch population-based case-control study on sporadic colon carcinomas. The study population consisted of 176 cases and 249 controls. Smoking status (never, ever), number of cigarettes smoked per day (never, <15, > or =15), total years of smoking (never, < or =30, >30), and years since first started smoking (never, < or =35, >35) were all evaluated. Cigarette smoking status was significantly differently related to p53 overexpression-positive (p53(pos)) tumors compared with p53 overexpression-negative (p53(neg)) tumors (p53(pos) versus p53(neg), OR 0.4, 95% CI 0.2-0.9), as well as to tumors with transversion mutations in APC, K-ras or p53 (transv(+)) compared with tumors without transversion mutations in one of these genes (transv(-)) (transv(+) versus transv(-), OR 2.5, 95% CI 1.0-5.9). Positive associations were observed with p53(neg) tumors and transv(+) tumors when compared with the population-based controls (ever versus transv(-), OR 1.5, 95% CI 0.9-2.8 and OR 2.2, 95% CI 0.9-5.6, respectively), inverse associations with p53(pos) tumors and transv(-) tumors (ever versus never, OR 0.5, 95% CI 0.3-1.0 and OR 0.8, 95% CI 0.5-1.3, respectively). Similar patterns of association were observed for the other smoking variables evaluated. In addition, although statistically non-significant, smoking was more notably positively associated with tumors that exhibit K-ras mutations, especially K-ras transversion mutations, than with tumors without K-ras mutations. An inverse relationship between smoking and the occurrence of APC mutations was suggested, whereas no clear associations were observed with MSI. Our data suggest that smoking-related colon cancers develop through a p53(neg) pathway and that smoking particularly results in colon carcinomas with transversion mutations.