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Background According to the Hong Kong Cancer Register in 2022, colorectal cancer (CRC) was the second most common cancer and the second leading cause of cancer deaths. There were 2,270 deaths from CRC, which is equivalent to 15.4% of all cancer deaths in Hong Kong in the year. Thus, the implementation of the Colorectal Cancer (CRC) Screening Programme in 2016 has significantly increased public awareness and identified people with the disease or people at increased risk of disease for prompt treatment and improved the treatment outcome. Smoking and alcohol consumption are established risk factors of CRC. We aimed to evaluate the association of smoking exposure and alcohol consumption with colorectal disease to define how smoking and alcohol consumption affect the risk.Methods We analyzed date from 1988 patients age 50-75 who were joined DH CRC Program in 2016-2025 and attended Kowloon West Cluster (KWC) Nurse Clinic managing post-colonoscopy follow-ups and surveillance for the patients, we identified 202 cases of colorectal adenocarcinoma, as compared with 233 controls (frequency match for age, sex and for the first time colonoscopy) were estimated using multiple logistic regression.Results Smoking exposure and alcohol consumption were much higher among CRC cases than among controls. Adjusted odds ratios for smoking and alcohol consumption were as follows: Current smoking: 2.070 (95% confidence interval (CI) = 1.240 to 3.457, P 0.004); former smoking: 1.783 (95% confidence interval (CI) = 1.030 to 3.084, P 0.037). Current alcohol consumption: 2.033 (95% confidence interval (CI) = 1.280 to 3.231, P 0.0025); former alcohol consumption: 1.693 (95% confidence interval (CI) = 1.071 to 1.280, P 0.02387). Significant trends were observed between the development of colorectal cancer and smoking and alcohol variables.Conclusions This study confirms that both smoking and alcohol consumption is a strongest associations with increased risk factors for colorectal cancer.