Esophageal cancer risk by type of alcohol drinking and smoking: a case-control study in Spain
The effect of tobacco smoking and alcohol drinking on esophageal cancer (EC) has never been explored in Spain where black tobacco and wine consumptions are quite prevalent. We estimated the independent effect of different alcoholic beverages and type of tobacco smoking on the risk of EC and its main histological cell type (squamous cell carcinoma) in a hospital-based case-control study in a Mediterranean area of Spain.
Methods: We only included incident cases with histologically confirmed EC (n=202). Controls were frequency-matched to cases by age, sex and province (n=455).
Information on risk factors was elicited by trained interviewers using structured questionnaires. Multiple logistic regression was used to estimate adjusted odds ratios and 95% confidence intervals (CI).
Results: Alcohol drinking and tobacco smoking were strong and independent risk factors for esophageal cancer.
Alcohol was a potent risk factor with a clear dose-response relationship, particularly for esophageal squamous-cell cancer. Compared to never-drinkers, the risk for heaviest drinkers ([greater than or equal to]75 g/day of pure ethanol) was 7.65 (95%CI, 3.16-18.49); and compared with never-smokers, the risk for heaviest smokers ([greater than or equal to]30 cigarettes/day) was 5.07 (95%CI, 2.06-12.47).
A low consumption of only wine and/or beer (1-24g/d) did not increase the risk whereas a strong positive trend was observed for all types of alcoholic beverages that included any combination of hardliquors with beer and/or wine (p-trend<0.00001). A significant increase in EC risk was only observed for black-tobacco smoking (2.5-fold increase), not for blond tobacco.
The effects for alcohol drinking were much stronger when the analysis was limited to the esophageal squamous cell carcinoma (n=160), whereas a lack of effect for adenocarcinoma was evidenced. Smoking cessation showed a beneficial effect within ten years whereas drinking cessation did not.
Conclusions: Our study shows that the risk of EC, and particularly the squamous cell type, is strongly associated with alcohol drinking.
The consumption of any combination of hard liquors seems to be harmful whereas a low consumption of only wine may not. This may relates to the presence of certain antioxidant compounds found in wine but practically lacking in liquors.
Tobacco smoking is also a clear risk factor, black more than blond.
Author: Jesus Vioque, Xavier Barber, Francisco Bolumar, Miquel Porta, Miguel Santibanez, Manoli Garcia de la Hera, Eduardo Moreno-Osset and for the PANESOES Study Group
Credits/Source: BMC Cancer 2008, 8:221
Published on: 2008-08-01
Copyright by the authors listed above - made available via BioMedCentral (Open Access). Please
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