© 1997 by Oxford University Press
Journal Of The National Cancer Institute, Vol 89, 1277-1284, Copyright © 1997 by Oxford University Press
MD Gammon, JB Schoenberg, H Ahsan, HA Risch, TL Vaughan, WH Chow, H Rotterdam, AB West, R Dubrow, JL Stanford, ST Mayne, DC Farrow, S Niwa, WJ Blot and JF Fraumeni Jr
BACKGROUND: Incidence rates for adenocarcinomas of the esophagus and
gastric cardia have risen steeply over the last few decades. To determine
risk factors for these tumors, we conducted a multicenter,
population-based, case-control study. METHODS: The study included 554
subjects newly diagnosed with esophageal or gastric cardia adenocarcinomas,
589 subjects newly diagnosed with esophageal squamous cell carcinoma or
other gastric adenocarcinomas, and 695 control subjects. Estimates of risk
(odds ratios [ORs] and corresponding 95% confidence intervals [CIs]) were
calculated for the four tumor types separately and for esophageal and
gastric cardia adenocarcinomas combined. RESULTS: Risk of esophageal and
gastric cardia adenocarcinomas combined was increased among current
cigarette smokers (OR = 2.4; 95% = 1.7-3.4), with little reduction observed
until 30 years after smoking cessation; this risk rose with increasing
intensity and duration of smoking. Risk of these tumors was not related to
beer (OR = 0.8; 95% CI = 0.6-1.1) or liquor (OR = 1.1; 95% CI = 0.8-1.4)
consumption, but it was reduced for drinking wine (OR = 0.6; 95% CI =
0.5-0.8). Similar ORs were obtained for the development of noncardia
gastric adenocarcinomas in relation to tobacco and alcohol use, but higher
ORs were obtained for the development of esophageal squamous cell
carcinomas. For all four tumor types, risks were higher among those with
low income or education. CONCLUSIONS: Smoking is a major risk factor for
esophageal and gastric cardia adenocarcinomas, accounting for approximately
40% of cases. IMPLICATIONS: Because of the long lag time before risk of
these tumors is reduced among ex-smokers, smoking may affect early stage
carcinogenesis. The increase in smoking prevalence during the first two
thirds of this century may be reflected in the rising incidence of these
tumors in the past few decades among older individuals. The recent decrease
in smoking may not yet have had an impact.
REVIEWS
Tobacco, alcohol, and socioeconomic status and adenocarcinomas of the esophagus and gastric cardia
Division of Epidemiology, Columbia School of Public Health, New York, NY, USA.
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