Abstract
Oesophageal adenocarcinoma has become much more common over the past 50 years, particularly in Britain, with an unexplained male to female ratio of > 4:1. Given the use of asbestos filtration in commercial brewing and reports of its unregulated use in British public houses in the 1970’s to clear draught beer “slops”, we have assessed the hypothesis that ingested asbestos could be a causative factor for this increased incidence. Importantly, occupational asbestos exposure increases the risk of adenocarcinoma but not squamous cell carcinoma of the oesophagus. The presence of asbestos fibres was consistently reported in filtered beverages including beers in the 1970s and asbestos bodies have been found in gastrointestinal tissue, particularly oesophageal tissue, at autopsy. There is no reported association between the intake of alcohol and oesophageal adenocarcinoma but studies would mostly have missed exposure from draught beer before 1980. Oesophageal adenocarcinoma has some molecular similarities to pleural mesothelioma, a condition that is largely due to inhalation of asbestos fibres, including predominant loss of tumour suppressor genes rather than an increase of classical oncogenic drivers. Trends in incidence of oesophageal adenocarcinoma and mesothelioma are similar, rising rapidly over the past 50 years but now plateauing. Asbestos ingestion, either from beer consumed before around 1980, or from occupational exposure, seems a plausible causative factor for oesophageal adenocarcinoma. If this is indeed the case, its incidence should fall back to a low baseline by around 2050.
Highlights
There has been a dramatic increase, approximately six-fold, in the incidence of oesophageal adenocarcinoma over the past 50 years,[1] but with a very uneven geographical distribution and a striking male predominance
In this article we review the possibility that ingestion of asbestos, used as a filtering agent in alcoholic drinks, beers, up to the late 1970s might be a causative factor for oesophageal adenocarcinoma
Of 2542 deaths from mesothelioma in 2015, only three of the deceased were born after 1975,55 and it has been predicted that asbestos-related mesothelioma should have disappeared in Britain by 2055, by which time anyone born before 1965 will be over 90.54 Given that asbestos ingestion from beer should only affect people who had already reached adulthood by the late 1970s, the epidemic of oesophageal adenocarcinoma, if related to asbestos ingestion from beer rather than occupational exposure, might resolve slightly earlier, perhaps by 2050, and should be reducing well before
Summary
There has been a dramatic increase, approximately six-fold, in the incidence of oesophageal adenocarcinoma over the past 50 years,[1] but with a very uneven geographical distribution and a striking male predominance. Reflux in turn is strongly associated with risk for oesophageal adenocarcinoma but modelling has estimated that other factors account for 78% of the increasing incidence in men and 33% of the increase in women.[5] Barrett’s oesophagus shows a male predominance, but this is much less marked with an overall risk ratio of just under 2:1.4. The increase has not impacted on all ages, suggesting a possible cohort effect.[6] in England where the incidence of adenocarcinoma rose more than three-fold between 1972 and 2012, incidence rates per 100,000 for men aged 40–49 years only increased from 1.7 to 3.1 whereas rates for those 80 years and above increased from 23.0 to 84.1.7 the overall incidence of oesophageal adenocarcinoma has been levelling off since ~2010 8 and possibly even starting to fall in countries with a high incidence such as England[7] and Denmark.[3] In this article we review the possibility that ingestion of asbestos, used as a filtering agent in alcoholic drinks, beers, up to the late 1970s might be a causative factor for oesophageal adenocarcinoma. Received: 18 August 2018 Revised: 21 March 2019 Accepted: 2 April 2019 Published online: 9 May 2019
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