Smoking and alcohol drinking in relation to the risk of esophageal squamous cell carcinoma: A population-based case-control study in China

Xiaorong Yang,Ziyu Yuan,Weimin Ye,Shuping Nie,Xingdong Chen,Maoqiang Zhuang,Ming Lu,Li Jin

doi:10.1038/s41598-017-17617-2

Abstract

Previous results regarding the associations between esophageal squamous-cell carcinoma (ESCC) risk and smoking/alcohol drinking in high-risk areas are inconsistent. We performed a large population-based case-control study from 2010 to 2013 in a high-incidence area of China, and enrolled 1353 ESCC cases and 1961 controls. Data regarding smoking and alcohol drinking were collected via face-to-face interviews using a structured questionnaire. Odd ratios (ORs) with 95% confidence intervals (CIs) were estimated using unconditional logistic regression models. After adjusting for alcohol drinking and other potential confounders, male heavy smokers (i.e., those who started smoked more than 20 cigarettes per day or 40 pack-years, or started smoking early), showed a moderately increased risk for ESCC; however, current smoking was not associated with an increased risk. Alcohol drinking among males significantly increased the risk for ESCC (OR = 2.20, 95%CI:1.79~2.70). We observed increasing excess ESCC risks with decreasing age at behavior initiation as well as with increasing duration and intensity of alcohol intake, which were particularly evident among current smokers. In contrast, neither smoking nor alcohol drinking was not associated with ESCC risk among females. In conclusion, alcohol drinking shows a monotonic dose-response relationship with ESCC risk among men, and this relationship is particularly evident among smokers.

Highlights

According to the most recent International Agency for Research on Cancer (IARC) report, 455,800 new esophageal cancer cases (3% of all cancers) were reported and 400,200 deaths due to esophageal cancer (5% of all cancer deaths) occurred worldwide in 20121
Since more than 95% of esophageal cancer cases are esophageal squamous-cell carcinoma (ESCC) in China[3], the present analysis focused on the effects of tobacco smoking and alcohol drinking on ESCC risk in this high-risk population
Compared with never alcohol drinkers, current alcohol drinkers had a more than two-fold increased risk of ESCC. Using this large population-based case-control study, we explored the associations between the risk of ESCC and various dimensions of active smoking, passive smoking, and alcohol drinking among a high-risk Chinese population

Summary

Introduction

According to the most recent International Agency for Research on Cancer (IARC) report, 455,800 new esophageal cancer cases (3% of all cancers) were reported and 400,200 deaths due to esophageal cancer (5% of all cancer deaths) occurred worldwide in 20121. The results regarding the effects of alcohol intake on ESCC risk in high-risk areas are inconsistent; the reported magnitudes of these associations range from no relationship[7,8,12] to 1.5–3.5-fold relative risk[10,13,14,18]. These controversial results might partly be explained by regional particularities, certain disadvantages associated with the study designs of previous studies might be the main culprits. Since more than 95% of esophageal cancer cases are ESCC in China[3], the present analysis focused on the effects of tobacco smoking and alcohol drinking on ESCC risk in this high-risk population

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Results

Conclusion