Alcohol, tobacco and oesophageal cancer: effects of the duration of consumption, mean intake and current and former consumption

Abstract

Summary Numerous epidemiological studies have shown that alcohol and tobacco consumption are the main risk factors for oesophageal cancer in Western countries. In these studies, the consumption of both alcohol and tobacco has almost always been measured as current mean intake. The present case-control study investigates the association between alcohol and tobacco consumption and the risk of oesophageal cancer by assessing exposure as total lifetime intake, mean weekly intake, duration of consumption and former and current consumption. Between 1991 and 1994, 208 cases and 399 control subjects were selected from three French university hospitals (Caen, Dijon and Toulouse). Eligible cases were men aged less than 85 years admitted to one of these hospitals with histologically proven squamous cell carcinoma of the oesophagus. During the interview, complete tobacco and alcohol consumption histories were recorded. Our findings suggest that alcohol consumption and tobacco consumption influence the risk of oesophageal cancer in different ways. In the case of alcohol, the relationship between the odds ratio and mean weekly intake was linear, the risk depending solely on mean weekly intake, with former and current consumption having similar effects. With regard to tobacco, the relationship between the odds ratio and mean weekly intake was loglinear; the risk depended mainly on the duration of consumption and former consumption had a lesser effect than current consumption. Our study suggests that total lifetime intake is not a correct measure of exposure for either alcohol or tobacco: for a given lifetime consumption of tobacco, a moderate intake during a long period carries a higher risk than a high intake during a shorter period and, conversely, for a given lifetime consumption of alcohol, a high intake during a shorter period carries a higher risk than a moderate intake during a longer period. Our results confirm the very low risk associated with a low alcohol intake, even over long periods. In contrast, there is a steep increase in the risk associated with smoking at even low mean intakes if these are continued over long periods. Our findings also suggest that even heavy smokers may benefit from quitting.

Joint Effects of Smoking and Alcohol Drinking on Esophageal Cancer Mortality in Japanese Men: Findings from the Japan Collaborative Cohort Study

“…Another case-control study in France suggested that alcohol consumption and tobacco consumption influenced the risk of esophageal cancer in different ways. In the case of alcohol, the risk depended only on mean intake; however, with regard to smoking, the risk depended mainly on duration of consumption (Launoy et al, 1997). These results were almost in accordance with the results of our study for a prospective cohort.…”

Independent and combined effects of alcohol intake, tobacco smoking and betel quid chewing on the risk of esophageal cancer in Taiwan

“…13,15,21,22 For drinking cessation no clear favorable effect was found, in those studies former drinkers were at a lower, 13,21 similar or even higher risk than current drinkers. 15,22 In our present study, quitting alcohol for 10 or more years and tobacco for 5 or more years were separately associated with a 70% and 60% risk reduction.…”

“…From a biological viewpoint, an apparent duration effect together with reduction of elevated risk after a relatively short time period of smoking cessation supports the hypothesis that tobacco contains both early-stage and late-stage carcinogens, as evaluated by IARC Monographs. 1 In contrast, the risk reduction after a long term of drinking cessation, as well as the inconsistent findings provided by earlier studies, 13,15,21,22 suggest that alcohol may not merely involve in a late-stage carcinogenesis of esophageal cancer, as proposed by IARC Monographs. 2 The practice of chewing of betel quid varies from country to country.…”

Promoter methylation and expression of Raf kinase inhibitory protein in esophageal squamous cell carcinoma

“…Tumorigenesis is a complicated process involving numerous factors, multiple steps and genetic as well as epigenetic alterations in various genes. The pathogenesis of ESCC has been mainly attributed to environmental factors, including malnutrition, smoking, alcohol use and inflammation (27)(28)(29). However, recent studies have revealed that genetic and Table V.…”