Importance of anatomical subsite in correlating risk factors in cancer of the oesophagus - report of a case - control study

Abstract

In Bangalore, cancer of the oesophagus is the third most common cancer in males and fourth most common in females with average annual age-adjusted incidence rates of 8.2 and 8.9 per 100,000 respectively. A case-control investigation of cancer of the oesophagus was conducted based on the Population-based cancer registry, Bangalore, India. Three hundred and forty-three cases of cancer of the oesophagus were age and sex matched with twice the number of controls from the same area, but with no evidence of cancer. Chewing with or without tobacco was a significant risk factor. In both sexes chewing was not a risk factor for cancer of the upper third of the oesophagus. Among males, non-tobacco chewing was a significant risk factor for the middle third but not for the other two segments and tobacco chewing was a significant risk factor for the lower third of the oesophagus, but not for the other two segments. Bidi smoking in males was a significant risk factor for all three segments being highest for the upper third, less for the middle third and still less for the lower third. The risk of oesophageal cancer associated with alcohol drinking was significant only for the middle third.

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

“…13 The evidence for 2-way interaction of betel quid chewing with drinking and smoking was also examined in our study. Adjusted for the third habit and possible confounding variables, the joint risks for chewing and drinking as well as chewing and smoking were fitted well by a multiplicative model, a finding that is supported by earlier studies that have shown that a substantially higher cancer risk was marked among areca nut chewers who also drank alcohol 3,23,27 or smoked tobacco. 3,23 Considering chewing with or without tobacco as a category, one multicenter case-control study in Southern India found a multiplicative interaction effect between chewing and drinking as well as chewing and smoking.…”

“…Adjusted for the third habit and possible confounding variables, the joint risks for chewing and drinking as well as chewing and smoking were fitted well by a multiplicative model, a finding that is supported by earlier studies that have shown that a substantially higher cancer risk was marked among areca nut chewers who also drank alcohol 3,23,27 or smoked tobacco. 3,23 Considering chewing with or without tobacco as a category, one multicenter case-control study in Southern India found a multiplicative interaction effect between chewing and drinking as well as chewing and smoking. 15 Although areca nut is chewed without tobacco in Taiwan, our results demonstrate that betel quid chewing modified the risk of drinking in determining the development of esophageal cancer based on an additive interaction model.…”

“…In our study, a 2.9-and 2.2-fold elevated risk of contracting esophageal cancer was found to relate to areca nut chewing with a piece of Piper Betel Linn inflorescence and with betel leaf/stem and inflorescence mixed, respectively; both types of products do not use tobacco as an ingredient in Taiwan. 4,9 Comparable results were reported by studies conducted in 2 areas of India, 15,23 in those studies a 1.6 -2.2-fold increase risk for esophageal cancer was observed among chewers without tobacco. These findings suggest that chewing products without tobacco was an independent risk factor for squamous cell carcinoma of the esophagus.…”

Relationship between site of oesophageal cancer and areca chewing and smoking in Taiwan

“…Very few studies have investigated the relationship between habitual substance use and location of oesophageal cancer (Nandakumar et al, 1996). Nandakumar et al studied oesophageal cancer (343 cases and 686 controls) in India and found that chewing areca preparations were associated with an increased risk for developing cancer in the middle third of the oesophagus.…”

“…Although much research has investigated oesophageal cancer risk factors (Nandakumar et al, 1996;Phukan et al, 2001;Wu et al, 2001), only one study, to our knowledge, from India has examined the association between substance use and the anatomic site of oesophageal cancer lesions (Nandakumar et al, 1996). We therefore attempted to clarify the influence of substance use on the anatomical site of oesophageal cancer occurrence in Taiwan.…”