Opium, tobacco, and alcohol use in relation to oesophageal squamous cell carcinoma in a high-risk area of Iran

Abstract

The very high incidence of oesophageal squamous cell carcinoma (ESCC) in Golestan Province in northeastern Iran was suggested by studies in the 1970s as partly due to opium use, which is not uncommon in this area, but based on limited numbers. From December 2003 to June 2007, we administered a validated structured questionnaire to 300 ESCC cases and 571 controls, matched on neighbourhood of residence, age (±2 years), and sex. We used conditional logistic regression models to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs) adjusted for potential confounders. Compared with those who used neither tobacco nor opium, risk of ESCC was increased in those who used tobacco only (OR, 95% CI: 1.70, 1.05 -2.73), in those who used opium only (2.12, 1.21 -3.74), and in those who used both tobacco and opium (2.35, 1.50 -3.67). All forms of tobacco use (cigarettes, hookah, and nass) were associated with higher ESCC risk. Similarly, use of both crude opium and other forms of opium were associated with higher risk. Alcohol consumption was seen in only 2% of the cases and 2% of the controls, and was not associated with ESCC risk.

The Prevalence, Attitudes, and Correlates of Waterpipe Smoking Among High School Students in Iran: a Cross-Sectional Study

“…Other factors that attract WP smokers, especially adolescents, are its aromatic and condensed smoke, attractive pipe design, availability, inexpensive tobacco, and social acceptance because of traditional associations and it being less stigmatized than cigarette smoking [22]. WP smoking is a new challenge for global public health efforts [23], and recent studies have shown that WP smoke is more harmful than cigarette smoke, because one session of WP smoking expose it's users to a larger amount of smoke and higher level of tobacco toxicants such as tar, carbon monoxide, nicotine, and arsenic compared with one cigarette [24][25][26][27][28][29].WP smoking is considered to be associated with lung cancer, esophageal cancer, low birth weight, periodontal diseases, and pulmonary dysfunction [30].…”

Global Patterns of Cancer Incidence and Mortality Rates and Trends

“…Smoking and alcohol consumption account for more than 90% of ESCC in the United States and several other western countries (144,145), but these risk factors play a less significant role for the cancer burden in high-risk areas such as Linxian (China) and Golestan (Iran;refs. 143,146). In these regions, both smoking prevalence and alcohol consumption are low (147) and the incidence of ESCC in women is as high as in men, despite the low prevalence of smoking in women compared with men (141).…”

“…In these regions, both smoking prevalence and alcohol consumption are low (147) and the incidence of ESCC in women is as high as in men, despite the low prevalence of smoking in women compared with men (141). Suggested risk factors for ESCC in these high-risk areas include poor nutrition, lack of fruit and vegetables, drinking hot beverages, and opium (143,146,(148)(149)(150)(151).…”

Reply: Hookah, opium, and tobacco smoking in relation to ESCC

“…Dr Chaouachi suggests that the association of hookah and oesophageal cancer observed in our study (Nasrollahzadeh et al, 2008) may be due to smoking opium, rather than tobacco, by a hookah. Whereas this is a very interesting hypothesis, it is unlikely to explain the results associated with hookah use.…”