Secondary Prevention of Esophageal Squamous Cell Carcinoma in Areas Where Smoking, Alcohol, and Betel Quid Chewing are Prevalent

Abstract

Esophageal cancer is ranked as the sixth most common cause of cancer death worldwide and has a substantial effect on public health. In contrast to adenocarcinoma arising from Barrett's esophagus in Western countries, the major disease phenotype in the Asia-Pacific region is esophageal squamous cell carcinoma which is attributed to the prevalence of smoking, alcohol, and betel quid chewing. Despite a multidisciplinary approach to treating esophageal cancer, the outcome remains poor. Moreover, field cancerization reveals that esophageal squamous cell carcinoma is closely linked with the development of head and neck cancers that further sub-optimize the treatment of patients. Therefore, preventive strategies are of paramount importance to improve the prognosis of this dismal disease. Since obstacles exist for primary prevention via risk factor elimination, the current rationale for esophageal cancer prevention is to identify high-risk groups at earlier stages of the disease, and encourage them to get a confirmatory diagnosis, prompt treatment, and intensive surveillance for secondary prevention. Novel biomarkers for identifying specific at-risk populations are under extensive investigation. Advances in image-enhanced endoscopy do not just substantially improve our ability to identify small precancerous or cancerous foci, but can also accurately predict their invasiveness. Research input from the basic sciences should be translated into preventive measures in order to decrease the disease burden of esophageal cancer.

Lack of association between Cyclin D1 gene G870A polymorphism and esophageal cancer: evidence from a meta-analysis

“…For example, EA is quite common in Western countries, and it is widely believed that EA arises from Barrett esophagus, an acquired condition in which the normal esophageal squamous epithelium is replaced by a metaplastic columnar cell-lined epithelium (Williams et al, 2006). However, ESCC is the major subtype in the Asia-Pacific countries, and its development is reportedly attributed to smoking, alcohol consumption, and betel quid chewing (Chung et al, 2010). In view of this geographic distribution difference, we subgrouped studies according to the types of esophageal cancer and found that the magnitude of the association between the CCND1 A870G polymorphism and esophageal cancer was augmented in the EA group relative to the ESCC group across all genetic comparisons except in the dominant model (Table 2), although the pooled associations lacked statistical significance.…”

Revisit of Field Cancerization in Squamous Cell Carcinoma of Upper Aerodigestive Tract: Better Risk Assessment with Epigenetic Markers

“…Prior to the endoscopic screening, patients underwent face-to-face interviews, physical examinations, and laboratory tests to identify traditional risk factors for SCCs in the head and neck region (24) and in the esophagus (25) that would be used as baseline comparators for the upcoming epigenetic approach. These included: the demographic characteristics (6, 7) of age, sex, and body mass index (BMI); the lifestyle risk factors (8, 9, 11) of alcohol drinking, betel quid chewing, and cigarette smoking (briefly as "ABC"); polymorphisms in genes encoding enzymes involved in the metabolism of alcohol (10-13), including aldehyde dehydrogenase (ALDH) 2, alcohol dehydrogenase (ADH) 1B, and ADH 1C; polymorphisms in genes encoding enzymes involved in the metabolism of xenobiotics (14), including glutathione S transferase (GST) P1, GST M1, and GST T1; and serological markers (15)(16)(17)(18), including increased mean corpuscular volume (MCV), Helicobacter pylori infection, and human papillomavirus infection.…”

Esophageal Carcinogenesis

“…Substantial alcohol intake, especially in combination with smoking, greatly increases the risk of squamous-cell carcinoma, but not adenocarcinoma [39]. The combination of smoking and alcohol abuse is associated with a similarly increased risk of head and neck cancer; indeed, clinically unsuspected squamous cell carcinoma of the esophagus is discovered incidentally in approximately 1% to 2% of patients with head and neck cancers [40]- [42]. Other causes of chronic esophageal irritation include achalasia [43] and esophageal diverticulum [44], in which food is retained and decomposed by bacteria, releasing various chemical irritants.…”