Sex differences in the proportion of esophageal squamous cell carcinoma cases attributable to tobacco smoking and alcohol consumption

Abstract

Objective: Alcohol and tobacco are the two major established environmental factors associated with squamous cell carcinoma of the esophagus (ESCC). However, the prevalence of these exposures differs substantially between men and women. Moreover, the prevalence of smoking has declined in recent years, whereas per capita consumption of alcohol has remained steady in both sexes. Quantifying the burden of ESCC attributable to these causal factors is necessary to inform potential preventive strategies. Methods: We estimated the population attributable fraction (PAF) of ESCC due to smoking and alcohol, using data from an Australian population based case-control study (305 ESCC cases, 1554 controls). Results: Estimated PAF for ESCC were 49% (95%CI: 38-60) and 32% (95%CI: 25-40) due to smoking and heavy alcohol consumption respectively. More than 75% of the ESCC burden in men could be attributed to smokers with heavy alcohol consumption. The highest burden was among ≥30 pack years smokers who also consumed alcohol heavily (>17 drinks/week); this differed significantly between men (PAF 36%, 95%CI 29-44) and women (PAF 5%, 95%CI 2-10). Among women only, low intakes of fruit and vegetables accounted for about 9% of the ESCC burden. Conclusion: The burden of ESCC attributable to smoking combined with heavy alcohol consumption is remarkably high in men. In women, the burden of ESCC due to these factors is lower, and poor nutrition may also play a role.

Phenome-Wide Association Study for Alcohol and Nicotine Risk Alleles in 26394 Women

“…The WHI subjects were recruited for three clinical trials and one observational study. There are well-known sex differences in smoking and drinking behaviors and their consequences (Pandeya et al, 2013;Cosgrove et al, 2014;White et al, 2015), and the current study provided novel important data regarding the role of alcohol and tobacco use and their genetics in women's health.…”

Nutrition in peri-operative esophageal cancer management

“…Risk factors for adenocarcinoma include male sex, advancing age, white race, gastroesophageal reflux disease, Barrett's esophagus, obesity, and smoking [4]. Alcohol and smoking are the main risk factors for squamous cell carcinoma [5].…”

Clinical Features of Patients with Esophageal and Second Primary Cancers

“…Additionally, Zhu et al (2012) observed that incidence of SPC in the EC patients was disproportionally higher in male than in female. The reason why SPC occurred in EC patients with male preponderance was not totally clarified yet, but it was generally deemed that tobacco and alcohol consumption played a crucial role in the prevalence of EC with the gender differences (Pandeya et al, 2013;Prabhu et al, 2014). Therefore, lifestyle changes such as restriction of cigarette smoking and alcohol consumption were suggested as one of the preventive strategies of developing SPC in EC patients (Jemal et al, 2011;Tang et al, 2014).…”