Tobacco, alcohol intake, and diet in relation to adenocarcinoma of the esophagus and gastric cardia (original) (raw)

Little is known about the etiology of adenocarcinoma of the distal esophagus/cardia, a cancer which has increased in incidence in the United States over the last two decades. We analyzed data on smoking, alcohol use, dietary intake, and other factors obtained from 173 hospitalized males with adenocarcinoma of the distal esophagus/cardia (cases) and 4,544 hospitalized males with diseases not related to smoking and of other organ systems than the gastrointestinal tract (controls). Cases of squamous cell carcinoma of the esophagus (_n_=136) and adenocarcinoma of the distal stomach (_n_=122) were included as separate case groups. All subjects were interviewed in 28 hospitals in eight cities in the US between 1981 and 1990. After adjustment for covariates, the odds ratio (OR) for adenocarcinoma of the distal esophagus/cardia for current smokers was 2.3 (95 percent confidence interval [CI]=1.4–3.9) and that for ex-smokers was 1.9 (CI=1.2–3.0) relative to never-smokers. The OR for drinkers of four or more ounces of whiskey-equivalents of alcohol per day (relative to those consuming less than one drink per week) was 2.3 (CI=1.3–4.3). Intakes of total fat and vitamin A from animal sources were significant risk factors and fiber intake was associated inversely with adenocarcinoma of the distal esophagus/cardia. Although the number of female cases of adenocarcinoma of the distal esophagus/cardia was small (_n_=21), significant associations were observed for smoking and alcohol.

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References

  1. Blot WJ, Devesa SS, Kneller RW, Fraumeni JF. Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 1991; 265: 1287–9.
    Google Scholar
  2. Zheng T, Mayne ST, Holford TR, et al. Time trend and age-period-cohort effects on incidence of esophageal cancer in Connecticut, 1935–89. Cancer Causes Control 1992; 3: 481–92.
    Google Scholar
  3. Yang PC, Davis S. Incidence of cancer of the esophagus in the US by histologic type. Cancer 1988; 61: 612–7.
    Google Scholar
  4. Hesketh PJ, Clapp RW, Doos WG, Spechler SJ. The increasing frequency adenocarcinoma of the esophagus. Cancer 1989; 64: 526–30.
    Google Scholar
  5. Harvey JC, Kagan R, Ahn C, Frankl H, Davidson W. Adenocarcinoma of the esophagus: a survival study. J Surg Oncol 1990; 45: 29–32.
    Google Scholar
  6. Powell J, McConkey CC. Increasing incidence of adenocarcinoma of the gastric cardia and adjacent sites. Br J Cancer 1990; 62: 440–3.
    Google Scholar
  7. Moller H, Jensen OM. Trends in incidence of esophagus, cardia, and stomach cancer in Denmark, 1943–1982. In: The Sixth Annual ECP Symposium, International Symposium on Gastric Carcinogenesis, 6th ed. London, 1988.
  8. MacDonald WC. Clinical and pathologic features of adenocarcinoma of the gastric cardia. Cancer 1972; 29: 724–32.
    Google Scholar
  9. MacDonald WC, MacDonald JB. Adenocarcinoma of the esophagus and/or gastric cardia. Cancer 1987; 60: 1094–8.
    Google Scholar
  10. Wang HH, Antonioli DA, Goldman H. Comparative features of esophageal and gastric adenocarcinomas: Recent changes in type and frequency. Hum Path 1986; 17: 482–7.
    Google Scholar
  11. Yang PC, Davis S. Epidemiological characteristics of adenocarcinoma of the gastric cardia and distal stomach in the United States, 1973–1982. Int J Epidemiol 1988; 17: 293–7.
    Google Scholar
  12. Levi F, Ollyo JB, La Vecchia C, Boyle P, Monnier P, Savary M. The consumption of tobacco, alcohol and the risk of adenocarcinoma in Barrett's oesophagus. Int J Cancer 1990; 45: 852–4.
    Google Scholar
  13. Li JY, Ershow AG, Chen ZJ, et al. A case-control study of cancer of the esophagus and gastric cardia in Linxian. Int J Cancer 1989; 43: 755–61.
    Google Scholar
  14. Wu-Williams AH, Yu MC, Mack TM. Life-style, work-place, and stomach cancer by subsite in young men of Los Angeles County. Cancer Res 1990; 50: 2569–76.
    Google Scholar
  15. Palli D, Bianchi S, Decarli A, et al. A case-control study of cancers of the gastric cardia in Italy. Br J Cancer 1992; 65: 263–6.
    Google Scholar
  16. Unakami M, Hara M, Fukuchi S, et al. Cancer of the gastric cardia and the habit of smoking. Acta Pathol Japonica 1989; 39: 420–4.
    Google Scholar
  17. Kabat GC, Wynder EL. Body mass index and lung cancer risk. Am J Epidemiol 1992; 135: 769–74.
    Google Scholar
  18. World Health Organization. International Classification of Diseases, Ninth Revision. Geneva: WHO, 1977.
    Google Scholar
  19. Hebert JR, Kabat GC. Differences in dietary intake associated with smoking status. Eur J Clin Nutr 1990; 44: 185–93.
    Google Scholar
  20. United States Department of Agriculture. Composition of Foods, Handbook No. 8. Washington, DC: US Government Printing Office, 1976.
    Google Scholar
  21. Anderson JW, Chen WL, Sieling B. Plant Fiber in Foods. Lexington, KY: HCF Diabetes Research Foundation, Inc., 1980.
    Google Scholar
  22. SAS Institute Inc. SAS/STAT User's Guide, Version 6, 4th ed., Cary, NC: SAS Institute Inc., 1990.
    Google Scholar
  23. Pottern LM, Morris LE, Blot WJ, Ziegler RG, Fraumeni JF. Esophageal cancer among Black men in Washington DC. I. Alcohol, tobacco, and other risk factors. JNCI 1981; 67: 777–83.
    Google Scholar
  24. Day NE, Munoz N. Esophagus. In: Schottenfeld D, Fraumeni JF, eds. Cancer Epidemiology and Prevention. Philadelphia, PA: WB Saunders, 1982: 596–623.
    Google Scholar
  25. Skinner DB, Walther BC, Riddell RH, Schmidt H, Iascone C, DeMeester TR: Barrett's esophagus: Comparison of benign and malignant cases. Ann Surg 1983; 198: 554–65.
    Google Scholar
  26. Gray JR, Coldman J, MacDonald WC, Cigarette and alcohol use in patients with adenocarcinoma of the gastric cardia or lower esophagus. Cancer 1992; 69: 2227–31.
    Google Scholar
  27. Nomura A, Grove JS, Stemmermann GN, Severson RK. A prospective study of stomach cancer and its relation to diet, cigarettes, and alcohol consumption. Cancer Res 1990; 50: 627–31.
    Google Scholar
  28. Saha SK. Smoking habits and carcinoma of the stomach: a case-control study. Jpn J Cancer Res 1991; 82: 497–502.
    Google Scholar
  29. Boeing H. Epidemiological research in stomach cancer: Progress over the last ten years. J Cancer Res Clin Oncol 1991; 117: 133–43.
    Google Scholar
  30. Hoshiyama Y, Sasaba T. A case-control study of stomach cancer and its relation to diet, cigarettes, and alcohol consumption in Saitama Prefecture, Japan, Cancer Causes Control 1992; 3: 441–8.
    Google Scholar
  31. Wynder El, Bross IJ. A study of etiological factors in cancers of the esophagus. Cancer 1961; 14: 389–413.
    Google Scholar
  32. Cook-Mozaffari PJ, Azordegan F, Day NE, et al. Oesophageal cancer studies in the Caspian littoral of Iran: results of a case-control study. Br J Cancer 1979; 39: 293–309.
    Google Scholar
  33. Hirayama T. An epidemiological study of cancer of the oesophagus in Japan, with special reference to the combined effect of selected environmental factors. In: Monograph No. 1, Int. Seminar on Epidemiology of Oesophageal Cancer. Bangalore, India, 4 November 1971: 45–60.
  34. Graham S, Marshall J, Haughey B, et al. Nutritional epidemiology of cancer of the esophagus. Am J Epidemiol 1990; 131: 454–67.
    Google Scholar
  35. Tuyns AJ, Riboli E, Doornbos G, Pequignot G. Diet and esophageal cancer in Calvados (France). Nutr Cancer 1987; 9: 81–92.
    Google Scholar
  36. DeCarli A, Liati P, Negri E, Franceschi S, La Vecchia C. Vitamin A and other dietary factors in the etiology of esophageal cancer. Nutr Cancer 1987; 10: 29–37.
    Google Scholar

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Authors

  1. Geoffrey C. Kabat
  2. Stephen K. C. Ng
  3. Ernst L. Wynder

Additional information

Dr Kabat is in the Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA. At the time of this work be was with the Division of Epidemiology, American Health Foundation, New York, NY. Drs Ng and Wynder are with the Division of Epidemiology, American Health Foundation. Address correspondence to Dr Kabat, Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, Belfer Bldg, Rm 1302, 1300 Morris Park Avenue, Bronx, NY 10461, USA. Supported by National Cancer Institute Program Project grant CA32617 and Center grant CA17613.

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Kabat, G.C., Ng, S.K.C. & Wynder, E.L. Tobacco, alcohol intake, and diet in relation to adenocarcinoma of the esophagus and gastric cardia.Cancer Causes Control 4, 123–132 (1993). https://doi.org/10.1007/BF00053153

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