Independent and combined effects of alcohol intake, tobacco smoking and betel quid chewing on the risk of esophageal cancer in Taiwan
Journal
International Journal of Cancer
Journal Volume
113
Journal Issue
3
Pages
475-482
Date Issued
2005
Author(s)
Abstract
A multicenter case-control study was conducted in northern and southern Taiwan to clarify the independent and combined effects of alcohol intake, tobacco smoking and betel quid chewing on the risk of esophageal cancer. A total of 513 patients with newly diagnosed and histopathologically confirmed squamous cell carcinoma of the esophagus and 818 gender, age and study hospital-matched controls were included. We found a significant dose-response relationship between the duration and intensity of consumption of the 3 substances and the development of this neoplasm in this site. Although the amount of alcohol consumed had a stronger effect on the risk of esophageal cancer than the number of years it was consumed, however, the number of years one smoked had a stronger effect on the risk than the amount of cigarettes consumed. The strongest risk factor of esophageal cancer was alcohol intake, with highest risk (OR = 13.9) being for those who consumed more than 900 g/day-year. Combined exposure to any 2 of 3 substances brought the risks up to 8.8-19.7 fold and, to all 3 substances, to 41.2-fold. A multiplicative interaction effect for alcohol drinkers who smoked on cancer risk was detected, whereas an additive interaction effect was found among drinkers who chewed. The combined effect of all 3 substances accounted for 83.7% of the attributable fraction of contracting esophageal cancer in this population. In conclusion, these results suggest that the intensity and the length of time alcohol and tobacco are used play different roles in the etiology of esophageal cancer. Alcohol separately interacts with tobacco and betel quid in a differently synergistic way in determining the development of this site of cancer.
SDGs
Other Subjects
adult; aged; alcohol consumption; article; betel nut; cancer localization; cancer risk; cigarette smoking; controlled study; dose response; drinking behavior; esophagus cancer; female; gender; human; major clinical study; male; priority journal; risk factor; squamous cell carcinoma; Adult; Aged; Alcohol Drinking; Areca; Carcinoma, Squamous Cell; Case-Control Studies; Cocarcinogenesis; Drug Combinations; Drug Synergism; Esophageal Neoplasms; Esophagus; Female; Humans; Incidence; Male; Middle Aged; Risk Factors; Taiwan; Tobacco
Type
journal article