Fruit and vegetable consumption in the prevention of oesophageal and cardia cancers.
The incidence of adenocarcinoma of the oesophagus has increased rapidly in recent decades. In order to appreciate the potential for prevention by means of dietary modification, we estimated the aetiological fractions and the increments in absolute risk attributable to low intake of fruit and vegetables for adenocarcinoma and squamous cell carcinoma of the oesophagus and for adenocarcinoma of the gastroesophageal junction. We conducted a nationwide population-based case-control study in Sweden, with participation of 608 cases and 815 controls. We used unconditional logistic regression to estimate relative risks, from which we calculated aetiological fractions. Individuals in the highest exposure quartile (median 4.8 servings/day) versus the lowest (median 1.5 servings/day) showed approximately 50% lower risk of oesophageal adenocarcinoma and 40% lower risk of oesophageal squamous cell carcinoma, but no risk reduction for gastric cardia adenocarcinoma. Approximately 20% of oesophageal adenocarcinoma, and likewise squamous cell carcinoma, in Sweden was attributed to consuming less than three servings of fruit and vegetables per day. A very large number of individuals (over 25,000) would need to increase their fruit and vegetable consumption moderately in order to prevent one oesophageal cancer per year. Moderate relative risk reductions translate into weak absolute risk reductions for oesophageal cancers in Sweden.
Terry
P
P
Department of Medical Epidemiology, Karolinska Institutet, Box 281, 171 77 Stockholm, Sweden. paul.terry@mep.ki.se
Lagergren
J
J
Hansen
H
H
Wolk
A
A
Nyrén
O
O
D000230:Adenocarcinoma / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D002299:Cardia / Q000473:pathology*; D016022:Case-Control Studies; D004032:Diet; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D005638:Fruit; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D013548:Sweden / Q000453:epidemiology; D014675:Vegetables