Association of smoking, alcohol drinking and dietary factors with esophageal cancer in high- and low-risk areas of Jiangsu Province, China.
OBJECTIVE
To study the main environmental and lifestyle factors that account for the regional differences in esophageal cancer (EC) risk in low- and high-risk areas of Jiangsu Province, China.


METHODS
Since 2003, a population-based case-control study has been conducted simultaneously in low-risk (Ganyu County) and high-risk (Dafeng County) areas of Jiangsu Province, China. Using identical protocols and pre-tested standardized questionnaire, following written informed consent, eligible subjects were inquired about their detail information on potential determinants of EC, including demographic information, socio-economic status, living conditions, disease history, family cancer history, smoking, alcohol drinking, dietary habits, frequency, amount of food intake, etc. Conditional logistic regression with maximum likelihood estimation was used to obtain Odds ratio (OR) and 95 % confidence interval (95% CI), after adjustment for potential confounders.


RESULTS
In the preliminary analysis of the ongoing study, we recruited 291 pairs of cases and controls in Dafeng and 240 pairs of cases and controls in Ganyu, respectively. In both low-risk and high-risk areas, EC was inversely associated with socio-economic status, such as level of education, past economic status and body mass index. However, this disease was more frequent among those who had a family history of cancer or encountered misfortune in the past 10 years. EC was also more frequent among smokers, alcohol drinkers and fast eaters. Furthermore, there was a geographic variation of the associations between smoking, alcohol drinking and EC risk despite the similar prevalence of these risk factors in both low-risk and high-risk areas. The dose-response relationship of smoking and smoking related variables, such as age of the first smoking, duration and amount were apparent only in high-risk areas. On the contrary, a dose-response relationship on the effect of alcohol drinking on EC was observed only in low-risk areas.


CONCLUSIONS
The environmental risk factors, together with genetic factors and gene-environmental interactions might be the main reason for this high-risk gradient in Jiangsu Province, China.
Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, Jiangsu Province, China.
Ming
M
Wu
Jin-Kou
JK
Zhao
Xiao-Shu
XS
Hu
Pei-Hua
PH
Wang
Yu
Y
Qin
Yin-Chang
YC
Lu
Jie
J
Yang
Ai-Min
AM
Liu
De-Lin
DL
Wu
Zuo-Feng
ZF
Zhang
Kok-J
KJ
Frans
Pieter
P
van 't Veer
D000368:Aged; D000428:Alcohol Drinking; D015992:Body Mass Index; D016022:Case-Control Studies; D002681:China / Q000453:epidemiology; D004777:Environment; D004938:Esophageal Neoplasms / Q000453:epidemiology*; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D015994:Incidence; D008019:Life Style; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012044:Regression Analysis; D012307:Risk Factors; D012907:Smoking; D012959:Socioeconomic Factors