title: Esophageal cancer risk by type of alcohol drinking and smoking: a case-control study in Spain.
abstract: BACKGROUND
  The effect of tobacco smoking and alcohol drinking on esophageal cancer (EC) has never been explored in Spain where black tobacco and wine consumptions are quite prevalent. We estimated the independent effect of different alcoholic beverages and type of tobacco smoking on the risk of EC and its main histological cell type (squamous cell carcinoma) in a hospital-based case-control study in a Mediterranean area of Spain.
  
  
  METHODS
  We only included incident cases with histologically confirmed EC (n = 202). Controls were frequency-matched to cases by age, sex and province (n = 455). Information on risk factors was elicited by trained interviewers using structured questionnaires. Multiple logistic regression was used to estimate adjusted odds ratios and 95% confidence intervals (CI).
  
  
  RESULTS
  Alcohol drinking and tobacco smoking were strong and independent risk factors for esophageal cancer. Alcohol was a potent risk factor with a clear dose-response relationship, particularly for esophageal squamous-cell cancer. Compared to never-drinkers, the risk for heaviest drinkers (> or = 75 g/day of pure ethanol) was 7.65 (95%CI, 3.16-18.49); and compared with never-smokers, the risk for heaviest smokers (> or = 30 cigarettes/day) was 5.07 (95%CI, 2.06-12.47). A low consumption of only wine and/or beer (1-24 g/d) did not increase the risk whereas a strong positive trend was observed for all types of alcoholic beverages that included any combination of hard liquors with beer and/or wine (p-trend<0.00001). A significant increase in EC risk was only observed for black-tobacco smoking (2.5-fold increase), not for blond tobacco. The effects for alcohol drinking were much stronger when the analysis was limited to the esophageal squamous cell carcinoma (n = 160), whereas a lack of effect for adenocarcinoma was evidenced. Smoking cessation showed a beneficial effect within ten years whereas drinking cessation did not.
  
  
  CONCLUSIONS
  Our study shows that the risk of EC, and particularly the squamous cell type, is strongly associated with alcohol drinking. The consumption of any combination of hard liquors seems to be harmful whereas a low consumption of only wine may not. This may relates to the presence of certain antioxidant compounds found in wine but practically lacking in liquors. Tobacco smoking is also a clear risk factor, black more than blond.
authors.affiliation: Departamento Salud Pública, Universidad Miguel Hernández, Elche-Alicante, Spain. vioque@umh.es
authors.forename: Jesus
authors.initials: J
authors.lastname: Vioque
authors.forename: Xavier
authors.initials: X
authors.lastname: Barber
authors.forename: Francisco
authors.initials: F
authors.lastname: Bolumar
authors.forename: Miquel
authors.initials: M
authors.lastname: Porta
authors.forename: Miguel
authors.initials: M
authors.lastname: Santibáñez
authors.forename: Manuela García
authors.initials: MG
authors.lastname: de la Hera
authors.forename: Eduardo
authors.initials: E
authors.lastname: Moreno-Osset
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology*; D016022:Case-Control Studies; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012306:Risk; D012307:Risk Factors; D012907:Smoking; D013030:Spain