Alcohol consumption and the risks of adenocarcinoma and squamous cell carcinoma of the esophagus.
OBJECTIVE
Alcohol has been declared a carcinogen for cancers of the esophagus, although the evidence relates largely to the squamous subtype. Evidence for an effect on adenocarcinomas is scant and inconsistent.


METHODS
We compared nationwide samples of patients with esophageal adenocarcinoma (EAC) (n=365) or esophagogastric junction adenocarcinoma (EGJAC) (n=426) or esophageal squamous cell carcinoma (ESCC) (n=303) with controls sampled from a population register (n=1580). We used generalized additive models to assess nonlinear effects of self-reported alcohol intake on cancer risk, and calculated odds ratios (ORs) and 95% confidence intervals (CIs) using multivariate logistic and piecewise regression.


RESULTS
We observed no association between average weekly alcohol intake and EAC or EGJAC risk. For ESCC, the relationship with alcohol was nonlinear. At intakes of less than 170 g/wk there was no significant association; at greater than this level, there was a significant linear effect (OR, 1.03; 95% CI, 1.02-1.05 per 10 g alcohol/wk). For ESCC, but not EAC or EGJAC, a statistically significant multiplicative interaction between smoking and alcohol was observed (P=.02). In analyses by beverage type, ESCC risks, but not EAC or EGJAC, increased linearly with beer intake (OR, 1.05; 95% CI, 1.04-1.07). Those who drank modest levels of wine (<50-90 g/wk) or port or spirits (<10-20 g/wk) had significantly lower risks of all 3 cancers than nondrinkers; higher intakes were associated with increased risks of ESCC only.


CONCLUSIONS
Alcohol intake above the recommended US dietary guidelines significantly increases the risk of ESCC, but not EAC or EGJAC. Smoking modifies the effect of alcohol intake on ESCC risk.
Pandeya
Nirmala
N
Queensland Institute of Medical Research, Brisbane, Australia; School of Population Health, The University of Queensland, Brisbane, Australia. Nirmala.Pandeya@qimr.edu.au
Williams
Gail
G
Green
Adèle C
AC
Webb
Penelope M
PM
Whiteman
David C
DC
D000230:Adenocarcinoma / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects*; D001315:Australia / Q000453:epidemiology; D001515:Beer / Q000009:adverse effects; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology*; D016022:Case-Control Studies; D004938:Esophageal Neoplasms / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012044:Regression Analysis; D012307:Risk Factors; D014920:Wine / Q000009:adverse effects; D055815:Young Adult