title: Male predominance of upper gastrointestinal adenocarcinoma cannot be explained by differences in tobacco smoking in men versus women.
abstract: BACKGROUND
  Adenocarcinomas of the upper gastrointestinal tract (UGI) show remarkable male predominance. As smoking is a well-established risk factor, we investigated the role of tobacco smoking in the male predominance of UGI adenocarcinomas in the United States NIH-AARP Diet and Health Study.
  
  
  METHODS
  A questionnaire was completed by 281,422 men and 186,133 women in 1995-1996 who were followed until 31st December 2003. Incident UGI adenocarcinomas were identified by linkage to state cancer registries. We present age-standardised cancer incidence rates per 100,000-person years and male/female ratios (M/F) calculated from age-adjusted Cox proportional hazards models, both with 95% confidence intervals (CI).
  
  
  RESULTS
  After 2013,142-person years follow-up, 338 adenocarcinomas of the oesophagus, 261 of gastric cardia and 222 of gastric non-cardia occurred in men. In women, 23 tumours of oesophagus, 36 of gastric cardia and 88 of gastric non-cardia occurred in 1351,958-person years follow-up. The age-standardised incidence rate of all adenocarcinoma sites was 40.5 (37.8-43.3) and 11.0 (9.2-12.8) in men and women, respectively. Among smokers, the M/F of all UGI adenocarcinomas was 3.4 (2.7-4.1), with a M/F of 7.3 (4.6-11.7) for tumours in oesophagus, 3.7 (2.5-5.4) for gastric cardia and 1.7 (1.2-2.3) for gastric non-cardia. In non-smokers, M/F ratios were 14.2 (5.1-39.5) for oesophagus, 6.1 (2.6-14.7) for gastric cardia and 1.3 (0.8-2.0) for gastric non-cardia. The overall M/F ratio was 3.0 (2.2-4.3).
  
  
  CONCLUSIONS
  The male predominance was similar in smokers and non-smokers for these cancer sites. These results suggest that the male predominance of upper GI adenocarcinomas cannot be explained by differences in smoking histories.
authors.affiliation: Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Rockville, MD, USA.
authors.forename: N D
authors.initials: ND
authors.lastname: Freedman
authors.forename: M H
authors.initials: MH
authors.lastname: Derakhshan
authors.forename: C C
authors.initials: CC
authors.lastname: Abnet
authors.forename: A
authors.initials: A
authors.lastname: Schatzkin
authors.forename: A R
authors.initials: AR
authors.lastname: Hollenbeck
authors.forename: K E L
authors.initials: KE
authors.lastname: McColl
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology*; D017677:Age Distribution; D000368:Aged; D002299:Cardia; D004938:Esophageal Neoplasms / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology*; D013274:Stomach Neoplasms / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology