title: Cigarette smoking and adenocarcinomas of the esophagus and esophagogastric junction: a pooled analysis from the international BEACON consortium.
abstract: BACKGROUND
  Previous studies that showed an association between smoking and adenocarcinomas of the esophagus and esophagogastric junction were limited in their ability to assess differences by tumor site, sex, dose-response, and duration of cigarette smoking cessation.
  
  
  METHODS
  We used primary data from 10 population-based case-control studies and two cohort studies from the Barrett's Esophagus and Esophageal Adenocarcinoma Consortium. Analyses were restricted to white non-Hispanic men and women. Patients were classified as having esophageal adenocarcinoma (n = 1540), esophagogastric junctional adenocarcinoma (n = 1450), or a combination of both (all adenocarcinoma; n = 2990). Control subjects (n = 9453) were population based. Associations between pack-years of cigarette smoking and risks of adenocarcinomas were assessed, as well as their potential modification by sex and duration of smoking cessation. Study-specific odds ratios (ORs) estimated using multivariable logistic regression models, adjusted for age, sex, body mass index, education, and gastroesophageal reflux, were pooled using a meta-analytic methodology to generate summary odds ratios. All statistical tests were two-sided.
  
  
  RESULTS
  The summary odds ratios demonstrated strong associations between cigarette smoking and esophageal adenocarcinoma (OR = 1.96, 95% confidence interval [CI] = 1.64 to 2.34), esophagogastric junctional adenocarcinoma (OR = 2.18, 95% CI = 1.84 to 2.58), and all adenocarcinoma (OR = 2.08, 95% CI = 1.83 to 2.37). In addition, there was a strong dose-response association between pack-years of cigarette smoking and each outcome (P < .001). Compared with current smokers, longer smoking cessation was associated with a decreased risk of all adenocarcinoma after adjusting for pack-years (<10 years of smoking cessation: OR = 0.82, 95% CI = 0.60 to 1.13; and > or =10 years of smoking cessation: OR = 0.71, 95% CI = 0.56 to 0.89). Sex-specific summary odds ratios were similar.
  
  
  CONCLUSIONS
  Cigarette smoking is associated with increased risks of adenocarcinomas of the esophagus and esophagogastric junction in white men and women; compared with current smoking, smoking cessation was associated with reduced risks.
authors: Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health/DHHS, 6120 Executive Blvd., Bethesda, MD 20852-7234, USA. michael.cook@nih.gov
authors: Michael B
authors: MB
authors: Cook
authors: Farin
authors: F
authors: Kamangar
authors: David C
authors: DC
authors: Whiteman
authors: Neal D
authors: ND
authors: Freedman
authors: Marilie D
authors: MD
authors: Gammon
authors: Leslie
authors: L
authors: Bernstein
authors: Linda M
authors: LM
authors: Brown
authors: Harvey A
authors: HA
authors: Risch
authors: Weimin
authors: W
authors: Ye
authors: Linda
authors: L
authors: Sharp
authors: Nirmala
authors: N
authors: Pandeya
authors: Penelope M
authors: PM
authors: Webb
authors: Anna H
authors: AH
authors: Wu
authors: Mary H
authors: MH
authors: Ward
authors: Carol
authors: C
authors: Giffen
authors: Alan G
authors: AG
authors: Casson
authors: Christian C
authors: CC
authors: Abnet
authors: Liam J
authors: LJ
authors: Murray
authors: Douglas A
authors: DA
authors: Corley
authors: Olof
authors: O
authors: Nyrén
authors: Thomas L
authors: TL
authors: Vaughan
authors: Wong-Ho
authors: WH
authors: Chow
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000209:etiology*; D004305:Dose-Response Relationship, Drug; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000209:etiology*; D004943:Esophagogastric Junction; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D012107:Research Design; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D016540:Smoking Cessation; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000209:etiology*; D013997:Time Factors