title: Tobacco smoking increases the risk of high-grade dysplasia and cancer among patients with Barrett's esophagus.
abstract: OBJECTIVE
  Esophageal adenocarcinoma arises from Barrett's esophagus (BE); patients with this cancer have a poor prognosis. Identification of modifiable lifestyle factors that affect the risk of progression from BE to esophageal adenocarcinoma might prevent its development. We investigated associations among body size, smoking, and alcohol use with progression of BE to neoplasia.
  
  
  METHODS
  We analyzed data from patients with BE identified from the population-based Northern Ireland BE register, diagnosed between 1993 and 2005 with specialized intestinal metaplasia (n = 3167). Data on clinical, demographic, and lifestyle factors related to diagnosis of BE were collected from hospital case notes. We used the Northern Ireland Cancer Registry to identify which of these patients later developed esophageal adenocarcinoma, adenocarcinomas of the gastric cardia, or esophageal high-grade dysplasia. Cox proportional hazards models were used to associate lifestyle factors with risk of progression.
  
  
  RESULTS
  By December 31, 2008, 117 of the patients with BE developed esophageal high-grade dysplasia or adenocarcinomas of the esophagus or gastric cardia. Current tobacco smoking was significantly associated with an increased risk of progression (hazard ratio = 2.03; 95% confidence interval, 1.29-3.17) compared with never smoking, and across all strata of smoking intensity. Alcohol consumption was not related to risk of progression. Measures of body size were infrequently reported in endoscopy reports, and body size was not associated with risk of progression.
  
  
  CONCLUSIONS
  Smoking tobacco increases the risk of progression to cancer or high-grade dysplasia 2-fold among patients with BE, compared with patients with BE that have never smoked. Smoking cessation strategies should be considered for patients with BE.
authors: Cancer Epidemiology and Health Services Research Group, Centre for Public Health, Queen's University Belfast, Northern Ireland, UK. h.mulholland@qub.ac.uk
authors: Helen G
authors: HG
authors: Coleman
authors: Shivaram
authors: S
authors: Bhat
authors: Brian T
authors: BT
authors: Johnston
authors: Damian
authors: D
authors: McManus
authors: Anna T
authors: AT
authors: Gavin
authors: Liam J
authors: LJ
authors: Murray
mesh_terms: D000230:Adenocarcinoma / Q000209:etiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000150:complications* / Q000473:pathology; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D055815:Young Adult