title: Areca users in combination with tobacco and alcohol use are associated with younger age of diagnosed esophageal cancer in Taiwanese men.
abstract: BACKGROUND
  Whether the habitual use of substances (tobacco, alcohol, or areca nut (seed of the Areca palm)) can affect the age of esophageal squamous cell carcinoma (ESCC) presentation has rarely been examined.
  
  
  METHODS
  The study subjects were those who were males and the first time to be diagnosed as ESCC (ICD-9 150) and who visited any of three medical centers in Taiwan between 2000 and 2009. A standardized questionnaire was used to collect substance uses and other variables.
  
  
  RESULTS
  Mean age (±SD) at presentation of ESCC was 59.2 (±11.3) years in a total of 668 cases. After adjusting for other covariates, alcohol drinkers were 3.58 years younger to have ESCC than non-drinkers (p = 0.002). A similar result was found among areca chewers, who were 6.34 years younger to have ESCC than non-chewers (p<0.0001), but not among cigarette smokers (p = 0.10). When compared to the group using 0-1 substances, subjects using both cigarettes and alcohol were nearly 3 years younger to contract ESCC. Furthermore, those who use areca plus another substance were 7-8 years younger. Subjects using all three substances had the greatest age difference, 9.20 years younger (p<0.0001), compared to the comparison group.
  
  
  CONCLUSIONS
  Our findings suggest that habitually consuming tobacco, alcohol, and areca nut can influence the age-onset of ESCC. Since the development of ESCC is insidious and life-threatening, our observation is worthy to be reconfirmed in the large-scale and long-term follow-up prospective cohort studies to recommend the screening strategy of this disease.
authors: Graduate Institute of Occupational Safety and Health, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors: Ming-Yen
authors: MY
authors: Lin
authors: Mei-Chin
authors: MC
authors: Chen
authors: I-Chen
authors: IC
authors: Wu
authors: Deng-Chyang
authors: DC
authors: Wu
authors: Yu-Jen
authors: YJ
authors: Cheng
authors: Chun-Chieh
authors: CC
authors: Wu
authors: Chee-Yin
authors: CY
authors: Chai
authors: Jang-Ming
authors: JM
authors: Lee
authors: Ming-Tsang
authors: MT
authors: Wu
mesh_terms: D000367:Age Factors; D000428:Alcohol Drinking / Q000009:adverse effects*; D001114:Areca / Q000009:adverse effects*; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000209:etiology*; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D062789:Tobacco Products