title: Facial flushing response to alcohol and the risk of esophageal squamous cell carcinoma: A comprehensive systematic review and meta-analysis.
abstract: OBJECTIVE
  The alcohol flushing response is common among ethnic East Asian populations, and has been associated with an increased risk in developing esophageal cancer, especially squamous cell esophageal cancer (ESCC). We aimed to quantify the relationship between the facial flushing response to alcohol consumption and ESCC.
  
  
  METHODS
  We conducted a meta-analysis of studies reporting on the association between the facial flushing response to alcohol consumption and ESCC. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated using a random effects model for the risk of ESCC associated with the facial flushing response in general, as well for different levels of alcohol consumption. Four databases, Medline, PubMed, Embase, and Current Contents Connect, were searched to 31 August 2015.
  
  
  RESULTS
  Seven studies, with 1014 ESCC cases, met the inclusion criteria. There was a positive relationship between the flushing response and ESCC (OR 1.97; 95% CI 1.25-3.13). Heterogeneity was observed (I(2)= 80%, P<0.001). Publication bias was not present. An increased risk of ESCC was present in the moderate and heavy drinkers who experienced flushing, compared with moderate and heavy drinkers who did not (OR 2.54; 95% CI 1.64-3.91, and OR 2.90; 95% CI 1.82-4.82, respectively).
  
  
  CONCLUSIONS
  Individuals who experience a facial flushing response to alcohol intake may be at increased risk of developing ESCC, particularly if they are moderate to heavy drinkers.
authors.affiliation: The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Level 5, South Block, Penrith, NSW 2751, Australia.
authors.forename: Juliana
authors.initials: J
authors.lastname: Andrici
authors.affiliation: The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Level 5, South Block, Penrith, NSW 2751, Australia.
authors.forename: Sharon X H
authors.initials: SX
authors.lastname: Hu
authors.affiliation: The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Level 5, South Block, Penrith, NSW 2751, Australia. Electronic address: eslickg@med.usyd.edu.au.
authors.forename: Guy D
authors.initials: GD
authors.lastname: Eslick
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects*; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology*; D004938:Esophageal Neoplasms / Q000453:epidemiology*; D000077277:Esophageal Squamous Cell Carcinoma; D005483:Flushing / Q000139:chemically induced*; D006801:Humans; D008297:Male; D016017:Odds Ratio; D012307:Risk Factors
keywords: Alcohol; Esophageal cancer; Facial flushing; Meta-analysis