Epidemiology

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Independent and combined effects of alcohol intake, tobacco smoking and betel quid chewing on the risk of esophageal cancer in Taiwan

  1. Chien-Hung Lee1,
  2. Jang-Ming Lee2,
  3. Deng-Chyang Wu3,
  4. Hon-Ki Hsu4,
  5. Ein-Long Kao5,
  6. Hsiao-Ling Huang6,
  7. Tsu-Nai Wang1,
  8. Meng-Chuan Huang7,
  9. Ming-Tsang Wu8,†,*

Article first published online: 28 SEP 2004

DOI: 10.1002/ijc.20619

Issue

International Journal of Cancer

International Journal of Cancer

Volume 113, Issue 3, pages 475–482, 20 January 2005

Additional Information

How to Cite

Lee, C.-H., Lee, J.-M., Wu, D.-C., Hsu, H.-K., Kao, E.-L., Huang, H.-L., Wang, T.-N., Huang, M.-C. and Wu, M.-T. (2005), Independent and combined effects of alcohol intake, tobacco smoking and betel quid chewing on the risk of esophageal cancer in Taiwan. Int. J. Cancer, 113: 475–482. doi: 10.1002/ijc.20619

Author Information

  1. 1

    Graduate Institute of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan

  2. 2

    Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan

  3. 3

    Department of Gastroentology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

  4. 4

    Department of Chest Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan

  5. 5

    Department of Chest Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

  6. 6

    Department of Community Health Science, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA

  7. 7

    Department of Public Health, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

  8. 8

    Graduate Institute of Occupational Safety and Health and Department of Occupational Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

  1. †

    Fax: +011886-7-3221806

*Graduate Institute of Occupational Health and Safety, Kaohsiung Medical University, No. 100 Shih-Chuan 1st Road, Kaohsiung, Taiwan

Publication History

  1. Issue published online: 18 NOV 2004
  2. Article first published online: 28 SEP 2004
  3. Manuscript Accepted: 13 JUL 2004
  4. Manuscript Received: 29 APR 2004

Funded by

  • Taiwan National Science Council. Grant Numbers: NSC 90-2320-B-037-040, NSC 90-2320-B-037-052
  • Taiwan National Health Research Institute. Grant Number: NHRI-CN-IN-9007P
  • Faculty Research Innovation Fund of Kaohsiung Medical University

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Keywords:

  • esophageal neoplasms;
  • alcohol drinking;
  • smoking;
  • areca;
  • risk factors

Abstract

A multicenter case-control study was conducted in northern and southern Taiwan to clarify the independent and combined effects of alcohol intake, tobacco smoking and betel quid chewing on the risk of esophageal cancer. A total of 513 patients with newly diagnosed and histopathologically confirmed squamous cell carcinoma of the esophagus and 818 gender, age and study hospital-matched controls were included. We found a significant dose-response relationship between the duration and intensity of consumption of the 3 substances and the development of this neoplasm in this site. Although the amount of alcohol consumed had a stronger effect on the risk of esophageal cancer than the number of years it was consumed, however, the number of years one smoked had a stronger effect on the risk than the amount of cigarettes consumed. The strongest risk factor of esophageal cancer was alcohol intake, with highest risk (OR = 13.9) being for those who consumed more than 900 g/day-year. Combined exposure to any 2 of 3 substances brought the risks up to 8.8–19.7 fold and, to all 3 substances, to 41.2-fold. A multiplicative interaction effect for alcohol drinkers who smoked on cancer risk was detected, whereas an additive interaction effect was found among drinkers who chewed. The combined effect of all 3 substances accounted for 83.7% of the attributable fraction of contracting esophageal cancer in this population. In conclusion, these results suggest that the intensity and the length of time alcohol and tobacco are used play different roles in the etiology of esophageal cancer. Alcohol separately interacts with tobacco and betel quid in a differently synergistic way in determining the development of this site of cancer.

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