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: Michael B Cook, Farin Kamangar, David C Whiteman, Neal D Freedman, Marilie D Gammon, Leslie Bernstein, Linda M Brown, Harvey A Risch, Weimin Ye, Linda Sharp, Nirmala Pandeya, Penelope M Webb, Anna H Wu, Mary H Ward, Carol Giffen, Alan G Casson, Christian C Abnet, Liam J Murray, Douglas A Corley, Olof Nyrén, Thomas L Vaughan, Wong-Ho Chow
• Journal: Journal of the National Cancer Institute (J Natl Cancer Inst) Vol. 102 Issue 17 Pg. 1344-53 (Sep 08 2010) ISSN: 1460-2105 [Electronic] United States
• PMID: 20716718 (Publication Type: Journal Article, Meta-Analysis, Research Support, N.I.H., Extramural, Research Support, N.I.H., Intramural, Research Support, Non-U.S. Gov't)

Topics

• Adenocarcinoma (epidemiology, etiology)
• Dose-Response Relationship, Drug
• Esophageal Neoplasms (epidemiology, etiology)
• Esophagogastric Junction
• Female
• Humans
• Incidence
• Male
• Research Design
• Risk Factors
• Smoking (adverse effects)
• Smoking Cessation
• Stomach Neoplasms (epidemiology, etiology)
• Time Factors