In the Journals

Combined alcohol, tobacco use increased esophageal cancer risk

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June 13, 2014

Individuals who used alcohol and tobacco in combination exhibited an approximately threefold risk of developing esophageal squamous cell carcinoma vs. those who only smoked or drank, according to recent findings.

previous studies have identified risk factors for the development of esophageal squamous cell carcinoma, in particular exposure to alcohol and tobacco, Anoop Prabhu, MD, from the Icahn School of Medicine at Mount Sinai Medical Center, and colleagues chose to examine the interaction between alcohol and tobacco in the risk esophageal cancer.

Researchers queried multiple electronic databases for eligible studies, which included population-based, case-control or cohort studies of esophageal squamous cell carcinoma that evaluated the effects of tobacco and/or alcohol.

The investigators utilized the synergy factor to quantify deviations from multiplicative effects, with synergy factor >1 defining a positive synergistic relationship. The researchers conducted meta-analyses to ascertain summary-adjusted , and random-effects models were used to determine the summary crude synergy factor.

In addition, Cochran’s Q test was used to evaluate the heterogeneity of the studies. The review identified 7,629 citations, of which five met eligibility criteria.

According to study results, the use of tobacco or alcohol was related to a 2030% increased risk for esophageal squamous cell carcinoma vs. nonuse.

“Our systematic review confirmed the expected exposure-dependent relationship of both alcohol and tobacco with the risk of [esophageal squamous cell carcinoma], as alcohol use and tobacco use were both independent risk factors for the development of [esophageal squamous cell carcinoma],” Prabhu said in a press release.

However, the use of both was linked to a roughly threefold risk esophageal squamous cell carcinoma; the summary adjusted OR for combined use was 3.28 (95% CI 2.1108; Cochran’s Q P value=.05). For those who had ever used tobacco and alcohol, there was a summary synergy factor of 1.85 (95% CI 1.452.38; Cochran’s Q P value=.49).

“Our study suggests that not only do alcohol and tobacco play an important role in the development of esophageal cancer, the combination of their use markedly increases their potency as carcinogens,” Prabhu said. “As a result, we as physicians should focus efforts directed at controlling the burden of esophageal cancer on those who consume both of these substances.”