Alcohol Intake and Esophageal Cancer: Epidemiologic Evidence

Abstract

Alcohol has long been established as a risk factor for cancers of the oral cavity, pharynx, esophagus, and liver [1, 2]. According to Kamangar et al. [3], two papers published in 1932 and 1939 reported an association between excessive use of alcohol (among other risk factors) and esophageal cancer on the basis of clinical observations alone. Subsequent studies conducted in the 1950s noted a similar relation between alcohol use and head and neck cancers but with an observation of a linear trend with both duration and amount of alcohol consumption [3]. Since tobacco smoking also has been consistently associated with esophageal and other head and neck cancers, studies performed among nonsmokers in the 1960s were important in establishing alcohol as a risk factor independent of smoking [3]. Furthermore, studies carried out in the 1970s helped demonstrate the role of the synergism between smoking and alcohol in human carcinogenesis [1, 4]. Finally, in 1988, the International Agency for Research on Cancer (IARC) published a report that summarized the epidemiologic data concerning alcohol use and cancer and offered convincing evidence on the causal effect of alcohol intake on some cancers, including esophageal cancer [4]. With respect to esophageal cancer, they evaluated data from eight cohort studies in which seven showed a significantly increased risk for esophageal cancer among heavy alcohol drinkers. They also evaluated 13 case-control studies in which 11 showed a statistically significant association between alcohol intake and esophageal cancer risk [2, 4]. For this chapter, studies published after the 1988 IARC report also were reviewed to reflect the current and comprehensive epidemiologic evidence on this topic.