ADENOCARCINOMA OF THE ESOPHAGUS AND ESOPHAGOGASTRIC JUNCTION IN WHITEMEN IN THE UNITED-STATES - ALCOHOL, TOBACCO, AND SOCIOECONOMIC-FACTORS

In the United States, the incidence of adenocarcinoma of the esophagus , including the esophagogastric (EG) junction, has been increasing rap idly over the past two decades. Except for an association with Barrett 's esophagus, little is known about the etiology of these cancers. A p opulation-based case-control interview study of 174 White men with ade nocarcinoma of the esophagus and 750 controls living in three areas of the United States offered the opportunity to investigate the relation ship of these cancers with smoking, alcohol drinking, socioeconomic fa ctors, and history of ulcer. There were significantly elevated risks f or men who smoked cigarettes (odds ratio [OR] = 2.1) or drank liquor ( OR = 1.6). For both cigarette smoking and liquor drinking, there were significant dose gradients with amount consumed. No reduction in risk was observed following smoking cessation. Subjects who switched from n onfilter to filter cigarettes experienced half the risk of those who o nly smoked nonfilter cigarettes. Inverse risk gradients were seen with increasing recent annual income, with the highest risk (OR = 3.4) for the lowest category. The risk for a history of ulcer (OR = 1.7), espe cially of the duodenum (OR = 2.2), was also significantly elevated. Th ese data suggest that tobacco and alcohol may be etiologic factors for adenocarcinoma of the esophagus and EG junction, but these factors do not appear to explain the rapid rise in incidence of these tumors. Th e associations with low social class and history of ulcer need to be e xplored in greater detail along with other factors that may account fo r the temporal trends in esophageal adenocarcinomas.