Alcohol, smoking and papillomavirus infection as risk factors for esophageal squamous-cell papilloma and esophageal squamous-cell carcinoma in Italy

Esophageal papilloma, an infrequent benign tumor, and esophageal squamous-c ell carcinoma sometimes appear to be associated with human papillomavirus ( HPV) infection, HPV being implicated in anogenital carcinogenesis. Our aim was to assess whether there is any epidemiological difference in terms of r isk factors for papilloma and cancer. From 1989 to 1996, a total of 12,011 patients (53% male, median age 52.7 years) were submitted to esophagogastro duodenoscopy by our Digestive Endoscopy Service. The genome of HPV was soug ht by PCR using 2 different primer sets. Of the total, 42 subjects (0.35%), 50% male with a mean age of 45.1 years, were suffering from esophageal squ amous-cell papilloma and 45 (0.37%), 91% male with a mean age of 63.0 years , from esophageal squamous-cell carcinoma Of these patients, only 2 with pa pilloma were HPV+. Compared with the general endoscopic population, patient s with papilloma do not present significantly different characteristics (ev en in terms of frequency of esophagitis and hiatal hernia). Those with carc inoma differ significantly both from the general endoscopic population and from those with papilloma in that they are more often male (p < 0.0001), ol der (p < 0.0001) and drinkers (p < 0.0001); they differ significantly only from the general population, but not from the papilloma patients, in smokin g habits. Papilloma appears to be neither a lesion involving a risk of deve lopment into a malignancy nor a marker for any such risk Environmental fact ors, such as alcohol and smoking, appear to play a decisive role in esophag eal carcinogenesis in northern Italy. Int. J. Cancer 86: 874-878, 2000. (C) 2000 Wiley-Liss, Inc.