Background: Cigarette smoking and alcohol consumption are well-known risk factors for esophageal squamous cell carcinoma (ESCC), which has a very poor prognosis. Successful screening strategies for precursor lesions that can be targets for early detection and treatment are required to prevent ESCC.
Methods: This is a prospectively cross-sectional study. To clarify whether daily smoking and/or alcohol consumption are risk factors for dysplasia, which is the initial lesion leading to ESCC. Lugol chromoendoscopy was performed in 1345 eligible individuals. Six hundred ninety individuals had daily smoking and/or alcohol consumption; 655 individuals did not smoke and drink alcohol. The effects of smoking and alcohol consumption among high-grade dysplasia (HGD), low-grade dysplasia (LGD), and controls without dysplasia were evaluated using multiple logistic regression analysis.
Results: Among 1345 individuals, 17 HGD and 23 LGD lesions were confirmed histologically. The prevalence of both smoking and drinking consumption was significantly higher in HGD than in LGD individuals (age and sex adjusted odds ratio; 113.0, 95% confidence interval; 6.26), whereas no significant difference was seen in both consumption between LGD individuals and controls (odds ratio; 1.29, 95% confidence interval; 0.33-6.37). Approximately 70% of HGD individuals, but only 13% of LGD individuals, both smoked and consumed alcohol.
Conclusions: Daily cigarette and alcohol consumption were not the risk factors for LGD, however, consumption of both were high-risk factors for HGD. We suggest that documenting the difference of risk factors for LGD and HGD can assist in the development of effective screening, early detection, and prevention strategies for ESCC.
*Division of Digestive Endoscopy/Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba
‡Department of Health Science, Shiga University of Medical Science, Shiga, Japan
Departments of †Gastroenterology
§Hospital Pathology, Showa University School of Medicine, Tokyo, Japan
This work was supported by a research on the association between risk of upper aerodigestive tract cancer and alcohol-metabolizing enzymes, and its clinical significance (20 to 10).
Reprints: Kazuhiro Kaneko, MD, PhD, Division of Digestive Endoscopy/Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwanoha 6-5-1, Kashiwa, Chiba, 277-8577, Japan (e-mail: firstname.lastname@example.org).
Conflict of interest: The authors declare no conflict of interest.
Received for publication January 20, 2009
accepted August 6, 2009