Tobacco and Public Health - TCSC Indonesia

Chapter 22
Smoking and cancer of the
oesophagus
Eva Negri
It has been estimated that in the year 2000 there were in the world about 280 000 new
cases of oesophageal cancer (OC) among men and 130 000 among women (Ferlay
et al. 2001). The great majority of these cases (220 000 men and 120 000 women) occur
in less developed countries. The age-standardized rate in men is twofold in less
developed areas compared to more developed areas of the world (12.8/100 000 vs
6.7/100 000). In women the ratio between rates in less and more developed areas is
5 (6.2/100 000 vs 1.3/100 000).
OC incidence rates show a remarkably large geographical variation, with a difference
of over 300-fold between high- and low-risk areas (Munoz and Day 1996). Very high
rates have been observed in a belt starting in eastern Turkey and extending through the
southern states of the former Soviet Union, Iran, and Iraq into northern China (Kmet
and Mahboudi 1972; Blot 1994). Large differences in rates can be observed also within
small geographical areas (Munoz and Day 1996), and rapid changes of rates over time
have been observed (Negri et al. 1996). In North America, rates are much higher
among African Americans than among whites (Munoz and Day 1996).
The vast majority of OC worldwide are squamous-cell carcinomas of the oesophagus
(SCCO), and most of the epidemiologic studies on OC were based solely or chiefly on
this histologic type. Increases in the incidence of adenocarcinoma of the oesophagus
(ACO) have been reported in the US and other countries, and adenocarcinoma has
become the most frequent cell type among US whites (Blot and McLaughlin 1999).
Squamous cell and adenocarcinoma of the oesophagus differ in geographic distribution,
temporal trends and risk factors, and thus represent two separate epidemiological
entities. Thus, they will be considered separately in this chapter.
Squamous-cell carcinoma of the oesophagus (SCCO)
Already in the late 1950s some studies reported an association between tobacco and
cancer of the oesophagus (Hammond and Horn 1958; Dorn 1959; Tuyns et al. 1977),
although the authors still doubted the causality of this association.
In the following years, further evidence accumulated, and in 1986 the International
Agency for Research on Cancer (IARC) concluded that ‘smoking is an important cause