Tobacco and Public Health - TCSC Indonesia

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TOBACCO AND ALCOHOL INTERACTION
Esophageal cancer
Esophageal cancer is an excellent example of a tumor caused by exposure to tobacco
and alcohol (Figure 36.2). Pioneering work by Tuyns and co-workers (Tuyns 1970;
Tuyns et al. 1977) carried out over several years have emphasized the importance of
both alcohol and tobacco as etiologic agents for this aggressive cancer. Much of this
research was carried out in the northwest of France, where the incidence of esophageal
cancer is exceptionally high. Case–control studies revealed that both alcohol and
tobacco are major risk factors and a greater than addictive effect was noted following
exposure to both agents. It was shown from an early study in France (Tuyns 1982) that
smoking in light consumers of alcohol carries less of a risk than smoking in heavy
drinkers. In the subgroup of persons that are heavily exposed to both agents, the risk of
esophageal cancer is nearly 40–50 times greater than in lightly exposed populations
(Figure 36.3). These data imply that control of both smoking and drinking will be
required to reduce the burden of esophageal cancer.
Fig. 36.2 Squamous cell cancer of the esophagus is one of the best examples of a tumor
related to exposure to both alcohol and tobacco.