Tobacco and Public Health - TCSC Indonesia

20+
TABAC
5.1
10–19
0–9
3.4
12.3
0–40
ALBERT B. LOWENFELS AND PATRICK MAISONNEUVE
1.0
44.4
19.9
7.3 18.0
41–80 81+
ALCOOL
Fig. 36.3 The effects of combined exposure to alcohol and tobacco on the risk of esophageal
cancer. (From Tuyns 1982.)
Most patients with esophageal cancer have been exposed to both tobacco
and alcohol, so it is difficult to estimate the independent impact of each single risk
factor. But in his study 743 esophageal cancers from the Calvados region of
Normandy, France, Tuyns found 19 non-drinkers and 75 non-smokers (Tuyns
1983). The relative risk of esophageal cancer in non-drinking smokers was approximately
5, compared to a relative risk of 11 in non-smoking heavy alcohol consumers.
It appears that both agents can act independently and that their relative effect will
to some extent depend upon the level of population exposure. One report suggests
that for tobacco, a moderate intake over a long time period poses a higher risk than
a high intake over a short period. For alcohol, high intake over a shorter period is
more likely to induce esophageal cancer than a low intake over a longer period.
(Launoy et al. 1997).
8.4
649