REVIEWSmoking cessation and the risk of oesophageal cancer: An overview of published studies
Introduction
The risk of oesophageal cancer is strongly related to tobacco and alcohol consumption, with relative risks (RR) over 100 in heavy smokers and heavy drinkers.1, 2 For both tobacco and alcohol there are strong dose–risk relations, and for tobacco there is also a strong duration–risk relation. It is known that oesophageal cancer risk is reduced in ex-smokers as compared to current smokers, but the function of risk after smoking cessation is still open to discussion.
We reviewed here cohort and case–control studies published before December 2005 on oesophageal cancer and smoking cessation. These were identified through Medline and by searching the references of the retrieved studies.
Section snippets
Cohort studies
About 10 cohort studies (including a nested case–control one) reported data on oesophageal cancer in relation to smoking cessation (Table 1). All studies – with the exception of the nested case–control – gave the RR for former smokers overall, since they collected information only at the enrollment of the study subjects.
A cohort of 25,000 Swedish men3 reported a RR of 1.3 in former smokers, as compared to never smokers (death rate 4.3/100,000 person years). In current smokers the RR was 1.1 for
Squamous-cell or not specified oesophageal carcinoma
At least 10 case–control studies reported information on squamous-cell or not specified oesophageal cancer risk after smoking cessation, and analyzed the time pattern of the change in risk after stopping smoking (Table 2).
In a case–control study from coastal South Carolina,12 including 207 men with oesophageal cancer, as compared to never smokers, those who had stopped smoking for less than 10 years had an odds ratio (OR) similar to that of current smokers (around 2), while the OR in those who
Discussion
Epidemiological studies on smoking cessation and squamous-cell oesophageal cancer indicate that former smokers had a lower risk of oesophageal cancer than current smokers. The risk of oesophageal cancer remains elevated several years (at least 10) after cessation of smoking, to decline by about 40% thereafter. Further, after 10 years since cessation of smoking, ex-smokers still have a twofold increased risk as compared to never smokers.
Alcohol is the other major risk factor for oesophageal
Acknowledgments
This work was conducted with the contribution of the Italian Association for Cancer Research, Milan, and the Italian League against Cancer. The authors thank Mrs. MP Bonifacino for editorial assistance.
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