Abstract
Introduction
We examined the association between smoking and the risk of Barrett’s esophagus (BE), a metaplastic precursor to esophageal adenocarcinoma.
Methods
We conducted a case–control study within the Kaiser Permanente Northern California population. Patients with a new diagnosis of BE (n = 320) were matched to persons with gastroesophageal reflux disease (GERD) (n = 316) and to population controls (n = 317). Information was collected using validated questionnaires from direct in-person interviews and electronic databases. Analyses used multivariate unconditional logistic regression that controlled for age, gender, race, and education.
Results
Ever smoking status, smoking intensity (pack-years), and smoking cessation were not associated with the risk of BE. Stratified analyses suggested that ever smoking may be associated with an increased risk of BE among some groups (compared to population controls): persons with long-segment Barrett’s esophagus (odds ratio [OR] = 1.72, 95% confidence interval [CI] 1.12–2.63); subjects without GERD symptoms (OR = 3.98, 95% CI 1.58–10.0); obese subjects (OR = 3.38, 95% CI 1.46–7.82); and persons with a large abdominal circumference (OR = 3.02, 95% CI (1.18–2.75)).
Conclusion
Smoking was not a strong or consistent risk factor for BE in a large community-based study, although associations may be present in some population subgroups.
Similar content being viewed by others
References
Blot WJ, McLaughlin JK (1999) The changing epidemiology of esophageal cancer. Semin Oncol 26:2–8
Corley DA, Buffler PA (2001) Oesophageal and gastric cardia adenocarcinomas: analysis of regional variation using the cancer incidence in five continents database. Int J Epidemiol 30:1415–1425. doi:10.1093/ije/30.6.1415
Kubo A, Corley DA (2002) Marked regional variation in adenocarcinomas of the esophagus and the gastric cardia in the United States. Cancer 95:2096–2102. doi:10.1002/cncr.10940
Reid BJ, Barrett MT, Galipeau PC et al (1996) Barrett’s esophagus: ordering the events that lead to cancer. Eur J Cancer Prev 5(Suppl 2):57–65. doi:10.1097/00008469-199612002-00009
Spechler SJ, Robbins AH, Rubins HB et al (1984) Adenocarcinoma and Barrett’s esophagus. An overrated risk? Gastroenterology 87:927–933
Pelucchi C, Gallus S, Garavello W, Bosetti C, La Vecchia C (2006) Cancer risk associated with alcohol and tobacco use: focus on upper aero-digestive tract and liver. Alcohol Res Health 29:193–198
Anderson LA, Watson RG, Murphy SJ et al (2007) Risk factors for Barrett’s oesophagus and oesophageal adenocarcinoma: results from the FINBAR study. World J Gastroenterol 13:1585–1594
Brown LM, Silverman DT, Pottern LM et al (1994) Adenocarcinoma of the esophagus and esophagogastric junction in white men in the United States: alcohol, tobacco, and socioeconomic factors. Cancer Causes Control 5:333–340. doi:10.1007/BF01804984
Gammon MD, Schoenberg JB, Ahsan H et al (1997) Tobacco, alcohol, and socioeconomic status and adenocarcinomas of the esophagus and gastric cardia. J Natl Cancer Inst 89:1277–1284. doi:10.1093/jnci/89.17.1277
Gonzalez CA, Agudo A, Montes J, Riboli E, Sanz JM (1994) Tobacco and alcohol intake in relation to adenocarcinoma of the gastric cardia in Spain. Cancer Causes Control 5:88–89. doi:10.1007/BF01830731
Kabat GC, Ng SK, Wynder EL (1993) Tobacco, alcohol intake, and diet in relation to adenocarcinoma of the esophagus and gastric cardia. Cancer Causes Control 4:123–132. doi:10.1007/BF00053153
Li JY, Ershow AG, Chen ZJ et al (1989) A case–control study of cancer of the esophagus and gastric cardia in Linxian. Int J Cancer 43:755–761. doi:10.1002/ijc.2910430502
Vaughan TL, Davis S, Kristal A, Thomas DB (1995) Obesity, alcohol, and tobacco as risk factors for cancers of the esophagus and gastric cardia: adenocarcinoma versus squamous cell carcinoma. Cancer Epidemiol Biomarkers Prev 4:85–92
Wu AH, Wan P, Bernstein L (2001) A multiethnic population-based study of smoking, alcohol and body size and risk of adenocarcinomas of the stomach and esophagus (United States). Cancer Causes Control 12:721–732. doi:10.1023/A:1011290704728
Veugelers PJ, Porter GA, Guernsey DL, Casson AG (2006) Obesity and lifestyle risk factors for gastroesophageal reflux disease, Barrett esophagus and esophageal adenocarcinoma. Dis Esophagus 19:321–328. doi:10.1111/j.1442-2050.2006.00602.x
Lagergren J, Bergstrom R, Lindgren A, Nyren O (2000) The role of tobacco, snuff and alcohol use in the aetiology of cancer of the oesophagus and gastric cardia. Int J Cancer 85:340–346. doi:10.1002/(SICI)1097-0215(20000201)85:3<340::AID-IJC8>3.0.CO;2-N
Sharma P, McQuaid K, Dent J et al (2004) A critical review of the diagnosis and management of Barrett’s esophagus: the AGA Chicago workshop. Gastroenterology 127:310–330. doi:10.1053/j.gastro.2004.04.010
Bani-Hani KE, Bani-Hani BK, Martin IG (2005) Characteristics of patients with columnar-lined Barrett’s esophagus and risk factors for progression to esophageal adenocarcinoma. World J Gastroenterol 11:6807–6814
Levi F, Ollyo JB, La Vecchia C et al (1990) The consumption of tobacco, alcohol and the risk of adenocarcinoma in Barrett’s oesophagus. Int J Cancer 45:852–854. doi:10.1002/ijc.2910450511
Edelstein ZR, Farrow DC, Bronner MP, Rosen SN, Vaughan TL (2007) Central adiposity and risk of Barrett’s esophagus. Gastroenterology 133:403–411. doi:10.1053/j.gastro.2007.05.026
Johansson J, Hakansson HO, Mellblom L et al (2007) Risk factors for Barrett’s oesophagus: a population-based approach. Scand J Gastroenterol 42:148–156. doi:10.1080/00365520600881037
Conio M, Filiberti R, Blanchi S et al (2002) Risk factors for Barrett’s esophagus: a case–control study. Int J Cancer 97:225–229. doi:10.1002/ijc.1583
Smith KJ, O’Brien SM, Smithers BM et al (2005) Interactions among smoking, obesity, and symptoms of acid reflux in Barrett’s esophagus. Cancer Epidemiol Biomarkers Prev 14:2481–2486. doi:10.1158/1055-9965.EPI-05-0370
Corley DA, Kubo A, Levin TR et al (2007) Abdominal Obesity and Body Mass Index as Risk Factors for Barrett’s Esophagus. Gastroenterology 133:34–41. doi:10.1053/j.gastro.2007.04.046
Hiatt RA, Friedman GD (1982) The frequency of kidney and urinary tract diseases in a defined population. Kidney Int 22:63–68. doi:10.1038/ki.1982.133
Krieger N (1992) Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology. Am J Public Health 82:703–710
Kleinbaum D, Kupper L, Morgenstern H (1982) Epidemiologic research: principles and quantitative methods. Van Nostrand Reinhold, New York
Hosmer D, Lameshow S (2000) Applied logistic regression. Wiley, New York
Rothman K, Greenland S (1998) Modern epidemiology, 2nd edn. Lippincott Williams & Wilkins, Philadelphia, PA
El-Serag HB, Tran T, Richardson P, Ergun G (2006) Anthropometric correlates of intragastric pressure. Scand J Gastroenterol 41:887–891. doi:10.1080/00365520500535402
Chattopadhyay DK, Greaney MG, Irvin TT (1977) Effect of cigarette smoking on the lower oesophageal sphincter. Gut 18:833–835. doi:10.1136/gut.18.10.833
Rattan S, Goyal RK (1975) Effect of nicotine on the lower esophageal sphincter. Studies on the mechanism of action. Gastroenterology 69:154–159
Kahrilas PJ, Gupta RR (1989) The effect of cigarette smoking on salivation and esophageal acid clearance. J Lab Clin Med 114:431–438
Dua K, Bardan E, Ren J, Sui Z, Shaker R (1998) Effect of chronic and acute cigarette smoking on the pharyngo-upper oesophageal sphincter contractile reflex and reflexive pharyngeal swallow. Gut 43:537–541
Endoh K, Leung FW (1994) Effects of smoking and nicotine on the gastric mucosa: a review of clinical and experimental evidence. Gastroenterology 107:864–878
Morrison A (1992) Screening in chronic disease, 2nd edn. Oxford University Press, New York
Gordon N Characteristics of Adult Members in Kaiser Permanente’s Northern California Region as estimated from the 2005 Kaiser Permanente Adult Member Health Survey. Kaiser Permanente Division of Research
California Adult Smoking Prevalence. California Department of Health Services Tobacco Control Section
Acknowledgments
Funding source
National Institutes of Health grants K08DK002697 and RO1 DK63616.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kubo, A., Levin, T.R., Block, G. et al. Cigarette smoking and the risk of Barrett’s esophagus. Cancer Causes Control 20, 303–311 (2009). https://doi.org/10.1007/s10552-008-9244-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10552-008-9244-4