Risk factors for esophageal cancer in a low-incidence area of Brazil

Authors

  • Orlando Milhomem Mota Associação de Combate ao Câncer em Goiás
  • Maria Paula Curado Associação de Combate ao Câncer em Goiás
  • José Carlos Oliveira Associação de Combate ao Câncer em Goiás
  • Edesio Martins Associação de Combate ao Câncer em Goiás
  • Daniela Medeiros Milhomem Cardoso Associação de Combate ao Câncer em Goiás

Keywords:

Esophagus, Esophageal neoplasms, Epidemiology, Risk factors, Food habits

Abstract

CONTEXT AND OBJECTIVES: Esophageal cancer is the eighth commonest type of cancer worldwide, occupying sixth place in terms of mortality. Smoking and alcohol use are known risk factors for this type of cancer. The aim here was to evaluate the risk factors for esophageal cancer in a low-incidence area. DESIGN AND SETTING: Case-control study in Goiânia, with 99 cases of esophageal cancer and 223 controls. METHODS: The variables were sociodemographic, dietary, occupational and lifestyle data. The sample was analyzed using the chi-square test, Mann-Whitney test and Mantel-Haenszel approach for multivariate analysis. Odds ratios (OR) were calculated with 5% significance and 95% confidence intervals. RESULTS: The risk of esophageal cancer was higher in patients ≥ 55 years (OR = 1.95; P < 0.001). Patients from rural areas were at greater risk of esophageal cancer (OR = 4.9; P < 0.001). Smoking was a risk factor among the cases (OR = 3.8; P < 0.001), as was exposure to woodstoves (OR = 4.42; P < 0.001). The practice of oral sex was not a risk factor (OR = 0.45; P = 0.04). Consumption of apples, pears, vegetables, cruciferous vegetables and fruit juices were protective against esophageal cancer. CONCLUSION: In a region in which the incidence of esophageal cancer is low, the most significant risk factors were exposure to woodstoves, smoking and living in rural areas.

Downloads

Download data is not yet available.

Author Biographies

Orlando Milhomem Mota, Associação de Combate ao Câncer em Goiás

MD. Head of Digestive Surgery Service, Hospital Araújo Jorge, Associação de Combate ao Câncer de Goiás (ACCG), and Postgraduate Program on Health Sciences, School of Medicine, Universidade Federal de Goiás (UFG), Goiânia, Goiás, Brazil.

Maria Paula Curado, Associação de Combate ao Câncer em Goiás

MD, PhD. Senior Researcher, International Prevention Research Institute and Population-Based Cancer Registry of Goiânia, Associação de Combate ao Câncer de Goiás (ACCG), Goiânia, Goiás, Brazil.

José Carlos Oliveira, Associação de Combate ao Câncer em Goiás

MD, PhD. Head of Head and Neck Surgery Service, Hospital Araújo Jorge, and Population-Based Cancer Registry of Goiânia, Associação de Combate ao Câncer de Goiás (ACCG), Goiânia, Goiás, Brazil.

Edesio Martins, Associação de Combate ao Câncer em Goiás

MHSc. Epidemiologist and doctoral student, Postgraduate Program on Health Sciences, School of Medicine, Universidade Federal de Goiás (UFG), and Population-Based Cancer Registry of Goiânia, Associação de Combate ao Câncer de Goiás (ACCG), Goiânia, Goiás, Brazil.

Daniela Medeiros Milhomem Cardoso, Associação de Combate ao Câncer em Goiás

MD. Endoscopist, Digestive Surgery Service, Hospital Araújo Jorge, Associação de Combate ao Câncer de Goiás (ACCG), and master’s degree student, Postgraduate Program on Health Sciences, School of Medicine, Universidade Federal de Goiás (UFG), Goiânia, Goiás, Brazil.

References

Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127(12):2893-917.

Sammon AM, Alderson D. Diet, reflux and the development of squamous cell carcinoma of the oesophagus in Africa. Br J Surg. 1998;85(7):891-6.

Yamaji T, Inoue M, Sasazuki S, et al. Fruit and vegetables consumption and squamous cell carcinoma of the esophagus in Japan: the JPHC study. Int J Cancer. 2008;123(8):1935-40.

Zhang SW, Chen WQ, Kong LZ, et al. An annual report: cancer incidence in 35 cancer registries in China, 2003. Bulletin of Chinese Cancer. 2007;16(7):494-506. Available from: http://en.cnki.com.cn/Article_en/CJFDTOTAL-ZHLU200707002.htm. Accessed in 2012 (May 24).

Herrera-Goepfert R, Lizano M, Akiba S, Carrillo-García A, Becker- D’Acosta M. Human papilloma virus and esophageal carcinoma in a Latin-American region. World J Gastroenterol. 2009;15(25):3142-7.

Instituto Nacional de Câncer José Alencar Gomes da Silva. Coordenação Geral de Ações Estratégicas. Coordenação de Prevenção e Vigilância. Estimativa 2012: incidência de câncer no Brasil. Rio de Janeiro: Inca; 2011. Available from: http://www1.inca.gov.br/estimativa/2012/estimativa20122111.pdf. Accessed in 2012 (May 24).

Vioque J, Barber X, Bolumar F, et al. Esophageal cancer risk by type of alcohol drinking and smoking: a case-control study in Spain. BMC Cancer. 2008;8:221.

Faivre J, Lepage C, Bouvier AM. Données récentes sur l’épidémiologie du cancer de l’œsophage [Recent data on the epidemiology of esophageal cancer]. Gastroenterol Clin Biol. 2005;29(5):534-9.

Grønbaek M, Becker U, Johansen D, et al. Population based cohort study of the association between alcohol intake and cancer of the upper digestive tract. BMJ. 1998;317(7162):844-7.

Schütze M, Boeing H, Pischon T, et al. Alcohol attributable burden of incidence of cancer in eight European countries based on results from prospective cohort study. BMJ. 2011;342:d1584.

Memik F. Alcohol and esophageal cancer, is there an exaggerated accusation? Hepatogastroenterology. 2003;50(54):1953-5.

Aune D, De Stefani E, Ronco A, et al. Fruits, vegetables and the risk of cancer: a multisite case-control study in Uruguay. Asian Pac J Cancer Prev. 2009;10(3):419-28.

DeStefani E, Deneo-Pellegrini H, Boffetta P, et al. Dietary patterns and risk of cancer: a factor analysis in Uruguay. Int J Cancer. 2009;124(6):1391-7.

Tavani A, La Vecchia C, Gallus S, et al. Red meat intake and cancer risk: a study in Italy. Int J Cancer. 2000;86(3):425-8.

Hu J, La Vecchia C, DesMeules M, et al. Meat and fish consumption and cancer in Canada. Nutr Cancer. 2008;60(3):313-24.

Cross AJ, Leitzmann MF, Gail MH, et al. A prospective study of red and processed meat intake in relation to cancer risk. PLoS Med. 2007;4(12):e325.

Launoy G, Milan C, Day NE, et al. Diet and squamous-cell cancer of the oesophagus: a French multicentre case-control study. Int J Cancer. 1998;76(1):7-12.

Brasil. Ministério do Planejamento, Orçamento e Gestão. Instituto Brasileiro de Geografia e Estatística. Censos Demográfico 2010. Sinopse do Censo e Resultados Preliminares do Universo. Rio de Janeiro: IBGE; 2011. Available from: http://www.ibge.gov.br/home/presidencia/noticias/imprensa/ppts/0000000402.pdf. Accessed in 2012 (May 24).

Malekshah AF, Kimiagar M, Pourshams A, et al. Vitamin deficiency in Golestan Province, northern Iran: a high-risk area for esophageal cancer. Arch Iran Med. 2010;13(5):391-4.

Kamangar F, Strickland PT, Pourshams A, et al. High exposure to polycyclic aromatic hydrocarbons may contribute to high risk of esophageal cancer in northeastern Iran. Anticancer Res. 2005;25(1B):425-8.

Pourshams A, Saadatian-Elahi M, Nouraie M, et al. Golestan cohort study of oesophageal cancer: feasibility and first results. Br J Cancer. 2005;92(1):176-81.

Dietz J, Pardo SH, Furtado CD, Harzheim E, Furtado AD. Fatores de risco relacionados ao câncer de esôfago no Rio Grande do Sul [Risk factors for esophageal cancer in Rio Grande do Sul, Brazil]. Rev Assoc Med Bras (1992). 1998;44(4):269-72.

Chen WQ. [Estimation of cancer incidence and mortality in China in 2004-2005]. Zhonghua Zhong Liu Za Zhi. 2009;31(9):664-8.

Wei WQ, Yang J, Zhang SW, Chen WQ, Qiao YL. [Analysis of the esophageal cancer mortality in 2004 - 2005 and its trends during last 30 years in China]. Zhonghua Yu Fang Yi Xue Za Zhi. 2010;44(5):398-402.

Yu X, Zhang T, Zhang H, et al. Comparison of lifestyle and living environment among high risk immigrant and low risk host residents: implications for esophageal cancer etiology. Asian Pac J Cancer Prev. 2010;11(6):1827-31.

Lee CH, Lee JM, Wu DC, et al. Independent and combined effects of alcohol intake, tobacco smoking and betel quid chewing on the risk of esophageal cancer in Taiwan. Int J Cancer. 2005;113(3):475-82.

Gimeno SG, de Souza JM, Mirra AP, Correa P, Haenszel W. Fatores de risco para o câncer de esôfago: estudo caso-controle em área metropolitana da regiäo Sudeste do Brasil [Risk factors for cancer of the esophagus: a case control study in a metropolitan area of South- Eastern Brazil]. Rev Saude Publica. 1995;29(3):159-65.

Menezes AM, Horta BL, Oliveira AL, et al. Risco de câncer de pulmão, laringe e esôfago atribuível ao fumo [Attributed risk to smoking for lung cancer, laryngeal cancer and esophageal cancer]. Rev Saude Publica. 2002;36(2):129-34.

Hashibe M, Boffetta P, Janout V, et al. Esophageal cancer in Central and Eastern Europe: tobacco and alcohol. Int J Cancer. 2007;120(7):1518-22.

Pandeya N, Williams GM, Sadhegi S, et al. Associations of duration, intensity, and quantity of smoking with adenocarcinoma and squamous cell carcinoma of the esophagus. Am J Epidemiol. 2008;168(1):105-14.

Boonyaphiphat P, Thongsuksai P, Sriplung H, Puttawibul P. Lifestyle habits and genetic susceptibility and the risk of esophageal cancer in the Thai population. Cancer Lett. 2002;186(2):193-9.

Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Secretaria de Gestão Estratégica e Participativa. Vigitel Brasil 2008: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico. Brasília: Ministério da Saúde; 2009.

Mir MM, Dar NA, Gochhait S, et al. p53 mutation profile of squamous cell carcinomas of the esophagus in Kashmir (India): a high-incidence area. Int J Cancer. 2005;116(1):62-8.

Weikert C, Dietrich T, Boeing H, et al. Lifetime and baseline alcohol intake and risk of cancer of the upper aero-digestive tract in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Int J Cancer. 2009;125(2):406-12.

Vassallo A, Correa P, De Stéfani E, et al. Esophageal cancer in Uruguay: a case-control study. J Natl Cancer Inst. 1985;75(6):1005-9.

De Stefani E, Muñoz N, Estève J, et al. Mate drinking, alcohol, tobacco, diet, and esophageal cancer in Uruguay. Cancer Res. 1990;50(2):426-31.

Kruel CDP, Prolla JC, Zatti H, et al. Mate-herb effect in esophageal carcinogenesis experimental model. In: Sixth World Congress of the International Society for Diseases of the Esophagus (ISDE); 1995 Aug. 23-26. Milan, Italy; ISDE; 1985. p. 248.

González CA, Jakszyn P, Pera G, et al. Meat intake and risk of stomach and esophageal adenocarcinoma within the European Prospective Investigation Into Cancer and Nutrition (EPIC). J Natl Cancer Inst. 2006;98(5):345-54.

Boeing H, Dietrich T, Hoffmann K, et al. Intake of fruits and vegetables and risk of cancer of the upper aero-digestive tract: the prospective EPIC-study. Cancer Causes Control. 2006;17(7):957-69.

Riboli E, Norat T. Epidemiologic evidence of the protective effect of fruit and vegetables on cancer risk. Am J Clin Nutr. 2003;78(3 Suppl):559S-569S.

Pavia M, Pileggi C, Nobile CG, Angelillo IF. Association between fruit and vegetable consumption and oral cancer: a meta-analysis of observational studies. Am J Clin Nutr. 2006;83(5):1126-34.

Oliveira JC, Martins E, Curado MP, Silva CMB, Moreira MAR. Dietary habits: a risk or protective factor for cancer of the mouth and oropharynx in Goias, Brazil? Appl Cancer Res. 2008;28(1):11-23.

Downloads

Published

2013-01-01

How to Cite

1.
Mota OM, Curado MP, Oliveira JC, Martins E, Cardoso DMM. Risk factors for esophageal cancer in a low-incidence area of Brazil. Sao Paulo Med J [Internet]. 2013 Jan. 1 [cited 2025 Mar. 12];131(1):27-34. Available from: https://periodicosapm.emnuvens.com.br/spmj/article/view/1265

Issue

Section

Original Article