Freedman ND, Murray LJ, Kamangar F et al.
Division of Cancer Epidemiology and Genetics, Rockville, MD, USA.
Gut 2011;60:1029–37.
Editor’s note: Over the last two decades, there has been a big change in the relative distribution of the two major histological subtypes of esophageal cancers, esophageal squamous cell carcinoma, and esophageal adenocarcinomas (N Engl J Med 2003;349:2241–52). Whereas esophageal squamous carcinoma was the dominant type, and remains so in most of the world, in Western Europe and North America esophageal adenocarcinoma is now more common (J Natl Cancer Inst 1994;86:1340–5). Esophageal adenocarcinoma is thought to be a consequence of chronic reflux disease associated with Barrett’s esophagus. Alcohol and smoking are the major risk factors for esophageal squamous cancer. However, previous investigations of associations between alcohol intake and esophageal adenocarcinoma have provided inconsistent results. To address this shortcoming, a consortium was assembled to combine data from nine previous case–control and two cohort studies on this subject. Using data from approximately 1000 controls and >3000 cases of esophageal adenocarcinoma, the authors were able to conclude that there was no association between alcohol use and adenocarcinoma of the lower esophagus or esophagogastric junction. In fact, moderate intake of alcohol (less than one drink per day) was associated with a decreasedrisk of esophageal adenocarcinoma. Even when intake rose to more than seven alcoholic drinks per day, no increased risk of esophageal adenocarcinoma emerged. Far from alcohol being a risk factor for esophageal adenocarcinoma, this study suggests that there may be some benefit from continuing to imbibe alcohol, at least as far as esophageal adenocarcinoma is concerned.