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American Journal of Epidemiology Advance Access published online on May 15, 2008
American Journal of Epidemiology, doi:10.1093/aje/kwn091
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American Journal of Epidemiology © The Author 2008. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

Practice of Epidemiology

Associations of Duration, Intensity, and Quantity of Smoking with Adenocarcinoma and Squamous Cell Carcinoma of the Esophagus

Nirmala Pandeya1,2, Gail M. Williams2, Shahram Sadhegi1,2, Adèle C. Green1, Penelope M. Webb1 and David C. Whiteman1

1 Population Studies and Human Genetics Division, Queensland Institute of Medical Research, Herston, Queensland, Australia
2 School of Population Health, University of Queensland, Brisbane, Queensland, Australia

Correspondence to Dr. David Whiteman, Queensland Institute of Medical Research, PO Royal Brisbane Hospital, Brisbane, Queensland 4029, Australia (e-mail: david.whiteman{at}qimr.edu.au)

Received for publication December 12, 2007. Accepted for publication March 18, 2008.

Smoking has been identified as a risk factor for esophageal cancer; however, there is evidence that magnitudes and patterns of association differ by histologic type. The authors aimed to measure and compare the independent effects of various dimensions of smoking (duration, intensity, total dose, and time since quitting) on risks of esophageal adenocarcinoma (EAC), gastroesophageal junction adenocarcinoma (GEJAC), and esophageal squamous cell carcinoma (ESCC). They used data from a population-based Australian case-control study (2002–2005) comprising 367 EAC cases, 426 GEJAC cases, and 309 ESCC cases and 1,580 controls. Multivariate logistic and generalized additive logistic regression (for nonlinear dose effects) were used. Ever smokers had significantly higher risks of EAC (odds ratio (OR) = 1.7, 95% confidence interval (CI): 1.3, 2.3), GEJAC (OR = 2.4, 95% CI: 1.8, 3.2), and ESCC (OR = 2.8, 95% CI: 2.0, 4.0) than did never smokers; however, there were significant differences in magnitude and patterns of association between subtypes. When multiple dimensions of smoking were assessed concurrently, duration was significantly associated with all three subtypes but intensity was associated only with GEJAC and ESCC, and the associations were nonlinear. For all types of esophageal cancer, time since quitting was independently associated with approximately 15–19% risk reductions per decade.

esophageal neoplasms; smoking

Abbreviations: CI, confidence interval; EAC, esophageal adenocarcinoma; ESCC, esophageal squamous cell carcinoma; GEJAC, gastroesophageal junction adenocarcinoma; OR, odds ratio


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