Abstract
There are marked differences in the etiology of the major histological types of esophageal cancer (EC)—squamous cell carcinomas (ESCC) and adenocarcinomas (EAC). This study aimed to summarize the current scientific knowledge on modifiable risk factors for EC, by histological type, through a systematic review of meta-analyses referenced in PubMed and ISI Web of Knowledge. We identified 100 meta-analyses on risk factors for ESCC (n = 54), EAC (n = 43), or EC (n = 51). ESCC risk significantly increased with alcohol and maté drinking, smoking, red and processed meat consumption and human papillomavirus infection, while it was negatively associated with body mass index and consumption of fruit, vegetables, white meat, folate, and some carotenoids. Cessation of drinking and smoking significantly reduced ESCC risk. For EAC, an increased risk was reported for smoking, body mass index, and red and processed meat consumption, while risk decreased with Helicobacter pylori infection, low/moderate alcohol drinking, physical activity, and consumption of fruit, vegetables, folate, fiber, beta-carotene, and vitamin C. Differences in results between meta-analyses and mechanisms underlying some of the associations found are discussed. This work reinforces the importance of a separate assessment of EC subtypes to allow for a proper evaluation of incidence trends and planning of prevention/control interventions.
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Acknowledgements
This work was supported by FEDER funds through the Operational Competitiveness Programme and by national funding from the Foundation for Science and Technology–FCT (Portuguese Ministry of Science, Technology and Higher Education) (FCOMP-01-0124-FEDER-021181), under the project “Determinants of gastric and esophageal cancers incidence in the north of Portugal” (PTDC/SAU-EPI/122460/2010), and the Unidade de Investigação em Epidemiologia - Instituto de Saúde Pública da Universidade do Porto (EPIUnit) (POCI-01-0145-FEDER-006862; UID/DTP/04750/2013). An individual Postdoc grant attributed to BP (SFRH/BPD/75918/2011) was co-funded by the FCT and the "Programa Operacional Capital Humano" (POCH/FSE).
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535_2017_1375_MOESM2_ESM.eps
Forest plots of overall and sex-specific associations between alcohol drinking cessation (A) and tobacco smoking cessation (B) and the occurrence of esophageal cancer. RR: relative risk, CI: confidence interval, ESCC: esophageal squamous cell carcinoma, EC: esophageal cancer. (EPS 60 kb)
535_2017_1375_MOESM3_ESM.eps
Forest plot of overall and sex-specific associations between BMI and the occurrence of esophageal cancer, by histological subtype. RR: relative risk, CI: confidence interval, ESCC: esophageal squamous cell carcinoma, EAC: esophageal adenocarcinoma. (EPS 53 kb)
535_2017_1375_MOESM4_ESM.eps
Forest plot of overall and sex-specific associations between fruit and vegetable consumption and the occurrence of esophageal cancer, by histological subtype. RR: relative risk, CI: confidence interval, ESCC: esophageal squamous cell carcinoma, EAC: esophageal adenocarcinoma. (EPS 89 kb)
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Castro, C., Peleteiro, B. & Lunet, N. Modifiable factors and esophageal cancer: a systematic review of published meta-analyses. J Gastroenterol 53, 37–51 (2018). https://doi.org/10.1007/s00535-017-1375-5
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DOI: https://doi.org/10.1007/s00535-017-1375-5