Smoking Plus Drinking: A Cancerous Mix for the Esophagus

Tobacco smoking and drinking alcohol had combined effect on esophageal cancer risk

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Drinking alcohol and smoking are often vices that go together. That combination of vices also may also except when discussing the risk for esophageal cancer.

Drinking alcohol and smoking have each been shown individually to increase the chance of developing esophageal cancer (cancer of the tube that carries food and drink to the stomach).

Now, researchers have reported that the cancer risk was even greater when a person both drank alcohol and smoked tobacco together.

"Tell your doctor if you drink alcohol or smoke."

This meta-analysis was led by Anoop Prabhu, MD, Advanced Endoscopy Fellow at the Icahn School of Medicine at Mount Sinai in New York, NY.

The researchers did a literature search for studies that ended by February 2013. They looked at studies about esophageal squamous cell carcinoma (ESCC), a class of esophageal cancer that begins in the cell lining. They found five studies that met their requirements.

Most of the risk for ESCC is associated with exposure to alcohol or tobacco or a low consumption of fruits and vegetables. Either tobacco use or alcohol consumption is associated with a 20 to 30 percent increased risk for ESCC compared to non-use.

Dr. Prabhu and colleagues found evidence that when alcohol and smoking were used together, the risk for esophageal cancer was compounded. Individuals who used both tobacco and alcohol had almost twice the risk of ESCC than if one simply added each risk separately. The combination of tobacco and alcohol also carried a more than a three-fold risk of esophageal cancer than if one did not smoke and did not drink.

Why there was such a greater risk if a person both smoked and drank is not known, but the authors of this study suggested that acetaldehyde plays a role. Acetaldehyde, a product found in alcohol when it is broken down in the body, is known to cause cancer. It is also found in cigarette smoke. Its effects may be greatly increased when the two are combined, the authors suggested.

The authors noted that the incidence of ESCC is declining in the United States, but this cancer is still very common in other countries — such as northern China and Iran. All five studies in this analysis were from Asia.

There are 4.4 new cases diagnosed per 100,000 people per year in the United States, according to the authors of this analysis. In comparison, the incidence in some parts of China has been estimated to be higher than 100 new cases per 100,000 people per year.

The authors expressed concern that the studies did not account for duration or intensity of exposure to tobacco.

In conclusion, the study's authors recommended that the intake of alcohol and use of tobacco be curtailed as much as possible. “We as physicians should focus efforts directed at controlling the burden of esophageal cancer on those who consume both of these substances," said Dr. Prabhu in a press release.

Their study appeared April 22 in The American Journal of Gastroenterology.

The authors declared no conflicts of interest.

Review Date: 
April 23, 2014
Last Updated:
May 7, 2014