Smoking, type of alcoholic beverage and squamous-cell oesophageal cancer in northern Italy.

Between 1992 and 1997, we conducted a case-control study of oesophageal cancer in 3 areas of northern Italy. Cases were 275 men, ages 39-77 years (median age 60), with a first incident squamous-cell carcinoma of the oesophagus. Controls were 593 men, ages 36-77 years (median age 60) admitted for acute illnesses, unrelated to tobacco and alcohol, to major hospitals of the areas under surveillance. Number of daily cigarettes was strongly associated with risk [odds ratio (OR) for > or =25 cigarettes/day = 7.0)]. Long-duration smoking showed particularly elevated ORs (OR = 6.4 for > or =35 years), and excess risk declined after smoking cessation (OR = 1.5 after > or = 10 years). Oesophageal cancer risk steeply rose with increasing level of alcohol consumption. ORs were 6.2 for 35-55 drinks and 24.5 for 84 drinks or more per week. No trend in risk emerged for duration of alcohol drinking or age at start of drinking. The risk in the highest joint level of alcohol drinking and current smoking was increased 130 folds (i.e., compatible with a multiplicative model). Excess risk in drinkers chiefly derived from wine. In conclusion, alcohol drinking and cigarette smoking were both important, but the roles of dose and duration of exposure differed. The association with alcohol was stronger than the one with smoking by exposure intensity, but apparently unaffected by duration or other temporal variables.