Novel epidemiologic evidence for the association between fermented fish sauce and esophageal cancer in South China.

Previous studies have suggested that fermented fish sauce is related to an increased risk for nasopharyngeal, thyroid and gastric cancers and has suspicious carcinogenic and promoting effects in the laboratory, but these reports have not investigated the association between this agent and esophageal cancer in population. Therefore, we investigated the relationship between esophageal cancer and consumption of fermented fish sauce, alcohol and tobacco after adjusting other risk factors using data from a large hospital-based case-control study in Chaoshan area of China. The subjects for analysis included 1,248 cases (median age 58.5 [range 29-82] years, 936 males, 312 females, some 50% with the habit of fermented fish sauce eating) with squamous cell carcinoma of the esophagus and the same amount of controls matched by sex and age. A significant increase in risk (OR 3.21; 95% CI 2.45-4.19) for eating fermented fish sauce compared to not eating and a significant dose-response relationship was found with the consumption of fermented fish sauce (p for trend < 0.001). In comparison based on the binary variables, the OR for the subjects with fermented fish sauce eating and current smoking was 15.5 with a 95% CI of 8.14-29.3, relative to those exposed to neither habit. The joint effect of fermented fish sauce (F) and smoking (S) was more than additive (F * S > F + S: 15.5 > 1 + (5.6 - 1) + (6.6 - 1)), but the effect for fermented fish sauce and alcohol was not found. It is concluded that risks of esophageal cancer in the population were substantially associated with fermented fish sauce. Further epidemiologic and experimental study are required to find a biologic causal relationship between them. Copyright 2002 Wiley-Liss, Inc.