Oesophageal cancer in France: potential importance of hot alcoholic drinks.

In France, major geographic variation exists in the incidence of oesophageal cancer, the highest incidence being reported in Normandy and Brittany. The role of alcohol in the risk of oesophageal cancer is well established in Western countries. One possible explanation for geographical variation of incidence is that higher incidence of oesophageal cancer is due to specific local alcoholic beverages. The aim of this study was to determine whether different types of alcoholic beverages exert different effects on the risk of oesophageal cancer, and whether the variation of incidence in France is due to variation in local drinking behaviour. We conducted a multicentre case-control study in 3 regions of France (Normandy, Burgundy and Midi-Pyrenees), among which there is a 5-fold variation in incidence. We selected 208 cases and 399 controls, all males. During the interview, the subject's entire alcohol history was reconstituted, noting each type of alcoholic beverage consumed throughout life. The link between the risk of oesophageal cancer and alcohol varies greatly according to the type of alcoholic beverage, with aniseed aperitifs, hot spirits (especially hot Calvados) and beer carrying the highest risk. Consumption of hot Calvados appeared to explain about 2/3 of the inter-regional and urban/rural differences in incidence, whereas total alcohol intake explained less than 1/5. Even after adjustment for all other alcoholic beverages, consumption of hot calvados explained almost half of the peak in incidence of oesophageal cancer in the Northwest of France, as well as half of the urban/rural differences in incidence.