Oesophagus

Combined effects of obesity, acid reflux and smoking on the risk of adenocarcinomas of the oesophagus

D C Whiteman¹, S Sadeghi^1,2, N Pandeya^1,2, B M Smithers³, D C Gotley³, C J Bain², P M Webb¹, A C Green¹, for the Australian Cancer Study

¹ Queensland Institute of Medical Research, Brisbane, Australia
² School of Population Health, University of Queensland, Brisbane, Australia
³ School of Medicine, University of Queensland, Brisbane, Australia

Dr D C Whiteman, Division of Population Studies and Human Genetics, Queensland Institute of Medical Research, PO Royal Brisbane Hospital, Queensland 4029, Australia; david.whiteman{at}qimr.edu.au

Objective: To measure the relative risks of adenocarcinomas of the oesophagus and gastro-oesophageal junction associated with measures of obesity, and their interactions with age, sex, gastro-oesophageal reflux symptoms and smoking.

Design and setting: Population-based case–control study in Australia.

Patients: Patients with adenocarcinomas of the oesophagus (n = 367) or gastro-oesophageal junction (n = 426) were compared with control participants (n = 1580) sampled from a population register.

Main outcome measure: Relative risk of adenocarcinoma of the oesophagus or gastro-oesophageal junction.

Results: Risks of oesophageal adenocarcinoma increased monotonically with body mass index (BMI) (p_trend <0.001). Highest risks were seen for BMI 40 kg/m² (odds ratio (OR) = 6.1, 95% CI 2.7 to 13.6) compared with "healthy" BMI (18.5–24.9 kg/m²). Adjustment for gastro-oesophageal reflux and other factors modestly attenuated risks. Risks associated with obesity were substantially higher among men (OR = 2.6, 95% CI 1.8 to 3.9) than women (OR = 1.4, 95% CI 0.5 to 3.5), and among those aged <50 years (OR = 7.5, 95% CI 1.7 to 33.0) than those aged 50 years (OR = 2.2, 95% CI 1.5 to 3.1). Obese people with frequent symptoms of gastro-oesophageal reflux had significantly higher risks (OR = 16.5, 95% CI 8.9 to 30.6) than people with obesity but no reflux (OR = 2.2, 95% CI 1.1 to 4.3) or reflux but no obesity (OR = 5.6, 95% 2.8 to 11.3), consistent with a synergistic interaction between these factors. Similar associations, but of smaller magnitude, were seen for gastro-oesophageal junction adenocarcinomas.

Conclusions: Obesity increases the risk of oesophageal adenocarcinoma independently of other factors, particularly among men. From a clinical perspective, these data suggest that patients with obesity and frequent symptoms of gastro-oesophageal reflux are at especially increased risk of adenocarcinoma.

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