Editor,—Recently, Lagergren and Nyrén (Gut1999;44:819–821) concluded that results from a population based cohort study in Sweden did not support a common link between colon cancer and oesophageal adenocarcinoma. However, there is consistent evidence that low intake of dietary fibre is associated with both diseases. In an analysis of 13 case control studies involving more than 5000 colorectal cancer cases, Howe and colleagues reported an inverse association between fibre intake and risk of colorectal cancer in 12 of the 13 studies, and an odds ratio of 0.53 (95% confidence interval 0.47 to 0.61) for the highest quintile of fibre intake compared with the lowest, in the combined analysis.1 Similarly, four case control studies have reported a significant inverse association between fibre intake and adenocarcinoma of the oesophagus and gastric cardia (table1).2-5 In contrast, two studies which included cases of squamous cell carcinoma found no significant link between fibre intake and squamous cell carcinoma of the oesophagus.2 5

Clearly, the dramatic increase in the incidence of adenocarcinoma of the oesophagus in …