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Alcohol consumption, cigarette smoking and risk of subtypes of oesophageal and gastric cancer: a prospective cohort study
  1. J Steevens1,
  2. L J Schouten1,
  3. R A Goldbohm2,
  4. P A van den Brandt1
  1. 1
    GROW-School for Oncology and Developmental Biology, Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
  2. 2
    Department of Prevention and Health, TNO Quality of Life, Leiden, The Netherlands
  1. Correspondence to Ms J Steevens, GROW-School for Oncology and Developmental Biology, Department of Epidemiology, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands; Jessie.Steevens{at}


Objective: Alcohol consumption and cigarette smoking may be differentially associated with oesophageal squamous cell carcinoma (OSCC), oesophageal adenocarcinoma (OAC), gastric cardia adenocarcinoma (GCA) and gastric non-cardia adenocarcinoma (GNCA). However, because this was based on retrospective studies, these hypotheses were examined in a prospective cohort.

Methods: The prospective Netherlands Cohort Study consists of 120 852 participants who completed a baseline questionnaire on diet and other cancer risk factors in 1986. After 16.3 years of follow-up, 107 OSCC, 145 OAC, 164 GCA and 491 GNCA cases were available for analysis using Cox proportional hazards models and the case–cohort approach.

Results: The multivariable adjusted incidence rate ratio (RR) for OSCC was 4.61 (95% CI 2.24 to 9.50) for ⩾30 g ethanol/day compared with abstainers (p trend <0.001), while no associations with alcohol were found for OAC, GCA or GNCA. Compared with never smokers, current smokers had RRs varying from 1.60 for GCA to 2.63 for OSCC, and were statistically significant or borderline statistically significant. Frequency, duration and pack-years of smoking were independently associated with risk of all four cancers. A positive interaction was found between alcohol consumption and smoking status regarding OSCC risk. The RR for current smokers who consumed >15 g/day of ethanol was 8.05 (95% CI 3.89 to 16.60; p interaction = 0.65), when compared with never smokers who consumed <5 g/day of ethanol.

Conclusions: This prospective study found alcohol consumption to be associated with increased risk of only OSCC. Cigarette smoking was associated with risk of all four cancers.

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  • ▸ Additional appendices are published online only at

  • Funding This study was financially supported by grant UM 2006-3562 from the Dutch Cancer Society. The Dutch Cancer Society had no involvement in study design, in collection, analysis and interpretation of data, in the writing of the report or in the decision to submit the report for publication.

  • Competing interests None.

  • Ethics approval The study was approved by the Medical Ethics Committees of the University Hospital Maastricht (Maastricht, The Netherlands) and TNO Nutrition (Zeist, The Netherlands).

  • Provenance and Peer review Not commissioned; externally peer reviewed.

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