Adenocarcinoma of the oesophagus and gastric cardia: Male preponderance in association with obesity
Introduction
The patterns of oesophageal cancer in Europe and North America are changing rapidly. The incidence of oesophageal adenocarcinoma is increasing by 5–10% per year.1 The striking increased trends seen in adenocarcinoma of the oesophagus and gastric cardia are thought to result from several modifiable and interrelated risk factors, including chronic gastro-oesophageal reflux disease, poor diet, H. pylori eradication, and obesity.1, 2, 3 A recent study of population attributable risks for oesophageal adenocarcinoma linked being overweight to 41% of cases.3
The Republic of Ireland has witnessed a marked increase in the prevalence of obesity since the early 1990s, and 67% of men and 75% of women over the age of 51 are now overweight or obese.4 During this same period there was a 38% increase in the number of cases of oesophageal adenocarcinoma registered by the National Cancer Registry of Ireland.5 The incidence rate of oesophageal cancer in Ireland is amongst the highest in the western world with 11.7 cases per 100 000 males and 6.1 cases per 100 000 females compared with a European Union average of 9.5/100 000 for males and 2.2/100 000 for females.5 The aim of this study was to examine the impact of Body Mass Index (BMI) and obesity on the risk of upper gastrointestinal cancer in Irish subjects.
Section snippets
Patients and methods
All histologically confirmed cases of adenocarcinoma and squamous cell carcinoma (SCC) of the oesophagus, oesophago-gastric junction, gastric cardia, and stomach, diagnosed or treated at the Oesophageal Unit of St. James’s Hospital, Dublin between 1994 and 2004 were included. This Unit treats approximately 35% of patients in the Republic of Ireland with tumours at these sites, and approximately 50% of referrals can be treated with curative intent.
The tumour location was based on endoscopic and
Results
The sample population consisted of 239 females and 521 males, 508 patients had adenocarcinoma and 252 had SCC of the oesophagus. Tumour sites were lower oesophagus (n = 279), mid oesophagus (n = 91), oesophago-gastric junction (n = 142), upper oesophagus (n = 26), gastric cardia (n = 65), and fundus, body or distal stomach (n = 157).
Discussion
This study of an Irish population firmly supports the link between rising BMI and the risk of both adenocarcinoma of the oesophagus and gastric cardia. Obesity (BMI >30 kg/m2) was associated with a 4-fold risk of adenocarcinoma of the oesophagus compared with males and females with a normal BMI. When the analysis was split for individual tumour sites the risks associated with high BMI were strikingly more marked for males compared with females. Males with a BMI in the top quartile had an OR of
Conflict of interest statement
None declared.
Acknowledgements
The authors are grateful to Professor Michael Gibney and Dr. Sinead Mc Carthy of the Irish Universities Nutrition Alliance (IUNA), Trinity College Dublin, for allowing access to raw BMI data of healthy controls that took part in the North/South Ireland National Food Consumption Survey.
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