Risk factors for esophageal cancer in women in Northern Italy

Background. The incidence of esophageal cancer in women in Italy is low, and its risk factors have not been studied extensively. Methods. The relationship between risk of esophageal cancer and frequency of consumption of tobacco, alcohol, and a few selected dietary items was studied in 57 Italian women with histologically confirmed incident cancers of the esophagus and 344 hospital control patients, using data from a case-control study conducted in Milan, Italy, 1984-1991. Results. The major risk factor for cancer of the esophagus in Italian women was cigarette smoking (relative risk [RR], 1.5 for <15 cigarettes/day, 95% confidence interval [CI], 0.6-3.8; and RR, 4.8 for ≥ 15 cigarettes/day, 95% CI, 2.2-10.3; compared with those who never smoked), followed by elevated alcohol consumption (RR, 2.3; 95% CI, 1.0-5.4 for three or more drinks/day, relative to teetotalers), which together explained more than 50% of cases. Among dietary items, high intake of fresh fruit showed a statistically significant protective effect (RR, 0.4; 95% CI, 0.2-0.9 for the highest versus the lowest tertile of intake). There was an inverse relationship with an estimate of beta-carotene intake (RR, 0.5; 95% CI, 0.2-1.0 for the highest versus the lowest level of intake). No association was evident with preformed vitamin A (retinol). Conclusion. On a population scale, tobacco is the major risk factor for esophageal cancer in Italian women. Although the incidence of esophageal cancer is much lower in women than in men, major risk and protective factors are similar for both sexes.