|
|||||
|
|
Sex and smoking differences in the association between gastroesophageal reflux and risk of esophageal squamous cell carcinoma in a high-incidence area: Golestan Cohort Study |
|
| Authors: | Ali Soroush Reza Malekzadeh Gholamreza Roshandel Masoud Khoshnia Hossein Poustchi Farin Kamangar Paul Brennan Paolo Boffetta Sanford M Dawsey Christian C Abnet Julian A Abrams Arash Etemadi |
| Institution: | 1. Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA;2. Digestive Oncology Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran;3. Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran;4. Liver and Pancreaticobilliary Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran;5. Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, Maryland, USA;6. International Agency for Research on Cancer, Lyon, France;7. Stony Brook Cancer Center, Stony Brook University, Stony Brook, New York, USA
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy;8. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA;9. Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York, USA |
| Abstract: | Prior studies have conflicting findings regarding the association between gastroesophageal reflux disease (GERD) and esophageal squamous cell carcinoma (ESCC). We examined this relationship in a prospective cohort in a region of high ESCC incidence. Baseline exposure data were collected from 50 045 individuals using in-person interviews at the time of cohort entry. Participants were followed until they developed cancer, died, or were lost to follow up. Participants with GERD symptoms were categorized into any GERD (heartburn or regurgitation), mixed symptoms, or heartburn alone. Multivariable Cox regression was used to assess the relationship between GERD symptom group and histologically confirmed ESCC. The model was adjusted for known risk factors for GERD and ESCC. 49 559 individuals were included in this study, of which 9005 had GERD symptoms. Over 13.0 years of median follow up, 290 individuals were diagnosed with ESCC. We found no association between any GERD and risk of ESCC (aHR 0.90, 95% CI: 0.66-1.24, P = .54). Similar findings were observed for the GERD symptom subtypes. Significant interactions between any GERD and sex (P = .013) as well as tobacco smoking (P = .028) were observed. In post-hoc analyses, GERD was associated with a decreased risk of ESCC in men (aHR 0.51, 95% CI: 0.27-0.98 P = .04) and in smokers (aHR 0.26, 95% CI: 0.08-0.83 P = .02). While there was little evidence for an overall association between GERD symptoms and ESCC risk, significant interactions with sex and smoking were observed. Men and smokers with GERD symptoms had a lower risk of ESCC development. |
| Keywords: | esophageal squamous cell carcinoma gastroesophageal reflux Golestan Cohort Study |