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. Issue 6 (1st November 2022)

• Record Type: Journal Article
• Authors: Soroush, Ali; Malekzadeh, Reza; Roshandel, Gholamreza; Khoshnia, Masoud; Poustchi, Hossein; Kamangar, Farin; Brennan, Paul; Boffetta, Paolo; Dawsey, Sanford M.; Abnet, Christian C.; Abrams, Julian A.; Etemadi, Arash
• Is Part Of: International journal of cancer. Volume 152:Issue 6(2023)
• Page Start: 1137
• Page End: 1149
• Publication Date: 2022-11-01
• Subjects: esophageal squamous cell carcinoma -- gastroesophageal reflux -- Golestan Cohort Study; Cancer -- Periodicals; Cancer -- Prevention -- Periodicals; 616.994
• DOI: 10.1002/ijc.34313
• Languages: English
• ISSNs: 0020-7136

Abstract

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. Abstract : What's new? While gastroesophageal reflux disease has been associated with increased risk of esophageal adenocarcinoma, its association with esophageal squamous cell carcinoma is unclear. This large prospective study in a population with high esophageal squamous cell carcinoma incidence found no association between gastroesophageal reflux disease symptoms and risk of esophageal squamous cell carcinoma within the full cohort. However, men and tobacco smokers with gastroesophageal reflux disease symptoms had a lower risk of developing esophageal squamous cell carcinoma. There was also a proximal shift in esophageal squamous cell carcinoma tumor location among cohort members with gastroesophageal reflux disease symptoms.