Alcohol, smoking and risk of oesophago-gastric cancer

Oesophago-gastric cancers (oesophageal and gastric cancers) are common, highly fatal cancers. Oesophageal squamous cell carcinoma (OSCC) and oesophageal adenocarcinoma (OAC) are the two main histological subtypes of oesophageal cancer. Globally, OSCC remains the most common histological subtype of oesophageal cancer, with the highest burden occurring along two geographic belts, one from north central China through the central Asian republics to northern Iran, and one from eastern to southern Africa. In Western countries, the incidence of OAC has increased dramatically over the past 40 years. OAC is now the most common subtype of oesophageal cancer in the United States, United Kingdom, and Australia. Approximately 90% of gastric cancers are adenocarcinoma, with the majority of cases diagnosed in Eastern Asia, Eastern Europe, and some Latin American countries. Smoking is an established risk factor for both oesophageal (OSCC and OAC) and gastric cancers. Alcohol consumption, however, is strongly associated with increased risk of OSCC and probably increases the risk of gastric cancer, but is not associated with OAC. Here, we review the current epidemiological evidence on associations between alcohol consumption, smoking and the risk of developing oesophago-gastric cancer, and emphasize the importance of focusing efforts on controlling the worldwide burden of oesophago-gastric cancer by reducing alcohol and tobacco use.