Evidence of Benefit
Tobacco, Alcohol, and Dietary Factors
Chemoprevention
Aspirin and nonsteroidal anti-inflammatory drugs
Tobacco, Alcohol, and Dietary Factors
In the United States, squamous cell carcinoma of the esophagus is strongly
associated with tobacco and alcohol abuse. The risk declines with smoking
cessation. In China, esophageal cancer is associated with deficiencies of
nutrients such as retinol, riboflavin, alpha-carotene and beta carotene,
alpha-tocopherol, ascorbate, and zinc, and with exposure to specific
carcinogens (e.g., N-nitroso compounds).[1]
Chemoprevention
A prospective, placebo-controlled, esophagus chemoprevention study randomly assigned
610 high-risk Chinese subjects.[2] Subjects ranged in age from 35 to 64 years
and received either placebo or combined low-dose retinol (15 mg or 50,000 IU)
plus riboflavin (200 mg) and zinc gluconate (50 mg) for 13.5 months. Standard
histological evaluations (including two endoscopic biopsies) were made of 93% of
all entered subjects. Micronuclei from esophageal cells were obtained before
therapy began and after the 13.5 months of treatment. Serum levels of vitamin
A, beta carotene, riboflavin, and zinc were obtained at 0, 2, and 13.5 months.
The second report of this study presented micronuclei frequency results.[3] A
statistically significant reduction occurred in the mean percentage of
micronucleated esophageal cells in the active-treatment group compared with the
placebo group. The pattern of cell proliferation, another potential
intermediate endpoint marker, also improved.[4]
Two National Cancer Institute-sponsored phase III trials of combinations of multiple vitamins and
minerals have been reported. Both were conducted in a high-risk area of China
(Linxian). In one, a complex modified factorial design was used to study four
different vitamin/mineral combinations administered for 5 years at doses one to two
times the U.S. recommended daily
allowances (RDA) to 29,584 subjects.[5] The combination of beta carotene,
alpha-tocopherol, and selenium was associated with a nonstatistically
significant 4% reduction in the esophageal cancer mortality rate. The other
trial included only higher-risk subjects with esophageal dysplasia [6] and had
a two-arm design (26 vitamins and minerals, including beta carotene,
alpha-tocopherol, and selenium, at two to three times the U.S. RDA in one arm versus placebo in the other). This 6-year
intervention was associated with a nonsignificant change: a 16% reduction in
the esophageal cancer mortality rate. Similar studies have not been conducted
in the United States.
Aspirin and nonsteroidal anti-inflammatory drugs
A systematic review and meta-analysis of the association of aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) with esophageal cancer identified two cohort and seven case-control studies published between 1980 and 2001.[7] Pooled results show a protective association between aspirin/NSAID use and esophageal cancer (odds ratio [OR] = 0.57; 95% confidence interval [CI], 0.47–0.71). Association with aspirin use was statistically significant (OR = 0.50; 95% CI, 0.38–0.66); association with NSAIDs was of borderline significance (OR = 0.75; 95% CI, 0.54–1.0). Aspirin/NSAID use was associated with lower risk of both adenocarcinoma (OR = 0.67; 95% CI, 0.51–0.87) and squamous cell carcinoma (OR = 0.58; 95% CI, 0.43–0.78).
References
-
Oesophagus. In: World Cancer Research Fund., American Institute for Cancer Research.: Food, Nutrition and the Prevention of Cancer: A Global Perspective. Washington, DC: The Institute, 1997, pp 118-129.
-
Muñoz N, Wahrendorf J, Bang LJ, et al.: No effect of riboflavine, retinol, and zinc on prevalence of precancerous lesions of oesophagus. Randomised double-blind intervention study in high-risk population of China. Lancet 2 (8447): 111-4, 1985.
[PUBMED Abstract]
-
Muñoz N, Hayashi M, Bang LJ, et al.: Effect of riboflavin, retinol, and zinc on micronuclei of buccal mucosa and of esophagus: a randomized double-blind intervention study in China. J Natl Cancer Inst 79 (4): 687-91, 1987.
[PUBMED Abstract]
-
Yang GC, Lipkin M, Yang K, et al.: Proliferation of esophageal epithelial cells among residents of Linxian, People's Republic of China. J Natl Cancer Inst 79 (6): 1241-6, 1987.
[PUBMED Abstract]
-
Blot WJ, Li JY, Taylor PR, et al.: Nutrition intervention trials in Linxian, China: supplementation with specific vitamin/mineral combinations, cancer incidence, and disease-specific mortality in the general population. J Natl Cancer Inst 85 (18): 1483-92, 1993.
[PUBMED Abstract]
-
Li JY, Taylor PR, Li B, et al.: Nutrition intervention trials in Linxian, China: multiple vitamin/mineral supplementation, cancer incidence, and disease-specific mortality among adults with esophageal dysplasia. J Natl Cancer Inst 85 (18): 1492-8, 1993.
[PUBMED Abstract]
-
Corley DA, Kerlikowske K, Verma R, et al.: Protective association of aspirin/NSAIDs and esophageal cancer: a systematic review and meta-analysis. Gastroenterology 124 (1): 47-56, 2003.
[PUBMED Abstract]
Back to Top
< Previous Section | Next Section > |