Tobacco, alcohol and tea drinking as risk factors for esophageal cancer: A case–control study from Mumbai, India

Esophageal cancer is a relatively rare form of cancer, but some world areas have a markedly higher incidence than others: China, Iceland, India, Japan and United Kingdom, appear to have a higher incidence, as well as the region around the Caspian Sea. In India the incidence rates vary across the country. Despite higher incidence rate, there are only few studies from the Indian subcontinent. This study conducted at Tata Memorial hospital, Mumbai, India, included 442 cases of esophageal cancer and 1628 hospital controls. Data was collected on chewing, smoking, alcohol habits and dietary habits. The results indicated a moderate 1.1 times excess risk for chewers of pan (betel-leaf) with tobacco, 1.8-fold excess risk for bidi smokers and 2-fold for cigarette smokers, and 1.8-fold excess risk for alcohol drinkers. There was a clear dose–response relationship in those with the habits. Among the beverages, tea drinking, common in India, showed a 4-fold excess risk for esophageal cancer. However fresh-fish showed a 20% reduction in risk for esophageal cancer. Besides several other risk factors, these may be studied in the Indian set-up which has a heterogeneous population with a varied life-style and dietary habits. This could give indicators for prevention.