International Journal of Clinical Oncology

, Volume 15, Issue 2, pp 126–134 | Cite as

Alcohol drinking, cigarette smoking, and the development of squamous cell carcinoma of the esophagus: epidemiology, clinical findings, and prevention

  • Masaru Morita
  • Ryuichi Kumashiro
  • Nobuhide Kubo
  • Yuichiro Nakashima
  • Rintaro Yoshida
  • Keiji Yoshinaga
  • Hiroshi Saeki
  • Yasunori Emi
  • Yoshihiro Kakeji
  • Yoshihisa Sakaguchi
  • Yasushi Toh
  • Yoshihiko Maehara
Review Article


Both cigarette smoking and alcohol drinking are well-established risk factors for esophageal squamous cell carcinoma (ESCC), and the relationship of dose to cancer risk has already been described. Furthermore, the synergistic effect of these two factors has been reported. Our case–control study revealed the odds ratio of ESCC to be 50.1 for those who were both heavy smokers and heavy drinkers in comparison to people who neither drank nor smoked. In patients with ESCC, head and neck cancers as well as dysplastic lesions are frequently observed. Heavy smoking and heavy drinking are closely related to such multicentric carcinogenesis events in the upper aerodigestive tract (UADT), including the esophagus and head andneck region. Polymorphisms in acetaldehyde dehydrogenase 2 (ALDH2) are reported to be a key event in deciding individual susceptibility to UADT cancer. Patients with inactive ALDH2, in whom facial flushing is usually observed after the drinking of alcohol, are at high risk for ESCC as well as multiple UADT cancers. For the early detection of the disease, effective follow up using endoscopy with Lugol staining or narrow band imaging endoscopy is strongly recommended for high-risk populations, such as smokers, heavy drinkers, people with experience of flushing after the drinking of alcohol, and patients with UADT cancer.


Esophageal cancer Smoking Drinking Multiple cancers Aldehyde dehydrogenase 



We thank Brian Quinn for his critical comments. This work was supported in part by a Grant-in-Aid from the Ministry of Education, Culture, Sport, Science and Technology of Japan.

Conflict of interest statement

No author has any conflict of interest.


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Copyright information

© Japan Society of Clinical Oncology 2010

Authors and Affiliations

  • Masaru Morita
    • 1
  • Ryuichi Kumashiro
    • 1
  • Nobuhide Kubo
    • 1
  • Yuichiro Nakashima
    • 1
  • Rintaro Yoshida
    • 1
  • Keiji Yoshinaga
    • 1
  • Hiroshi Saeki
    • 1
  • Yasunori Emi
    • 1
  • Yoshihiro Kakeji
    • 1
  • Yoshihisa Sakaguchi
    • 2
  • Yasushi Toh
    • 1
    • 2
  • Yoshihiko Maehara
    • 1
  1. 1.Department of Surgery and Science, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  2. 2.Department of Gastroenterological SurgeryNational Kyushu Cancer CenterFukuokaJapan

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