Cancer Causes & Control

, Volume 26, Issue 10, pp 1365–1373 | Cite as

Impact of pre-diagnosis behavior on risk of death from esophageal cancer: a systematic review and meta-analysis

  • Paul P. Fahey
  • Kylie-Ann Mallitt
  • Thomas Astell-Burt
  • Glenn Stone
  • David C. Whiteman
Review article



Most people diagnosed with esophageal cancer will die from their disease, but it is not known whether survival is influenced by pre-morbid behavior. We undertook a systematic review and meta-analysis to investigate the impact of pre-diagnosis behavior on risk of death for esophageal cancer.


We performed a systematic review of studies reporting on the relationship between pre-diagnosis smoking, alcohol consumption, overweight and obesity, physical activity and regular consumption of nonsteroidal anti-inflammatory drugs, and risk of death from esophageal squamous cell carcinoma (ESCC) and adenocarcinomas (EACs). Study characteristics are presented and aggregate results are compiled using meta-analysis.


From an initial pool of 644 non-duplicate records, 13 articles arising from 12 studies met the inclusion criteria. Considerable variation was observed between studies in location, measurement categories, adjustment for other risks, and results. Pooled estimates suggested that for ESCC pre-diagnosis smoking was associated with a 1.19 times [95 % confidence interval (CI) 1.04–1.36] increased risk of death and pre-diagnosis alcohol consumption with a 1.36 times increased risk of death (95 % CI 1.15–1.61). No significant effects were observed for EAC. We observed a lower risk of death for both ESCC and EAC associated with high pre-diagnosis body mass index (BMI) ≥25 kg/m2 (ESCC hazard ratio 0.80, 95 % CI 0.67–0.95; EAC 0.80, 95 % CI 0.68–0.95), although there was significant heterogeneity across studies.


Our findings suggest that a number of modifiable pre-diagnosis risk factors have a carryover effect on the risk of death from esophageal cancer. These include smoking, drinking alcohol, and BMI.


Esophageal squamous cell carcinoma Esophageal adenocarcinoma Risk of death Health behavior 

Supplementary material

10552_2015_635_MOESM1_ESM.pdf (326 kb)
PubMed search criteria and additional results arising from the meta-analyses (PDF 325 kb)


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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  1. 1.Centre for Research in MathematicsUniversity of Western SydneySydneyAustralia
  2. 2.School of Science and HealthUniversity of Western SydneySydneyAustralia
  3. 3.Faculty of MedicineUniversity of New South WalesSydneyAustralia
  4. 4.School of Computing, Engineering and MathematicsUniversity of Western SydneySydneyAustralia
  5. 5.QIMR Berghofer Medical Research InstituteBrisbaneAustralia

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