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International Journal of Epidemiology 2000;29:36-42
© International Epidemiological Association 2000

Tobacco type and risk of squamous cell cancer of the oesophagus in males: a French multicentre case-control study

Guy Launoya, Chantal Milanb, Jean Faivreb, Patrice Pienkowskic and Marc Gignouxa

a Registre des Cancers Digestifs du Calvados (CJF INSERM No 9603), Caen, France.
b Registre des Cancers Digestifs de Côte d'Or (CRI INSERM No 9505), Dijon, France.
c Registre des Cancers Digestifs de Haute-Garonne, Toulouse, France.

Reprint requests to: Guy Launoy, CJF INSERM No 9603, Faculté Médecine CHU, Caen, France.

Background The association between tobacco smoking and oesophageal cancer is well established. However, some major questions remain unanswered such as the importance of kind of tobacco and smoke inhalation. The aim of this study was to investigate the effect of each kind of tobacco on the risk of squamous cell cancer of the oesophagus in men and to test whether the effect of kind of tobacco is similar whatever the sub-site of cancer. Tobacco consumption was assessed by the number of years of consumption and time since quitting.

Methods We conducted a multicentre case-control study in three university hospitals in France (Caen, Dijon, and Toulouse). From 1991 to 1994, 208 cases and 399 controls, all male, were selected. During the interview, the subject's entire tobacco history was recalled, noting each type of tobacco consumed throughout life.

Results Strong tobacco, dark tobacco and non-filter-tipped cigarettes were associated with an increase in risk whatever the adjustments, whilst light, filter-tipped cigarettes and mild tobacco were not. Hand-rolled cigarettes were more strongly associated with risk than manufactured cigarettes. The effect of hand-rolled cigarettes appeared stronger for the lower third whilst those of strong cigarettes and dark tobacco appeared stronger for the upper third of the oesophagus. The effect of inhaling was confined to the upper third.

Conclusions Our results, emphasizing the role of dark tobacco, hand-rolled cigarettes, strong cigarettes and non-filter-tipped cigarettes are in line with previous publications. Moreover, they suggest that the mechanism underlying the tobacco effect could be different according to the sub-site of cancer.

Keywords Oesophagus, cancer, case-control study, tobacco

Accepted 28 May 1999


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