Attributable Causes of Esophageal Cancer Incidence and Mortality in China

Background: To estimate the contribution of tobacco smoking, alcohol drinking, low vegetable intake and low fruit intake to esophageal cancer mortality and incidence in China. Methodology/Principal Findings: We calculated the proportion of esophageal cancer attributable to four known modifiable risk factors [population attributable fraction (PAF)]. Exposure data was taken from meta-analyses and large-scale national surveys of representative samples of the Chinese population. Data on relative risks were also from meta-analyses and large-scale prospective studies. Esophageal cancer mortality and incidence came from the 3rd national death cause survey and population-based cancer registries in China. We estimated that 87,065 esophageal cancer deaths (men 67,686; women: 19,379) and 108,206 cases (men: 83,968, women: 24,238) were attributable to tobacco smoking, alcohol drinking, low vegetable intake and low fruit intake in China in 2005. About 17.9 % of esophageal cancer deaths among men and 1.9% among women were attributable to tobacco smoking. About 15.2 % of esophageal cancer deaths in men and 1.3 % in women were caused by alcohol drinking. Low vegetable intake was responsible for 4.3 % esophageal cancer deaths in men and 4.1 % in women. The fraction of esophageal cancer deaths attributable to low fruit intake was 27.1 % in men and 28.0% in women. Overall, 46 % of esophageal cancers (51 % in men and 33 % in women) were attributable to these four modifiable risk factors