Studies of the aetiology of oesophageal adenocarcinoma

Oesophageal adenocarcinoma (OAC), a cancer with dismal prognosis, has been increasing rapidly in incidence over the last 30 years, nowhere more so than in the UK. Intriguingly, it is a disease predominantly among white males, but there is a paucity of data from England. In performing a range of epidemiological studies, it has been confirmed that OAC has risen five-fold in the West Midlands, UK, five times more common among men, and predominantly a disease among Caucasians. A reduced incidence of OAC was identified among subjects with prostate cancer, suggesting a protective effect of anti-androgen therapy. Examination of a general practice database revealed a negative association with aspirin, non-steroidal anti-inflammatories and statins with OAC, and a positive association with inhaled steroids, increasing number of drugs with a side effect of reducing the lower oesophageal sphincter, and drugs used for asthma/COPD. Finally, a region wide case-control study, confirmed the positive association seen with increasing body mass index, waist circumference, smoking and reflux symptoms, with negative associations seen with a diet high in fruit and vegetables. This work has identified potentially modifiable risk factors that may be employed to reduce the incidence of oesophageal adenocarcinoma, and better help stratify those most likely to benefit from endoscopic surveillance