Siân Sweetland, Sarah Floud, Kezia Gaitskell, Gillian K Reeves, Emily Banks, Valerie Beral, Lucy Carpenter, Carol Dezateux (chair), Sarah Floud, Jane Green, Julietta Patnick, Richard Peto, Gillian Reeves, Cathie Sudlow, Simon Abbott, Rupert Alison, Sarah Atkinson, Krys Baker, Angela Balkwill, Isobel Barnes, Judith Black, Roger Blanks, Anna Brown, Andrew Chadwick, Dave Ewart, Sarah Floud, Kezia Gaitskell, Toral Gathani, Laura Gerrard, Adrian Goodill, Carol Hermon, Darren Hogg, Alison Hudak, Isobel Lingard, Sau Wan Kan, Nicky Langston, Keren Pepier, Kirstin Pirie, Gillian Reeves, Keith Shaw, Emma Sherman, Karl Smith-Byrne, Helena Strange, Siân Sweetland, Ruth Travis, Lyndsey Trickett, Clare Wotton, Owen Yang, Heather Young,

Adiposity and risk of oesophageal cancer subtypes in the Million Women Study

  • General Medicine
  • Epidemiology
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Abstract Background The strong association of body mass index (BMI) with increased oesophageal adenocarcinoma risk is established, but its relationship with oesophageal squamous cell carcinoma is less clear. There is little evidence regarding the association of abdominal adiposity with either subtype. Methods In a large prospective cohort of women in the UK, mean age 56.2 [standard deviation (SD) = 4.9] years, we investigated the risk of oesophageal adenocarcinoma and squamous cell carcinoma in relation to self-reported BMI, waist circumference (WC) and waist-hip ratio (WHR), using Cox regression to estimate adjusted relative risks (RR) and 95% confidence intervals (CIs), taking account of potential reverse causation bias. Results During mean follow-up of 17.7 (SD = 4.9) years, 1386 adenocarcinomas and 1799 squamous cell carcinomas of the oesophagus were registered among 1 255 529 women. Compared with women of BMI 22.5 to <25 kg/m2, those with BMI ≥35 kg/m2 had a 2.5-fold risk of adenocarcinoma (adjusted RR = 2.46, 95% CI = 1.99–3.05) and an almost 70% reduction in risk of squamous cell carcinoma (RR = 0.32, 95% CI = 0.22–0.46). These associations were broadly similar in each 5-year follow-up period, and were evident in both never and ever smokers, although somewhat stronger for squamous cell carcinoma among current and past smokers than in never smokers (Pheterogeneity = 0.007). After controlling for BMI, WC and WHR were associated with risk of squamous cell carcinoma but not adenocarcinoma. Conclusions In this population of middle-aged women, there was robust evidence that greater BMI is associated with an increased risk of oesophageal adenocarcinoma and a reduced risk of squamous cell carcinoma.

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