Environmental tobacco smoking (ETS) and esophageal cancer: A population‐based case‐control study in Jiangsu Province, China

• Published in: International journal of cancer Vol. 156; no. 8; pp. 1552 - 1562
• Main Authors: Jin, Zi‐Yi, Liu, Kuangyu, Wallar, Gina, Zhou, Jin‐Yi, Mu, Li‐Na, Liu, Xing, Li, Li‐Ming, He, Na, Wu, Ming, Zhao, Jin‐Kou, Zhang, Zuo‐Feng
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 15.04.2025; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; Case-Control Studies; case–control study; China; China - epidemiology; Environmental Exposure - adverse effects; environmental tobacco smoking; Epidemiology; Esophageal cancer; Esophageal Neoplasms - epidemiology; Esophageal Neoplasms - etiology; Esophagus; Female; Humans; Lung cancer; Male; Middle Aged; Passive smoking; Population studies; Public health; RESEARCH ARTICLE; Risk Factors; Risk groups; Smoking; Tobacco; Tobacco Smoke Pollution - adverse effects; Tobacco smoking; China; Jiangsu China; case–control study; environmental tobacco smoking; esophageal cancer; China
• ISSN: 0020-7136; 1097-0215; 1097-0215
• DOI: 10.1002/ijc.35254

Esophageal cancer continues to pose a significant public health issue in areas with increased incidence rates such as China. Although involuntary smoking was defined as a group 1 carcinogen for lung cancer, few studies have explored the impact of environmental tobacco smoking (ETS) on esophageal cancer. In this paper, we examined the association between ETS and esophageal cancer in high‐risk groups in Jiangsu Province, China. Epidemiologic data were collected for 2969 newly diagnosed cases and 8019 population controls including exposure to active/passive smoking and risk factors. The unconditional logistic regression model and the semi‐Bayes (SB) method were applied to assess adjusted odds ratios (ORs) and confidence intervals (CIs). ETS exposure (ever vs. never) was positively associated with esophageal cancer with an SB‐adjusted OR (95% CI) of 1.44 (1.31–1.58) among overall population, and 1.56 (1.35–1.82) among non‐smokers (i.e., non‐active smokers), with corresponding population attributable fractions of 15.0% (95% CI: 10.3%–18.9%) and 12.1% (95% CI: 8.8%–19.8%), respectively. The association was more prominent in men at work and in women at home, with SB‐adjusted OR (95% CI) of 1.36 (1.17–1.58) and 1.61 (1.35–1.58), respectively. A dose–response relationship between ETS exposure and the disease was detected across the entire population as well as in non‐smokers. This is the largest population‐based case–control study of ETS and esophageal cancer and the first study to evaluate such association among non‐smokers in a Chinese population. We recommend strengthening the ongoing anti‐tobacco public health initiatives in China with a particular emphasis on creating a tobacco‐free work/home environment. What's new? Although passive smoking has been defined as a group 1 carcinogen for lung cancer, few studies have explored the impact of environmental tobacco smoking on esophageal cancer. In this large Chinese population‐based case–control study, environmental tobacco smoking consistently showed a positive relationship with esophageal cancer in the overall population and among non‐smokers, affecting both men and women. About 15.0% of cases in the overall population were attributable to environmental tobacco exposure both at home and in the workplace. A more comprehensive smoke‐free law would be an effective prevention strategy to reduce esophageal cancer incidence in China.