Etiology and risk factors for oesophageal adenocarcinoma: possibilities for chemoprophylaxis?

The rapid increase in the incidence of oesophageal adenocarcinoma, particularly among white males, seems to be a true increase occurring in many parts of the industrialised world during the last few decades. Some main risk factors have been established: i.e. Barrett's oesophagus, gastrooesophageal reflux, high body mass, male sex, tobacco smoking, and high dietary intake of fruit and vegetables. Several other potential risk factors have been studied for which the evidence is less clear, including medications that relax the lower oesophageal sphincter or diets high in fat or low in nutrients from plant foods. Other factors have been found to be possibly inversely linked with the risk of oesophageal adenocarcinoma, including infection with Helicobacter pylori and anti-inflammatory drugs (such as aspirin and other non-steroidal anti-inflammatory drugs, including cyclo-oxygenase inhibitors). The methodological problem of ‘confounding by indication’ makes it difficult to interpret the results of anti-inflammatory drugs, and currently such medication cannot be recommended for the prevention of oesophageal adenocarcinoma. Similarly, since there is no strong evidence of a preventive effect of medical or surgical antireflux therapy with regard to risk of oesophageal adenocarcinoma, such therapy cannot be recommended in the prevention of this cancer. Although some of the known risk factors might contribute to the increasing incidence of oesophageal adenocarcinoma, the explanation that can entirely explain this striking trend remains to be identified. Oesophageal adenocarcinoma is a highly deadly cancer, but the overall prognosis and the prognosis after oesophageal cancer surgery has improved during recent years.