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Volume 45, Issue 18 , Pages 3156-3165, December 2009

Oesophageal cancer in Golestan Province, a high-incidence area in northern Iran – A review

Farhad Islami
- Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Kargar Shomali Avenue, 14117 Tehran, Iran
- International Agency for Research on Cancer, 69008 Lyon, France
- King’s College London, Thames Cancer Registry, London SE1 3QD, UK
Farin Kamangar
- Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Kargar Shomali Avenue, 14117 Tehran, Iran
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD 20892-7232, USA
- Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, MD 21251, USA
Dariush Nasrollahzadeh
- Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Kargar Shomali Avenue, 14117 Tehran, Iran
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, SE-171 77 Stockholm, Sweden
Henrik Møller
- King’s College London, Thames Cancer Registry, London SE1 3QD, UK
Paolo Boffetta
- International Agency for Research on Cancer, 69008 Lyon, France
Reza Malekzadeh
- Digestive Disease Research Center, Shariati Hospital, Tehran University of Medical Sciences, Kargar Shomali Avenue, 14117 Tehran, Iran
- Corresponding author: Tel.: +98 21 82415300; fax: +98 21 82415400.

Received 26 July 2009; received in revised form 11 September 2009; accepted 15 September 2009. published online 05 October 2009.

Abstract

Golestan Province, located in the south-east littoral of the Caspian Sea in northern Iran, has one of the highest rates of oesophageal cancer (OC) in the world. We review the epidemiologic studies that have investigated the epidemiologic patterns and causes of OC in this area and provide some suggestions for further studies.

Oesophageal squamous cell carcinoma (OSCC) constitutes over 90% of all OC cases in Golestan. In retrospective studies, cigarettes and hookah smoking, nass use (a chewing tobacco product), opium consumption, hot tea drinking, poor oral health, low intake of fresh fruit and vegetables, and low socioeconomic status have been associated with higher risk of OSCC in Golestan. However, the association of tobacco with OSCC in this area is not as strong as that seen in Western countries. Alcohol is consumed by a very small percentage of the population and is not a risk factor for OSCC in this area.

Other factors, such as polycyclic aromatic hydrocarbons, N-nitroso compounds, drinking water contaminants, infections, food contamination with mycotoxins, and genetic factors merit further investigation as risk factors for OSCC in Golestan. An ongoing cohort study in this area is an important resource for studying some of these factors and also for confirming the previously found associations.

Keywords: Oesophageal neoplasms, Carcinoma, squamous cell, Adenocarcinoma, Epidemiology, Risk factors, Review, Iran