Abstract
The last decades have witnessed an unprecedented rise in the incidence of oesophageal
adenocarcinoma. This rise has mainly affected men, and current male-to-female sex
ratio estimates range from 7–10 to 1. Major risk factors for oesophageal adenocarcinoma
are gastro-oesophageal reflux disease and obesity, especially in combination. The
prevalence of these risk factors has increased during the last decades, but there
does not seem to be a marked differential distribution among men and women. However,
reflux among men is more often associated with erosive reflux disease than it is among
women. There is also evidence that male-type obesity, with a prominent abdominal distribution
of fat, confers a greater risk increase for oesophageal adenocarcinoma than the female
equivalent. Due to the marked male predominance and the finding that women tend to
develop specialized intestinal metaplasia (Barrett's oesophagus) and adenocarcinoma
at a later age than men, interest has been directed towards a potential aetiological
role of reproductive factors and sex hormones. Breastfeeding has been found to be
a protective factor for the development of adenocarcinoma, while no association has
hitherto been established with other reproductive factors. Taken together, the male
predominance in the incidence of oesophageal adenocarcinoma may partly be explained
by the differential effect of the major risk factors reflux disease and obesity, but
the mechanisms whereby this occurs need to be elucidated. Moreover, the association
with breastfeeding indicates a need for extensive epidemiological studies to clarify
a possible role of sex hormonal influence in the aetiology of oesophageal adenocarcinoma.
Keywords
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Article info
Publication history
Published online: April 25, 2011
Accepted:
April 2,
2011
Received:
March 16,
2011
Identification
Copyright
© 2011 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
