Tobacco smoking

Avoid

3 studies · 1 recommendation

Last updated: February 27, 2026

Avoid3 studies

Tobacco smoking increases esophageal cancer risk two- to fivefold regardless of tobacco form

Three studies encompassing over 128,000 participants consistently link tobacco smoking to elevated esophageal cancer risk. Two case-control studies found current smokers face odds ratios of 4.8–5.4 for squamous-cell esophageal carcinoma compared to never smokers, with higher tar yields compounding the risk (OR 1.8 for ≥10 mg vs <10 mg tar). All tobacco forms—cigarettes, hookah, and smokeless tobacco—independently increase risk, with combined tobacco and opium use yielding an OR of 2.35 (95% CI: 1.50–3.67). A Nordic twin cohort study following 127,575 participants over 27 years confirmed these findings: current smokers had HR 2.14 (95% CI: 1.95–2.34) for tobacco-related cancers, and genetically controlled twin-pair analysis showed HR 1.85 (95% CI: 1.15–2.98), ruling out shared genetic confounding. Former smokers retained elevated but reduced risk (HR 1.31), reinforcing that cessation lowers but does not eliminate the hazard.

Evidence

Cancer in twin pairs discordant for smoking : The Nordic Twin Study of Cancer

Authors: Adami, Hans-Olov, Clemmensen, Signe, Harris, Jennifer R., Hjelmborg, Jacob, Kaprio, Jaakko, Korhonen, Tellervo, Nordic Twin Study Canc NorTwinCan

Published: January 1, 2022

In this Nordic twin cohort of 127,575 participants followed for a median of 27 years, esophageal cancer was included among the tobacco-related cancer sites with 7,379 total cases recorded. Current smokers showed HR 2.14 (95% CI: 1.95–2.34) and former smokers HR 1.31 (95% CI: 1.17–1.48) for all tobacco-related cancers versus never smokers. The monozygotic discordant twin-pair analysis (109 pairs) yielded HR 1.85 (95% CI: 1.15–2.98) for current smokers and HR 1.69 (95% CI: 1.00–2.87) for former smokers compared to their genetically identical never-smoking co-twin.

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Risk factors for esophageal squamous cell carcinoma

Authors: Nesheli, Dariush Nasrollahzadeh

Published: October 3, 2013

In a case-control study of 300 ESCC cases and 571 matched controls in Golestan Province, Iran, combined tobacco and opium use was associated with an OR of 2.35 (95% CI: 1.50–3.67). All forms of tobacco use—cigarettes, hookah, and nass—were independently associated with increased ESCC risk. Controls were matched by neighborhood, age (±2 years), and sex, with conditional logistic regression adjusting for potential confounders.

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Cigarette tar yield and risk of upper digestive tract cancers: case-control studies from Italy and Switzerland

Authors: Altieri, Andrea, Bosetti, Cristina, Conti, E., Dal Maso, Luigino, Franceschi, Silvia, Gallus, Silvano, La Vecchia, Carlo, Levi, Fabio, Negri, Eva, Zambon, Paola

Published: January 1, 2003

In a matched case-control study of 395 squamous-cell oesophageal carcinoma cases and 1066 controls from Italy and Switzerland (1992-1999), multivariate odds ratios for current smokers versus never smokers were 4.8 for <20 mg tar and 5.4 for ≥20 mg tar cigarettes smoked for the longest time, adjusted for age, sex, study centre, education, and alcohol consumption. Comparing ≥10 mg to <10 mg tar brands smoked in the previous six months yielded an OR of 1.8, after controlling for number of cigarettes and smoking duration. A direct relationship between tar yield and oesophageal cancer risk was confirmed.

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