In East Asians, a strong association has been reported to exist between a past or current history of facial flushing after a small dose of alcohol (flushers) and heterozygosity for inactive aldehyde dehydrogenase-2 (ALDH2)
furthermore, individuals with the latter have been shown to have a higher relative risk of alcohol-related oral and esophageal cancers as compared to individuals with wild-type ALDH2 alleles. The purpose of this study was to examine whether flushers with oral or/and pharyngeal squamous cell carcinoma might also at a higher risk of synchronous or metachronous cancers of the upper gastrointestinal (UGI), and to clarify the relationship between the risks associated with flushing and those associated with alcohol and smoking. This is a retrospective study conducted using a questionnaire and medical chart review. We sent a questionnaire to 240 patients or families of patients treated for head and neck squamous cell carcinomas (HNSCCs) from 2004 to 2011, to determine if the patients had a past or current history of flushing after a small dose of alcohol, and also whether they were habitual smoker or drinkers
the 121 patients or their families who replied were enrolled in this study. In addition to being classified as flushers or non-flushers, the patients were dichotomized into heavy smokers (蠇10 pack-years) and non-heavy smokers, and into heavy drinkers (consumption of 蠇20 g of alcohol per day) and non-heavy drinkers. We evaluated the relationships among these factors and the occurrence of second primary cancers in the UGI tract. Flushers showed a higher incidence of second primary cancers (22% v.s. 11% in 5 years), although the difference was not significant. Univariate analysis showed a higher hazard ratio in heavy drinkers than in flushers or smokers, however, this was also not statistically significant. Multivariate analyses showed that a history of flushing was associated with a higher hazard ratio than drinking or smoking habit, however, the difference were not significant. A simple interview about the drinking habit and history of facial flushing after a small dose of alcohol may be useful for identifying patients at high risk for HNSCC.