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Smoking and the risk of gastric cancer in the European Prospective Investigation Into Cancer and Nutrition (EPIC)
Author(s) -
González Carlos A.,
Pera Guillem,
Agudo Antonio,
Palli Domenico,
Krogh Vittorio,
Vineis Paolo,
Tumino Rosario,
Panico Salvatore,
Berglund Göran,
Simán Henrik,
Nyrén Olof,
Agren Asa,
Martinez Carmen,
Dorronsoro Miren,
Barricarte Aurelio,
Tormo María J.,
Quiros Jose R.,
Allen Naomi,
Bingham Sheila,
Day Nicholas,
Miller Antony,
Nagel Gabriele,
Boeing Heiner,
Overvad Kim,
Tjonneland Anne,
BuenodeMesquita H. Bas,
Boshuizen Hendriek C.,
Peeters Petra,
Numans Mattijs,
ClavelChapelon François,
Helen Ishaki,
Agapitos Emmanuel,
Lund Eiliv,
Fahey Michael,
Saracci Rodolfo,
Kaaks Rudolf,
Riboli Elio
Publication year - 2003
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.11426
Subject(s) - european prospective investigation into cancer and nutrition , medicine , hazard ratio , prospective cohort study , confidence interval , cancer , body mass index , proportional hazards model , stomach cancer , incidence (geometry) , demography , physics , sociology , optics
Smoking has recently been recognised as causally associated with the development of gastric cancer (GC). However, evidence on the effect by sex, duration and intensity of smoking, anatomic subsite and cessation of smoking is limited. Our objective was to assess the relation between tobacco use and GC incidence in the European Prospective Investigation into Cancer and Nutrition (EPIC). We studied data from 521,468 individuals recruited from 10 European countries taking part in the EPIC study. Participants completed lifestyle questionnaires that included questions on lifetime consumption of tobacco and diet in 1991–1998. Participants were followed until September 2002, and during that period 305 cases of stomach cancer were identified. After exclusions, 274 were eligible for the analysis, using the Cox proportional hazard model. After adjustment for educational level, consumption of fresh fruit, vegetables and preserved meat, alcohol intake and body mass index (BMI), there was a significant association between cigarette smoking and gastric cancer risk: the hazard ratio (HR) for ever smokers was 1.45 (95% confidence interval [CI] = 1.08–1.94). The HR of current cigarette smoking was 1.73 (95% CI = 1.06–2.83) in males and 1.87 (95% CI = 1.12–3.12) in females. Hazard ratios increased with intensity and duration of cigarette smoked. A significant decrease of risk was observed after 10 years of quitting smoking. A preliminary analysis of 121 cases with identified anatomic site showed that current cigarette smokers had a higher HR of GC in the cardia (HR = 4.10) than in the distal part of the stomach (HR = 1.94). In this cohort, 17.6 % (95% CI = 10.5–29.5 %) of GC cases may be attributable to smoking. Findings from this large study support the causal relation between smoking and gastric cancer in this European population. Stomach cancer should be added to the burden of diseases caused by smoking. © 2003 Wiley‐Liss, Inc.