Smoking and alcohol drinking in relation to risk of gastric cancer: A population-based, prospective cohort study

Authors

  • Krister Sjödahl,

    Corresponding author
    1. Unit of Esophageal and Gastric Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
    • Department of Surgery, P9: 03, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
    Search for more papers by this author
    • Fax: +46-8-331587.

  • Yunxia Lu,

    1. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
    2. Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
    Search for more papers by this author
  • Tom I.L. Nilsen,

    1. Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
    Search for more papers by this author
  • Weimin Ye,

    1. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
    Search for more papers by this author
  • Kristian Hveem,

    1. Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
    Search for more papers by this author
  • Lars Vatten,

    1. Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
    Search for more papers by this author
  • Jesper Lagergren

    1. Unit of Esophageal and Gastric Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
    Search for more papers by this author

Abstract

The relations between tobacco, alcohol and risk of gastric cancer need to be established, and any gain from preventive measures should be estimated. We conducted a population-based, prospective cohort study in Nord-Trondelag county in Norway. During 1984–1986, adult residents were invited to a health survey and they answered questionnaires that assessed exposure to tobacco and alcohol, together with potential confounding factors. The exposure assessment regarding alcohol was limited to a 14-day period. New gastric cancers that occurred during follow-up (1984–2002) were identified by linkage to the Norwegian Cancer Registry. Cox proportion hazards regression models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CI), adjusted for sex, education and body mass index. Follow-up of 1,117,648 person-years at risk among 69,962 cohort members revealed 251 gastric cancers, including 224 noncardia cancers. The risk was almost twice as high in daily smokers (HR = 1.88 [CI 95% = 1.33–2.67]) as in never smokers. Independent dose-response relations were found with earlier age at initiation (p = 0.02), frequency (p = 0.00) and duration of smoking (p = 0.00). Attributable risk (AR) of gastric cancer among current smokers was 8.7/100,000 person-years and the corresponding population AR was 18.4%. No statistically significant associations between various degrees of exposure to alcohol and risk of gastric cancer was revealed, but combined high use of cigarettes (>20/day) and alcohol (>5 occasions/14 days) increased the risk of noncardia gastric cancer nearly 5-fold (HR = 4.90 [95% CI = 1.90–12.62]), compared to nonusers. It is concluded that smoking is a dose-dependent risk factor for gastric cancer. Combined high exposure to smoking and alcohol further increases the risk. Successful preventive measures could considerably reduce the incidence of gastric cancer. © 2006 Wiley-Liss, Inc.

Ancillary