Risk factors for esophageal and gastric cancers in Shanxi Province, China: A case–control study
Introduction
Upper gastrointestinal (UGI) cancers, including esophageal and gastric cancer, are among the most common causes of cancer death in the world, with an estimated 562 000 esophageal and 883 000 gastric cancer deaths annually [1]. Shanxi Province in north central China has among the highest esophageal cancer rates in the world [2]. However, to date, no single dominant environmental risk factor has been identified for esophageal or gastric cancer in this region.
Tobacco smoking is consistently reported as an important risk factor of esophageal cancer [3], [4], [5], [6], [7], especially for squamous cell carcinoma, and gastric cancer [4], [8], [9] in the West, but appears to incur little or no effect for these cancers in Asian countries [9], [10], [11], [12]. Our group previously reported that tobacco smoking was only a modest risk factor for esophageal cancer, and did not increase risk for gastric cardia adenocarcinoma (GCA) or gastric noncardia adenocarcinoma (GNCA) in Linxian, Henan Province [9], which is geographically adjacent to Shanxi Province.
Similar to smoking, alcohol consumption is considered a dominant risk factor for esophageal squamous cell carcinoma (ESCC) in the West [13], [14], [15], but has not been associated with risk in Linxian or Shanxi Province [9], [16].
Among different lifestyle factors, dietary factors may play an important role in the carcinogenesis of esophageal cancer. Some specific dietary elements, like pickled vegetable juice and moldy food, have been reported to be associated with esophageal cancer risk in north China [9], [16]. Nutrition-related deficiencies in vitamins, minerals, and other micronutrients have also been linked to the elevated risk of esophageal and gastric cancer in these areas [17], [18].
To explore the role of these risk factors in esophageal cancer in detail, we conducted a large case–control study in Shanxi Province. Because cancers of the esophagus and stomach are anatomically adjacent, may share common etiologies, and occur at very high rates in this region of north central China, we also evaluated risk factors for gastric cancer, including GCA and GNCA.
Section snippets
Study population
This study was based on a case–control study of upper gastrointestinal (UGI) tract cancers conducted in Shanxi Province, China [19], [20]. Briefly, the recruiting criteria for cases include: (1) Males or females over 20 years old; (2) Residents from Taiyuan, Linfen, Jinzhong, Changzhi, and Xinzhou; (3) Recently diagnosed for cancer of the esophagus or stomach without previous treatment; (4) Had surgical treatment for tumor at the Shanxi Cancer Hospital; (5) Diagnoses were histologically
Results
A total of 600 ESCC, 599 GCA, and 316 GNCA cases and their 1514 matched controls were included in the current analyses. Among ESCC cancers, 7% were anatomically located in the upper third of the esophagus, 70% in the middle, and 23% in the lower third. Gender, age, and geographic region distribution of study subjects are shown in Table 1. Overall, nearly three-quarters of cases were males and the median age of all cases was 59 years.
Discussion
We evaluated lifestyle factors and risk of three UGI cancers in this relatively large case–control study (significant risk factors are summarized in Table 6). Tobacco smoking and alcohol drinking conferred little or no increased risk for these UGI cancers, while several SES and dietary factors showed significant associations for one or more of the UGI cancers. The strongest and most consistent risk factors across all three UGI cancer sites were the increased risk in persons who consumed
Conclusions
This large case–control study of UGI cancers corroborated prior results that showed that tobacco and alcohol have only minor roles in these cancers in north central China, where rates of esophageal and gastric cancer are among the highest in the world. The study also confirmed the protective role for vegetable and fruit consumption, and highlighted the importance of thermal damage as a strong risk factor for UGI cancer.
Conflict of interest
The authors declare that they have no conflict of interest.
Contributors
NH, X-YH, CG, TD, AMG, and PRT designed and conducted the study; YG conducted the statistical analyses; AMG and PRT oversaw the statistical analyses; YG wrote the first draft of the manuscript; all authors contributed the writing and/or editing of the final manuscript.
Acknowledgements
This study was supported by the Intramural Research Program of National Institutes of Health, National Cancer Institute, Division of Cancer Epidemiology and Genetics. The funding unit had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
We thank all the subjects who participated in the study and all the collaborators who contributed to its success.
We thank the editorial assistance of the Fellows Editorial Board of National Institutes
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