Skip to main content
Log in

Tobacco Smoking and Alcohol Drinking as Risk Factors for Stomach Cancer: a Case-Control Study in Uruguay

  • Published:
Cancer Causes & Control Aims and scope Submit manuscript

Abstract

Objectives: To estimate the risk of stomach cancer associated with alcohol drinking and tobacco smoking in Uruguayan men.

Methods: A case-control including 331 cases and 622 controls was conducted in Montevideo, Uruguay, during the period 1992-96. The study was restricted to men, and both cases and controls were patients admitted to the major four hospitals in Montevideo. Response rates were high and similar for both series (92.8 for cases and 92.6 percent for controls). Controls were frequency-matched to cases on age and residence, and patients with conditions related a priori to tobacco smoking and alcohol drinking were considered ineligible for the study. All patients were interviewed shortly after admission using a structured questionnaire by two trained social workers. Relative risks, approximated by the odds ratios (OR), were estimated by unconditional logistic regression in models including major potential confounders.

Results: Smoking duration was associated with an increased risk of 2.2 for smokers of more than 50 years, with a significant dose-response pattern, after controlling for major confounders. Quitters of more than 15 years displayed an OR of 1.1, very close to the risk of never-smokers. A younger age at having started smoking was associated with an increased risk, whereas pack-years of cigarettes showed a significant dose-response. Also, alcohol drinking (particularly hard liquor and beer) was associated with an OR of 2.4 (95 percent confidence interval = 1.5-3.9), after controlling for the effect of tobacco, vegetables, and other types of alcohol beverages.

Conclusions: These findings add further support to the role of tobacco and alcohol in gastric carcinogenesis. Cancer Causes and Control 1998, 9, 321-329

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. De Stefani E, Fierro L, Barrios E, Ronco A. Cancer mortality trends in Uruguay, 1953–1991. Int J Cancer 1994; 56: 634–9.

    Google Scholar 

  2. Vassallo JA, De Stefani E, Barrios E, Ronco A. Cancer incidence in Uruguay, 1991 [in Spanish]. Montevideo, Uruguay: Comisión Honoraria de Lucha contra el Cancer, Barreiro & Ramos, 1996.

    Google Scholar 

  3. Flamant R, Lasserre O, Lazar P. Differences in sex ratio according to cancer site and possible relationship with use of tobacco and alcohol. Review of 65,000 cases. J Natl Cancer Inst 1964; 32: 1309–16.

    Google Scholar 

  4. D'Avanzo B, La Vecchia C, Franceschi S. Alcohol consumption and the risk of gastric cancer. Nutr Cancer 1994; 22: 57–64.

    Google Scholar 

  5. Comisión Honoraria de Lucha contra el Cáncer. Knowledge, beliefs, attitude and practices concerning cancer [in Spanish]. Technical cooperation OPP/BID/PNUD. Population survey. Montevideo, Uruguay: Comisión Honoraria de Lucha contra el Cancer, 1993: 55–65.

    Google Scholar 

  6. Tredaniel J, Boffetta P, Buiatti E, Saracci R, Hirsch A. Tobacco smoking and gastric cancer: Review and meta-analysis. Int J Cancer 1997; 72: 565–73.

    Google Scholar 

  7. González CA, Agudo A. Tobacco smoking and alcohol consumption. Eur J Gastroenter Hepatol 1994; 6: 1083–8.

    Google Scholar 

  8. Lauren P. The two histological main types of gastric carcinoma: diffuse and so-called intestinal type. An attempt at a histoclinical classification. Acta Pathol Microbiol Scand 1965; 64: 31–49.

    Google Scholar 

  9. International Agency for Research on Cancer. Alcohol Drinking. Lyon, France: IARC, 1988; Monogr Eval Carcinog Risk Chem Humans, Vol. 44.

    Google Scholar 

  10. Breslow NE, Day NE. Statistical Methods in Cancer Research. Vol. I. The Analysis of Case-control Studies. Lyon, France: IARC, 1980.

    Google Scholar 

  11. Gammon MD, Schoenberg JB, Ahsan H, et al. Tobacco, alcohol, and socioeconomic status and adenocarcinomas of the esophagus and gastric cardia. J Natl Cancer Inst 1997; 89: 1277–84.

    Google Scholar 

  12. Baker RJ, Nelder JA. The GLIM System. Release 3. Oxford, UK: Numerical Algorithm Group, 1978.

    Google Scholar 

  13. Hammond EC. Smoking in relation to the death rates of 1 million men and women. Natl Cancer Inst Monogr 1966; 19: 127–204.

    Google Scholar 

  14. Hirayama T. Life-style and Mortality. A Large-scale Census-based Cohort Study in Japan. Basel, Switzerland: Karger, 1990.

    Google Scholar 

  15. Kahn HA. The Dorn study of smoking and mortality among US veterans: report of eight and one-half years' observation. Natl Cancer Inst Monogr 1966; 19: 1–125.

    Google Scholar 

  16. Kato I, Tominaga S, Matsumoto K. A prospective study of stomach cancer among a rural Japanese population: a 6-year survey. Jpn J Cancer Res 1992; 83: 568–75.

    Google Scholar 

  17. Kneller RW, McLaughlin JK, Bjelke E, et al. A cohort study of stomach cancer in a high-risk American population. Cancer 1991; 68: 672–8.

    Google Scholar 

  18. Kono S, Ikeda M, Tokudome S, Nishizumi M, Kuratsune M. Cigarette smoking, alcohol and cancer mortality: a cohort study of male Japanese physicians. Jpn J Cancer Res 1987; 78: 1323–8.

    Google Scholar 

  19. Nomura A, Grove JS, Stemmermann GN, Severson RK. A prospective study of stomach cancer and its relation to diet, cigarettes, and alcohol consumption. Cancer Res 1990; 50: 627–31.

    Google Scholar 

  20. Doll R, Peto R, Wheatly K, Gray R, Sutherland I. Mortality in relation to smoking: 40 years' observations on male British doctors. Br Med J 1994; 309: 901–11.

    Google Scholar 

  21. McLaughlin JK, Hrubec Z, Blot WJ, Fraumeni JF Jr. Smoking and cancer mortality among US veterans: A 26-year follow up. Int J Cancer 1995; 60: 190–3.

    Google Scholar 

  22. Correa P, Fontham E, Pickle LW, Chen V, Lin Y, Haenszel W. Dietary determinants of gastric cancer in South Louisiana inhabitants. J Natl Cancer Inst 1985; 75: 645–54.

    Google Scholar 

  23. De Stefani E, Correa P, Fierro L, Carzoglio J, Deneo-Pellegrini H, Zavala D. Alcohol drinking and tobacco smoking in gastric cancer. A case-control study. Rev Epidemiol Santé Publ 1990; 38: 297–301.

    Google Scholar 

  24. Kato I, Tominaga S, Ito Y, et al. A comparative case-control analysis of stomach cancer and atrophic gastritis. Cancer Res 1990; 50: 6559–64.

    Google Scholar 

  25. Risch HA, Jain M, Choi NW, et al Dietary factors and incidence of cancer of the stomach. Am J Epidemiol 1985; 122: 947–59.

    Google Scholar 

  26. Hansson LE, Baron J, Nyren O, Bergstrom R, Wolk A, Adami HO. Tobacco, alcohol and the risk of gastric cancer. A case-control study in Sweden. Int J Cancer 1994; 57: 26–31.

    Google Scholar 

  27. Hoey J, Montvernay C, Lambert R. Wine and tobacco: risk factors for gastric cancer in France. Am J Epidemiol 1981; 113: 668–74.

    Google Scholar 

  28. Wu-Williams AH, Yu MC, Mack TM. Life-style, workplace and stomach cancer by subsite in young men of Los Angeles County. Cancer Res 1990; 50: 2569–76.

    Google Scholar 

  29. You WC, Blot WJ, Chang YS, et al. Diet and high risk of stomach cancer in Shandong, China. Cancer Res 1988; 48: 3518–23.

    Google Scholar 

  30. Yu GP, Hsieh C-c. Risk factors for stomach cancer: a population-based case-control study in Shanghai. Cancer Causes Control 1991; 2: 169–74.

    Google Scholar 

  31. Saha SK. Smoking habits and carcinoma of the stomach: a case-control study. Jpn J Cancer Res 1991; 82: 497–502.

    Google Scholar 

  32. Haenszel W, Kurihara M, Segi M, Lee RKC. Stomach cancer among Japanese in Hawaii. J Natl Cancer Inst 1972; 49: 969–88.

    Google Scholar 

  33. Dockerty JD, Marshall S, Fraser J, Pearce N. Stomach cancer in New Zealand: time trends, ethnic group differences and a cancer registry-based case-control study. Int J Epidemiol 1991; 20: 45–53.

    Google Scholar 

  34. Williams RHP, Smith J, Cole TJ, Craven JL. Dietary and smoking habits in gastric cancer: a detailed study of 64 cases and controls. Gut 1975; 16: 843.

    Google Scholar 

  35. Hoshino H, Hirayama T, Arimoto H, et al. Gastric cancer risk factors: a case-control study based on medical records. Jpn J Cancer Res 1985; 76: 846–50.

    Google Scholar 

  36. Tajima K, Tominaga S. Dietary habits and gastrointestinal cancers: a comparative case-control study of the stomach and large intestinal cancers in Nagoya Japan. Jpn J Cancer Res 1985; 76: 705–16.

    Google Scholar 

  37. Tominaga K, Koyama Y, Sasagawa M, Hiroki M, Nagai M. A case-control study of stomach cancer and its genesis in relation to alcohol consumption, smoking, and familial cancer history. Jpn J Cancer Res 1991; 82: 974–9.

    Google Scholar 

  38. Hu J, Zhang S, Jia E, et al. Diet and cancer of the stomach: a case-control study in China. Int J Cancer 1988; 41: 331–5.

    Google Scholar 

  39. Boeing H, Frentzel-Beyme R, Berger M, et al. Case-control study on stomach cancer in Germany. Int J Cancer 1991; 47: 858–64.

    Google Scholar 

  40. Buiatti E, Palli D, Decarli A, et al. Italian multicenter case-control study on gastric cancer and diet. I. Frequencies of food consumption Int J Cancer 1989; 44: 611–6.

    Google Scholar 

  41. La Vecchia C, Negri E, Decarli A, D'Avanzo B, Franceschi S. A case-control study of diet and gastric cancer in northern Italy. Int J Cancer 1987; 40: 484–9.

    Google Scholar 

  42. Jedrychowski W, Boeing H, Wahrendorf J, Popiela T, Tobiasz-Adamczyk B, Kulig J. Vodka consumption, tobacco smoking and risk of gastric cancer in Poland. Int J Epidemiol 1993; 22: 606–13.

    Google Scholar 

  43. Tuyns AJ, Pequignot G, Gignoux M, Valla A. Cancers of the digestive tract, alcohol and tobacco. Int J Cancer 1982; 30: 9–11.

    Google Scholar 

  44. Trichopoulos D, Ouranos G, Day NE, et al. Diet and cancer of the stomach: a case-control study in Greece. Int J Cancer 1985; 36: 291–7.

    Google Scholar 

  45. Ferraroni M, Negri E, La Vecchia C, D'Avanzo B, Franceschi S. Socioeconomic indicators, tobacco and alcohol in the aetiology of digestive tract neoplasms. Int J Epidemiol 1989; 18: 556–62.

    Google Scholar 

  46. Agudo A, Gonzalez CA, Marcos G, et al. Consumption of alcohol, coffee, and tobacco, and gastric cancer in Spain. Cancer Causes Control 1992; 3: 137–43.

    Google Scholar 

  47. Demirer T, Icli F, Uzanalimoglu O, Kucuk O. Diet and stomach cancer incidence. A case-control study in Turkey. Cancer 1990; 65: 2344–8.

    Google Scholar 

  48. Wynder EL, Kmet J, Dungal N, Segi M. An epidemiologic investigation of gastric cancer. Cancer 1963; 16: 1461–96.

    Google Scholar 

  49. Guo W, Blot WJ, Li JY, et al. A nested case-control study of oesophageal and stomach cancer in the Lin-xian nutrition intervention trial. Int J Epidemiol 1994; 23: 444–50.

    Google Scholar 

  50. Falcao JM, Dias JA, Miranda AC, Leitao CN, Lacerda MM, Cayolla da Motta L. Red wine consumption and gastric cancer in Portugal: a case-control study. Eur J Cancer Prev 1994; 3: 269–76.

    Google Scholar 

  51. Tayler R, Piper DW. The carcinogenic effect of cigarette smoke. The effect of cigarette smoke on human gastric mucosal cells in organ culture. Cancer 1977; 39: 2520–3.

    Google Scholar 

  52. Fontham E, Zavala D, Correa P, et al. Diet and chronic atrophic gastritis: a case-control study. J Natl Cancer Inst 1986; 76: 621–7.

    Google Scholar 

  53. Hecht SS, Chen CB, Hoffmann D. Tobacco-specific nitrosamines: occurrence, formation, carcinogenicity and metabolism. Acc Chem Res 1979; 12: 92–8.

    Google Scholar 

  54. La Vecchia C, D'Avanzo B, Airoldi L, Braga C, Decarli A. Nitrosamine intake and gastric cancer risk. Eur J Cancer Prev 1995; 4: 469–74.

    Google Scholar 

  55. Hecht SS, Hoffmann D. N-Nitroso compounds and tobacco-induced cancers in man. In: O'Neill I, Chen J, Bartsch H, eds. Relevance to Human Cancer of N-Nitroso Compounds, Tobacco Smoking and Mycotoxins. Lyon, France: International Agency for Research on Cancer, 1991; IARC Sci. Pub. No. 105.

    Google Scholar 

  56. Sundby P. Alcoholism and Mortality. Oslo, Norway: Universitetsforlaget, 1967.

    Google Scholar 

  57. Pell S, D'Alonzo CA. A five-year mortality study of alcoholics. J Occup Med 1973; 15: 120–5.

    Google Scholar 

  58. Robinette CD, Hrubec Z, Fraumeni JF Jr. Chronic alcoholism and subsequent mortality in World War II veterans. Am J Epidemiol 1979; 109: 687–700.

    Google Scholar 

  59. Hakulinen T, Lehtimaki L, Lehtonen M, Teppo L. Cancer morbidity among two male cohorts with increased alcohol consumption in Finland. J Natl Cancer Inst 1974; 52: 1711–4.

    Google Scholar 

  60. Monson RR, Lyon JL. Proportional mortality among alcoholics. Cancer 1975; 36: 1077–9.

    Google Scholar 

  61. Adelstein A, White G. Alcoholism and mortality. Popul Trends 1976; 6: 7–13.

    Google Scholar 

  62. Dean G, MacLennan R, McLoughlin H, Shelley E. Causes of death of blue-collar workers at a Dublin brewery, 1954–73. Br J Cancer 1979; 40: 581–9.

    Google Scholar 

  63. Jensen OM. Cancer Morbidity and Causes of Death among Danish Brewery Workers. Lyon, France: International Agency for Research on Cancer, 1980.

    Google Scholar 

  64. Schmidt W, Popham RE. The role of drinking and smoking in mortality from cancer and other causes in male alcoholics. Cancer 1981; 47: 1031–41.

    Google Scholar 

  65. Gordon T, Kannel WB. Drinking and mortality: the Framingham study. Am J Epidemiol 1984; 120: 97–107.

    Google Scholar 

  66. Gaspar J, Laires A, Rueff J. Genotoxic flavonoids and red wine: a possible role in stomach carcinogenesis. Eur J Cancer Prev 1994; 3(Suppl. 2): 13–7.

    Google Scholar 

  67. Walker EA, Castegnaro M, Garren L, Toussaint G, Kowalski B. Intake of volatile nitrosamines from consumption of alcohols. J Natl Cancer Inst 1979; 63: 947–51.

    Google Scholar 

  68. Olson SH, Kelsey JL, Pearson TA, Levin B. Characteristics of a hypothetical group of controls for a case-control study. Am J Epidemiol 1994; 139: 302–11.

    Google Scholar 

  69. International Agency for Research on Cancer. Schistosomes, Liver Flukes and Helicobacter Pylori. Lyon, France: IARC, 1994; Monogr Eval Carcinog Risk Humans, Vol. 61.

    Google Scholar 

  70. The EuroGast Study Group. Epidemiology of, and risk factors for Helicobacter pylori infection among 3194 asymptomatic subjects in 17 populations. Gut 1993; 34: 1672–6.

    Google Scholar 

  71. Tsugane S, Tei Y, Takahashi T, Watanabe S, Sugano K. Salty food intake and risk of Helicobacter pylori infection. Jpn J Cancer Res 1994; 85: 474–8.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

De Stefani, E., Boffetta, P., Carzoglio, J. et al. Tobacco Smoking and Alcohol Drinking as Risk Factors for Stomach Cancer: a Case-Control Study in Uruguay. Cancer Causes Control 9, 321–329 (1998). https://doi.org/10.1023/A:1008829321668

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1008829321668

Navigation