One hundred twenty-nine adenocarcinomas involving the esophagus and/or gastric cardia differed significantly from 212 cancers of the rest of the stomach as follows: male-female ratio, 6:1 versus 2:1, birth outside Canada, US or UK, 12% versus 34%; parent or sibling with gastric cancer, 5% versus 13%; previous duodenal ulcer, 23% versus 9%; chronic reflux symptoms, 25% versus 3%; hiatal hernia, 51% versus 11%. Of the 129 esophagocardia cancers, 24 involved the esophagus alone, 48 the cardia and esophagus, 33 the cardia alone or cardia and fundus, and 24 the upper stomach and lower esophagus extensively. Thirty-four were associated with Barrett's esophagus. The 72 patients with involvement of both the upper stomach and lower esophagus (48 cardia and esophagus, 24 extensive) were identical with the esophagocardia group as a whole. The 24 patients with esophageal cancer and the 34 with Barrett's epithelium were the same clinically as the whole esophagocardia group except more had chronic reflux and hiatal hernia. The 33 patients with cancer confined to the cardia or cardia and fundus resembled the whole esophagocardia group but did not have Barrett's esophagus. Adenocarcinoma of the esophagocardia region is probably a different disease from cancer of the rest of the stomach.
It has been postulated that an infectious agent and/or specific sexual behaviour is involved in the aetiology of anal cancer, in analogy with the aetiology established for cancer of the cervix. A case-control study of 29,648 women with cancers registered in the Danish Cancer Registry during 1968-87 tested the hypothesis that anal cancer patients were more likely than patients with colon, stomach, or vulva cancer to have had a previous diagnosis of cervical intraepithelial neoplasia (CIN) or invasive cervical cancer. The odds ratio of CIN, adjusted for age and year of diagnosis, for anal vs colon cancer was 5.2 (95% confidence interval [CI] 3.3-8.3), that for anal vs stomach cancer 3.6 (2.1-6.0), and that for anal vs vulva cancer 1.6 (0.9-2.9). The median time from diagnosis of CIN to diagnosis of the registered cancer was 151 months for anal, 112 months for vulva, 114 months for colon, and 126 months for stomach cancer. The association with previous invasive cervical cancer was also investigated; no patient with cervical cancer in this second analysis had been included in the CIN analysis. The odds ratios were similar. In addition, anal cancer patients were significantly more likely to have had cervical cancer than were patients with vulva cancer (odds ratio 1.8 [1.0-3.9]). The strong association between anal cancer and CIN/invasive cervical cancer suggests that these cancers share common risk factors. The association is at least as strong as that between cervical and vulva cancer.
A twelve-year series of 375 patients with gastric carcinoma has been studied. Primary tumours were classified as intestinal type (58%) or diffuse (26%), whereas 16% were unclassifiable. The relative age and sex incidence rates of intestinal type and diffuse gastric carcinoma were estimated using the age and sex distribution of individuals in Norway as the basis for calculation. There was no difference in the rates of diffuse gastric carcinoma between the sexes. On the other hand, the rate of men with intestinal type carcinoma was more than twice as high as that of women. This difference was consistent within each age group from adolescence to senescence. The findings indicate that Laurén's two types of gastric carcinoma are aetiologically different. The rates of both types increased with age up to the 70-79 age group, whereas the rates in octogenarians tended to be lower than in septuagenarians. A comparison of our data with the data of incidence of gastric cancer in Norway indicates that some of the older patients do not come for surgery.
BACKGROUND: The reasons for the increasing incidence of and strong male predominance in patients with oesophageal and cardia adenocarcinoma remain unclear. The authors hypothesised that airborne occupational exposures in male dominated industries might contribute. METHODS: In a nationwide Swedish population based case control study, 189 and 262 cases of oesophageal and cardia adenocarcinoma respectively, 167 cases of oesophageal squamous cell carcinoma, and 820 frequency matched controls underwent personal interviews. Based on each study participant's lifetime occupational history the authors assessed cumulative airborne occupational exposure for 10 agents, analysed individually and combined, by a deterministic additive model including probability, frequency, and intensity. Furthermore, occupations and industries of longest duration were analysed. Relative risks were estimated by odds ratios (OR), with 95% confidence intervals (CI), using conditional logistic regression, adjusted for potential confounders. RESULTS: Tendencies of positive associations were found between high exposure to pesticides and risk of oesophageal (OR 2.3 (95% CI 0.9 to 5.7)) and cardia adenocarcinoma (OR 2.1 (95% CI 1.0 to 4.6)). Among workers highly exposed to particular agents, a tendency of an increased risk of oesophageal squamous cell carcinoma was found. There was a twofold increased risk of oesophageal squamous cell carcinoma among concrete and construction workers (OR 2.2 (95% CI 1.1 to 4.2)) and a nearly fourfold increased risk of cardia adenocarcinoma among workers within the motor vehicle industry (OR 3.9 (95% CI 1.5 to 10.4)). An increased risk of oesophageal squamous cell carcinoma (OR 3.9 (95% CI 1.2 to 12.5)), and a tendency of an increased risk of cardia adenocarcinoma (OR 2.8 (95% CI 0.9 to 8.5)), were identified among hotel and restaurant workers. CONCLUSIONS: Specific airborne occupational exposures do not seem to be of major importance in the aetiology of oesophageal or cardia adenocarcinoma and are unlikely to contribute to the increasing incidence or the male predominance.
To examine the risk of gastric cancer associated with alcohol consumption and smoking in men and women in Moscow, Russia.
A case-control study which includes 448 cases and 610 controls was conducted. Cases consisted of patients with newly diagnosed histologically confirmed gastric cancer. Controls were patients admitted during the study period to the hospital with diagnoses other than cancer and/or gastrointestinal diseases. Information on demographic variables, smoking, alcohol consumption and diet was collected from all subjects. Venous blood was drawn from 361 cases and 441 controls. A serological test for Helicobacter pylori immunoglobulin G was performed.
Alcohol consumption, particularly vodka consumption, was found to increase the risk of gastric cancer. In men the effect of hard liquor drinking was stronger for cancer of the cardia (OR = 3.4, CI = 1.2-10.2), while in women the effect was stronger for cancer of sites other than gastric cardia (OR = 1.5, CI = 1.0-2.3). Smoking increased the risk of developing gastric cancer in men, but not in women. In men a dose-response relationship between mean number of cigarettes smoked per day (p = 0.03), pack-years of cigarettes smoked (p = 0.01) and duration of smoking (p = 0.08) and the risk of cancer of gastric cardia was observed. Further statistical analysis revealed interactions between effect of smoking and alcohol consumption and between smoking and H. pylori infection status.
The findings further support the role of alcohol consumption and smoking in the etiology of gastric cancer.
The association between alcohol consumption and risk of gastric cancer remains controversial. Moreover, prospective data on the role of alcoholic beverage type are sparse. We prospectively investigated the association between total alcohol (ethanol) intake as well as specific alcoholic beverages and risk of gastric cancer in the Swedish Mammography Cohort, a population-based cohort of 61,433 women. Alcohol intake and other dietary exposures were assessed at baseline (1987-1990) and again in 1997 using a food-frequency questionnaire. Incident gastric cancer cases were ascertained through the Swedish Cancer Register. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). During 966,807 person-years of follow-up, through June 2005, 160 incident cases of gastric cancer occurred. Total alcohol intake was not significantly associated with risk of gastric cancer. Compared with nondrinkers, the multivariate HR of gastric cancer for women with an alcohol intake of 40 g or more per week was 1.33 (95% CI, 0.79-2.25). Consumption of medium-strong/strong beer was associated with a statistically significant increased risk of gastric cancer; the multivariate HR for women who consumed more than one serving of medium-strong/strong beer per week (median, 2.5 drinks/week) was 2.09 (95% CI, 1.11-3.93; p-trend = 0.02) compared with no consumption. Consumption of light beer, wine, and hard liquor was not significantly associated with gastric cancer risk. Our findings suggest that constituents of beer other than alcohol may be associated with an increased risk of gastric cancer.
Gastric cancer mortality incidence data registered in two different areas of Eastern Transylvania (Roumania) were reported related to 325,000 inhabitants from the period of 1951-1972. The findings were compared to some geographical environmental factors deriving from an area of 13,300 km with 905,700 inhabitants. A 2-3.5 times larger incidence of gastric cancer (75-140 per 100,000/year) was found in some selected geographical areas of the intermontane depressions of Gheorgheni and Ciuc in comparison to hilly area of Transylvanian Tableland. The difference might be explained by some unknown environmental gastric cancer risk factors. Of the natural factors, the presence of magmatic substrata shows a significant degree of correlation. The main pedological factor seems to be badly drained pseudoglyied podzolic and peaty soils of low pH and high content of organic matter. Sofs drinking waters also may be involved as risk factor. High altitude, cold climate determining a restricted assortiment of cultivated plants, the successive production of vegetal and animal food on the same soil for livelong periods and several generations, especially in isolated rural areas, seem to represent gastric cancer risk factors. According to authors' opinion a survey of the high-risk population selected on the basis of the environmental factors, especially of the persons suffering from gastric disorders considered today possible precursors of gastric cancer, may offer some progress in detecting early gastric malignancy in the future.