Population Attributable Risks of Esophageal and Gastric Cancers

Lawrence S Engel; Wong–Ho Chow; Thomas L Vaughan; Marilie D Gammon; Harvey A Risch; Janet L Stanford; Janet B Schoenberg; Susan T Mayne; Robert Dubrow; Heidrun Rotterdam; A. Brian West; Martin Blaser; William J Blot; Mitchell H Gail; Joseph F Fraumeni

doi:10.1093/jnci/djg047

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Population Attributable Risks of Esophageal and Gastric Cancers

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Population Attributable Risks of Esophageal and Gastric Cancers

Lawrence S Engel, Wong–Ho Chow, Thomas L Vaughan, Marilie D Gammon, Harvey A Risch, Janet L Stanford, Janet B Schoenberg, Susan T Mayne, Robert Dubrow, Heidrun Rotterdam, …

JNCI : Journal of the National Cancer Institute, Vol.95(18), pp.1404-1413

09/17/2003

DOI: https://doi.org/10.1093/jnci/djg047

PMID: 13130116

Abstract

Background: Several risk factors have been identified for esophageal adenocarcinoma, gastric cardia adenocarcinoma, esophageal squamous cell carcinoma, and noncardia gastric adenocarcinoma, but no study has comprehensively examined their contributions to the cancer burden in the general population. Herein, we estimate the population attributable risks (PARs) for various risk factors observed in a multicenter population–based case–control study. Methods: We calculated PARs by using 293 patients with esophageal adenocarcinoma, 261 with gastric cardia adenocarcinoma, 221 with esophageal squamous cell carcinoma, 368 with noncardia gastric adenocarcinoma, and 695 control subjects. We included smoking for all four tumor types and Helicobacter pylori infection for noncardia gastric adenocarcinoma as established causal risk factors as well as several other factors for which causality is under evaluation. Results: Ever smoking, body mass index above the lowest quartile, history of gastroesophageal reflux, and low fruit and vegetable consumption accounted for 39.7% (95% confidence interval [CI] = 25.6% to 55.8%), 41.1% (95% CI = 23.8% to 60.9%), 29.7% (95% CI = 19.5% to 42.3%), and 15.3% (95% CI = 5.8% to 34.6%) of esophageal adenocarcinomas, respectively, with a combined PAR of 78.7% (95% CI = 66.5% to 87.3%). Ever smoking and body mass index above the lowest quartile were responsible for 45.2% (95% CI = 31.3% to 59.9%) and 19.2% (95% CI = 4.9% to 52.0%) of gastric cardia adenocarcinomas, respectively, with a combined PAR of 56.2% (95% CI = 38.1% to 72.8%). Ever smoking, alcohol consumption, and low fruit and vegetable consumption accounted for 56.9% (95% CI = 36.6% to 75.1%), 72.4% (95% CI = 53.3% to 85.8%), and 28.7% (95% CI = 11.1% to 56.5%) of esophageal squamous cell carcinomas, respectively, with a combined PAR of 89.4% (95% CI = 79.1% to 95.0%). Ever smoking, history of gastric ulcers, nitrite intake above the lowest quartile, and H. pylori infection were responsible for 18.3% (95% CI = 6.5% to 41.8%), 9.7% (95% CI = 5.4% to 16.8%), 40.7% (95% CI = 23.4% to 60.7%), and 10.4% (95% CI = 0.3% to 79.6%) of noncardia gastric adenocarcinomas, respectively, with a combined PAR of 59.0% (95% CI = 16.2% to 91.4%). Conclusion: In this population, a few known risk factors account for a majority of esophageal and gastric cancers. These results suggest that the incidence of these cancers may be decreased by reducing the prevalence of smoking, gastroesophageal reflux, and being overweight and by increasing the consumption of fruits and vegetables.

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Title: Population Attributable Risks of Esophageal and Gastric Cancers
Creators: Lawrence S Engel - Affiliations of authors: L. S. Engel, W.–H. Chow, M. H. Gail, J. F. Fraumeni, Jr., Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; T. L. Vaughn, J. L. Stanford, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, and Department of Epidemiology, University of Washington, Seattle, WA; M. D. Gammon, School of Public Health, University of North Carolina, Chapel Hill; H. A. Risch, S. T. Mayne, R. Dubrow, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT; J. B. Schoenberg (retired), Cancer Epidemiology Services, New Jersey Department of Health and Senior Services, Trenton, NJ; H. Rotterdam, Department of Pathology, College of Physicians and Surgeons of Columbia University, New York, NY; A. B. West, Department of Pathology, New York University, New York, NY; M. Blaser, Department of Medicine, New York University School of Medicine, New York, NY; W. J. Blot, International Epidemiology Institute, Rockville, MD
Wong–Ho Chow - Affiliations of authors: L. S. Engel, W.–H. Chow, M. H. Gail, J. F. Fraumeni, Jr., Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; T. L. Vaughn, J. L. Stanford, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, and Department of Epidemiology, University of Washington, Seattle, WA; M. D. Gammon, School of Public Health, University of North Carolina, Chapel Hill; H. A. Risch, S. T. Mayne, R. Dubrow, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT; J. B. Schoenberg (retired), Cancer Epidemiology Services, New Jersey Department of Health and Senior Services, Trenton, NJ; H. Rotterdam, Department of Pathology, College of Physicians and Surgeons of Columbia University, New York, NY; A. B. West, Department of Pathology, New York University, New York, NY; M. Blaser, Department of Medicine, New York University School of Medicine, New York, NY; W. J. Blot, International Epidemiology Institute, Rockville, MD
Thomas L Vaughan - Affiliations of authors: L. S. Engel, W.–H. Chow, M. H. Gail, J. F. Fraumeni, Jr., Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; T. L. Vaughn, J. L. Stanford, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, and Department of Epidemiology, University of Washington, Seattle, WA; M. D. Gammon, School of Public Health, University of North Carolina, Chapel Hill; H. A. Risch, S. T. Mayne, R. Dubrow, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT; J. B. Schoenberg (retired), Cancer Epidemiology Services, New Jersey Department of Health and Senior Services, Trenton, NJ; H. Rotterdam, Department of Pathology, College of Physicians and Surgeons of Columbia University, New York, NY; A. B. West, Department of Pathology, New York University, New York, NY; M. Blaser, Department of Medicine, New York University School of Medicine, New York, NY; W. J. Blot, International Epidemiology Institute, Rockville, MD
Marilie D Gammon - Affiliations of authors: L. S. Engel, W.–H. Chow, M. H. Gail, J. F. Fraumeni, Jr., Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; T. L. Vaughn, J. L. Stanford, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, and Department of Epidemiology, University of Washington, Seattle, WA; M. D. Gammon, School of Public Health, University of North Carolina, Chapel Hill; H. A. Risch, S. T. Mayne, R. Dubrow, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT; J. B. Schoenberg (retired), Cancer Epidemiology Services, New Jersey Department of Health and Senior Services, Trenton, NJ; H. Rotterdam, Department of Pathology, College of Physicians and Surgeons of Columbia University, New York, NY; A. B. West, Department of Pathology, New York University, New York, NY; M. Blaser, Department of Medicine, New York University School of Medicine, New York, NY; W. J. Blot, International Epidemiology Institute, Rockville, MD
Harvey A Risch - Affiliations of authors: L. S. Engel, W.–H. Chow, M. H. Gail, J. F. Fraumeni, Jr., Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; T. L. Vaughn, J. L. Stanford, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, and Department of Epidemiology, University of Washington, Seattle, WA; M. D. Gammon, School of Public Health, University of North Carolina, Chapel Hill; H. A. Risch, S. T. Mayne, R. Dubrow, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT; J. B. Schoenberg (retired), Cancer Epidemiology Services, New Jersey Department of Health and Senior Services, Trenton, NJ; H. Rotterdam, Department of Pathology, College of Physicians and Surgeons of Columbia University, New York, NY; A. B. West, Department of Pathology, New York University, New York, NY; M. Blaser, Department of Medicine, New York University School of Medicine, New York, NY; W. J. Blot, International Epidemiology Institute, Rockville, MD
Janet L Stanford - Affiliations of authors: L. S. Engel, W.–H. Chow, M. H. Gail, J. F. Fraumeni, Jr., Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; T. L. Vaughn, J. L. Stanford, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, and Department of Epidemiology, University of Washington, Seattle, WA; M. D. Gammon, School of Public Health, University of North Carolina, Chapel Hill; H. A. Risch, S. T. Mayne, R. Dubrow, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT; J. B. Schoenberg (retired), Cancer Epidemiology Services, New Jersey Department of Health and Senior Services, Trenton, NJ; H. Rotterdam, Department of Pathology, College of Physicians and Surgeons of Columbia University, New York, NY; A. B. West, Department of Pathology, New York University, New York, NY; M. Blaser, Department of Medicine, New York University School of Medicine, New York, NY; W. J. Blot, International Epidemiology Institute, Rockville, MD
Janet B Schoenberg - Affiliations of authors: L. S. Engel, W.–H. Chow, M. H. Gail, J. F. Fraumeni, Jr., Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; T. L. Vaughn, J. L. Stanford, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, and Department of Epidemiology, University of Washington, Seattle, WA; M. D. Gammon, School of Public Health, University of North Carolina, Chapel Hill; H. A. Risch, S. T. Mayne, R. Dubrow, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT; J. B. Schoenberg (retired), Cancer Epidemiology Services, New Jersey Department of Health and Senior Services, Trenton, NJ; H. Rotterdam, Department of Pathology, College of Physicians and Surgeons of Columbia University, New York, NY; A. B. West, Department of Pathology, New York University, New York, NY; M. Blaser, Department of Medicine, New York University School of Medicine, New York, NY; W. J. Blot, International Epidemiology Institute, Rockville, MD
Susan T Mayne - Affiliations of authors: L. S. Engel, W.–H. Chow, M. H. Gail, J. F. Fraumeni, Jr., Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; T. L. Vaughn, J. L. Stanford, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, and Department of Epidemiology, University of Washington, Seattle, WA; M. D. Gammon, School of Public Health, University of North Carolina, Chapel Hill; H. A. Risch, S. T. Mayne, R. Dubrow, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT; J. B. Schoenberg (retired), Cancer Epidemiology Services, New Jersey Department of Health and Senior Services, Trenton, NJ; H. Rotterdam, Department of Pathology, College of Physicians and Surgeons of Columbia University, New York, NY; A. B. West, Department of Pathology, New York University, New York, NY; M. Blaser, Department of Medicine, New York University School of Medicine, New York, NY; W. J. Blot, International Epidemiology Institute, Rockville, MD
Robert Dubrow - Affiliations of authors: L. S. Engel, W.–H. Chow, M. H. Gail, J. F. Fraumeni, Jr., Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; T. L. Vaughn, J. L. Stanford, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, and Department of Epidemiology, University of Washington, Seattle, WA; M. D. Gammon, School of Public Health, University of North Carolina, Chapel Hill; H. A. Risch, S. T. Mayne, R. Dubrow, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT; J. B. Schoenberg (retired), Cancer Epidemiology Services, New Jersey Department of Health and Senior Services, Trenton, NJ; H. Rotterdam, Department of Pathology, College of Physicians and Surgeons of Columbia University, New York, NY; A. B. West, Department of Pathology, New York University, New York, NY; M. Blaser, Department of Medicine, New York University School of Medicine, New York, NY; W. J. Blot, International Epidemiology Institute, Rockville, MD
Heidrun Rotterdam - Affiliations of authors: L. S. Engel, W.–H. Chow, M. H. Gail, J. F. Fraumeni, Jr., Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; T. L. Vaughn, J. L. Stanford, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, and Department of Epidemiology, University of Washington, Seattle, WA; M. D. Gammon, School of Public Health, University of North Carolina, Chapel Hill; H. A. Risch, S. T. Mayne, R. Dubrow, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT; J. B. Schoenberg (retired), Cancer Epidemiology Services, New Jersey Department of Health and Senior Services, Trenton, NJ; H. Rotterdam, Department of Pathology, College of Physicians and Surgeons of Columbia University, New York, NY; A. B. West, Department of Pathology, New York University, New York, NY; M. Blaser, Department of Medicine, New York University School of Medicine, New York, NY; W. J. Blot, International Epidemiology Institute, Rockville, MD
A. Brian West - Affiliations of authors: L. S. Engel, W.–H. Chow, M. H. Gail, J. F. Fraumeni, Jr., Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; T. L. Vaughn, J. L. Stanford, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, and Department of Epidemiology, University of Washington, Seattle, WA; M. D. Gammon, School of Public Health, University of North Carolina, Chapel Hill; H. A. Risch, S. T. Mayne, R. Dubrow, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT; J. B. Schoenberg (retired), Cancer Epidemiology Services, New Jersey Department of Health and Senior Services, Trenton, NJ; H. Rotterdam, Department of Pathology, College of Physicians and Surgeons of Columbia University, New York, NY; A. B. West, Department of Pathology, New York University, New York, NY; M. Blaser, Department of Medicine, New York University School of Medicine, New York, NY; W. J. Blot, International Epidemiology Institute, Rockville, MD
Martin Blaser - Affiliations of authors: L. S. Engel, W.–H. Chow, M. H. Gail, J. F. Fraumeni, Jr., Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; T. L. Vaughn, J. L. Stanford, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, and Department of Epidemiology, University of Washington, Seattle, WA; M. D. Gammon, School of Public Health, University of North Carolina, Chapel Hill; H. A. Risch, S. T. Mayne, R. Dubrow, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT; J. B. Schoenberg (retired), Cancer Epidemiology Services, New Jersey Department of Health and Senior Services, Trenton, NJ; H. Rotterdam, Department of Pathology, College of Physicians and Surgeons of Columbia University, New York, NY; A. B. West, Department of Pathology, New York University, New York, NY; M. Blaser, Department of Medicine, New York University School of Medicine, New York, NY; W. J. Blot, International Epidemiology Institute, Rockville, MD
William J Blot - Affiliations of authors: L. S. Engel, W.–H. Chow, M. H. Gail, J. F. Fraumeni, Jr., Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; T. L. Vaughn, J. L. Stanford, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, and Department of Epidemiology, University of Washington, Seattle, WA; M. D. Gammon, School of Public Health, University of North Carolina, Chapel Hill; H. A. Risch, S. T. Mayne, R. Dubrow, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT; J. B. Schoenberg (retired), Cancer Epidemiology Services, New Jersey Department of Health and Senior Services, Trenton, NJ; H. Rotterdam, Department of Pathology, College of Physicians and Surgeons of Columbia University, New York, NY; A. B. West, Department of Pathology, New York University, New York, NY; M. Blaser, Department of Medicine, New York University School of Medicine, New York, NY; W. J. Blot, International Epidemiology Institute, Rockville, MD
Mitchell H Gail - Affiliations of authors: L. S. Engel, W.–H. Chow, M. H. Gail, J. F. Fraumeni, Jr., Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; T. L. Vaughn, J. L. Stanford, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, and Department of Epidemiology, University of Washington, Seattle, WA; M. D. Gammon, School of Public Health, University of North Carolina, Chapel Hill; H. A. Risch, S. T. Mayne, R. Dubrow, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT; J. B. Schoenberg (retired), Cancer Epidemiology Services, New Jersey Department of Health and Senior Services, Trenton, NJ; H. Rotterdam, Department of Pathology, College of Physicians and Surgeons of Columbia University, New York, NY; A. B. West, Department of Pathology, New York University, New York, NY; M. Blaser, Department of Medicine, New York University School of Medicine, New York, NY; W. J. Blot, International Epidemiology Institute, Rockville, MD
Joseph F Fraumeni - Affiliations of authors: L. S. Engel, W.–H. Chow, M. H. Gail, J. F. Fraumeni, Jr., Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; T. L. Vaughn, J. L. Stanford, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, and Department of Epidemiology, University of Washington, Seattle, WA; M. D. Gammon, School of Public Health, University of North Carolina, Chapel Hill; H. A. Risch, S. T. Mayne, R. Dubrow, Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, CT; J. B. Schoenberg (retired), Cancer Epidemiology Services, New Jersey Department of Health and Senior Services, Trenton, NJ; H. Rotterdam, Department of Pathology, College of Physicians and Surgeons of Columbia University, New York, NY; A. B. West, Department of Pathology, New York University, New York, NY; M. Blaser, Department of Medicine, New York University School of Medicine, New York, NY; W. J. Blot, International Epidemiology Institute, Rockville, MD
Publication Details: JNCI : Journal of the National Cancer Institute, Vol.95(18), pp.1404-1413
Date published: 09/17/2003
Publisher: Oxford University Press
Academic Unit: Center for Advanced Biotechnology and Medicine
Language: English
Resource Type: Journal article
Identifiers: 991031665713104646