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Jayasekara H, MacInnis RJ, Lujan‐Barroso L, Mayen‐Chacon A, Cross AJ, Wallner B, Palli D, Ricceri F, Pala V, Panico S, Tumino R, Kühn T, Kaaks R, Tsilidis K, Sánchez M, Amiano P, Ardanaz E, Chirlaque López MD, Merino S, Rothwell JA, Boutron‐Ruault M, Severi G, Sternby H, Sonestedt E, Bueno‐de‐Mesquita B, Boeing H, Travis R, Sandanger TM, Trichopoulou A, Karakatsani A, Peppa E, Tjønneland A, Yang Y, Hodge AM, Mitchell H, Haydon A, Room R, Hopper JL, Weiderpass E, Gunter MJ, Riboli E, Giles GG, Milne RL, Agudo A, English DR, Ferrari P. Lifetime alcohol intake, drinking patterns over time and risk of stomach cancer: A pooled analysis of data from two prospective cohort studies. Int J Cancer 2021; 148:2759-2773. [PMID: 33554339 PMCID: PMC9290950 DOI: 10.1002/ijc.33504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/22/2020] [Accepted: 01/04/2021] [Indexed: 02/03/2023]
Abstract
Alcohol consumption is causally linked to several cancers but the evidence for stomach cancer is inconclusive. In our study, the association between long-term alcohol intake and risk of stomach cancer and its subtypes was evaluated. We performed a pooled analysis of data collected at baseline from 491 714 participants in the European Prospective Investigation into Cancer and Nutrition and the Melbourne Collaborative Cohort Study. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for incident stomach cancer in relation to lifetime alcohol intake and group-based life course intake trajectories, adjusted for potential confounders including Helicobacter pylori infection. In all, 1225 incident stomach cancers (78% noncardia) were diagnosed over 7 094 637 person-years; 984 in 382 957 study participants with lifetime alcohol intake data (5 455 507 person-years). Although lifetime alcohol intake was not associated with overall stomach cancer risk, we observed a weak positive association with noncardia cancer (HR = 1.03, 95% CI: 1.00-1.06 per 10 g/d increment), with a HR of 1.50 (95% CI: 1.08-2.09) for ≥60 g/d compared to 0.1 to 4.9 g/d. A weak inverse association with cardia cancer (HR = 0.93, 95% CI: 0.87-1.00) was also observed. HRs of 1.48 (95% CI: 1.10-1.99) for noncardia and 0.51 (95% CI: 0.26-1.03) for cardia cancer were observed for a life course trajectory characterized by heavy decreasing intake compared to light stable intake (Phomogeneity = .02). These associations did not differ appreciably by smoking or H pylori infection status. Limiting alcohol use during lifetime, particularly avoiding heavy use during early adulthood, might help prevent noncardia stomach cancer. Heterogeneous associations observed for cardia and noncardia cancers may indicate etiologic differences.
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Affiliation(s)
- Harindra Jayasekara
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneVictoriaAustralia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, The University of MelbourneMelbourneVictoriaAustralia
- Centre for Alcohol Policy ResearchLa Trobe UniversityBundooraVictoriaAustralia
| | - Robert J. MacInnis
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneVictoriaAustralia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, The University of MelbourneMelbourneVictoriaAustralia
| | - Leila Lujan‐Barroso
- Unit of Nutrition and Cancer, Catalan Institute of Oncology ‐ ICO, Nutrition and Cancer Group, Bellvitge Biomedical Research Institute ‐ IDIBELL, L'Hospitalet de LlobregatBarcelonaSpain
- Department of Nursing of Public HealthMental Health and Maternity and Child Health School of Nursing Universitat de BarcelonaBarcelonaSpain
| | - Ana‐Lucia Mayen‐Chacon
- Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer, World Health OrganizationLyonFrance
| | - Amanda J. Cross
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Bengt Wallner
- Department of Surgical and Perioperatve Sciences, SurgeryUmeå University HospitalUmeåSweden
| | - Domenico Palli
- Cancer Risk Factors and Life‐Style Epidemiology UnitInstitute for Cancer Research, Prevention and Clinical Network – ISPROFlorenceItaly
| | - Fulvio Ricceri
- Department of Clinical and Biological SciencesUniversity of TurinTurinItaly
- Unit of Epidemiology, Regional Health Service ASL TO3GrugliascoItaly
| | - Valeria Pala
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di MilanoMilanItaly
| | - Salvatore Panico
- Dipartimento di Medicina Clinica e ChirurgiaFederico II UniversityNaplesItaly
| | - Rosario Tumino
- Cancer Registry and Histopathology DepartmentProvincial Health Authority (ASP)RagusaItaly
| | - Tilman Kühn
- Division of Cancer EpidemiologyGerman Cancer Research Center (DKFZ)HeidelbergGermany
| | - Rudolf Kaaks
- Division of Cancer EpidemiologyGerman Cancer Research Center (DKFZ)HeidelbergGermany
| | - Kostas Tsilidis
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Maria‐Jose Sánchez
- Escuela Andaluza de Salud Pública (EASP)GranadaSpain
- Instituto de Investigación Biosanitaria ibs.GRANADAGranadaSpain
- CIBER in Epidemiology and Public Health (CIBERESP)MadridSpain
- Universidad de GranadaGranadaSpain
| | - Pilar Amiano
- CIBER in Epidemiology and Public Health (CIBERESP)MadridSpain
- Public Health Division of Gipuzkoa, BioDonostia Research InstituteDonostia‐San SebastianSpain
| | - Eva Ardanaz
- CIBER in Epidemiology and Public Health (CIBERESP)MadridSpain
- Navarra Public Health InstitutePamplonaSpain
- IdiSNA, Navarra Institute for Health ResearchPamplonaSpain
| | - María Dolores Chirlaque López
- CIBER in Epidemiology and Public Health (CIBERESP)MadridSpain
- Department of EpidemiologyRegional Health Council, IMIB‐Arrixaca, Murcia UniversityMurciaSpain
| | - Susana Merino
- Public Health Directorate, Regional Government of AsturiasOviedoSpain
| | - Joseph A. Rothwell
- CESP (U1018), Faculté de médecineUniversité Paris‐Saclay, UVSQ, INSERMVillejuifFrance
- Gustave RoussyVillejuifFrance
| | | | - Gianluca Severi
- CESP (U1018), Faculté de médecineUniversité Paris‐Saclay, UVSQ, INSERMVillejuifFrance
- Gustave RoussyVillejuifFrance
- Department of StatisticsComputer Science and Applications “G. Parenti” (DISIA), University of FlorenceFlorenceItaly
| | - Hanna Sternby
- Department of SurgeryInstitution of Clinical Sciences Malmö, Lund UniversityLundSweden
| | - Emily Sonestedt
- Nutritional Epidemiology, Department of Clinical Sciences MalmöLund UniversityMalmöSweden
| | - Bas Bueno‐de‐Mesquita
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM)BilthovenThe Netherlands
| | - Heiner Boeing
- Institute of Nutrition Science, University of PotsdamNuthetalGermany
| | - Ruth Travis
- Cancer Epidemiology Unit, Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Torkjel M. Sandanger
- Department of Community Medicine, Faculty of Health SciencesUiT‐the Arctic University of NorwayTromsøNorway
| | | | - Anna Karakatsani
- Hellenic Health FoundationAthensGreece
- 2nd Pulmonary Medicine DepartmentSchool of Medicine, National Kapodistrian University of Athens, “ATTIKON” University HospitalHaidariGreece
| | | | - Anne Tjønneland
- Danish Cancer Society Research CenterCopenhagenDenmark
- Department of Public HealthUniversity of CopenhagenCopenhagenDenmark
| | - Yi Yang
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneVictoriaAustralia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, The University of MelbourneMelbourneVictoriaAustralia
| | - Allison M. Hodge
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneVictoriaAustralia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, The University of MelbourneMelbourneVictoriaAustralia
| | - Hazel Mitchell
- School of Biotechnology and Biomolecular Sciences, University of New South WalesKensingtonNew South WalesAustralia
| | - Andrew Haydon
- Department of Medical OncologyAlfred HospitalMelbourneVictoriaAustralia
| | - Robin Room
- Centre for Alcohol Policy ResearchLa Trobe UniversityBundooraVictoriaAustralia
- Centre for Social Research on Alcohol and Drugs, Department of Public Health SciencesStockholm UniversityStockholmSweden
| | - John L. Hopper
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, The University of MelbourneMelbourneVictoriaAustralia
| | - Elisabete Weiderpass
- Office of the Director, International Agency for Research on Cancer, World Health OrganizationLyonFrance
| | - Marc J. Gunter
- Nutritional Epidemiology Group, International Agency for Research on Cancer, World Health OrganizationLyonFrance
| | - Elio Riboli
- Department of Epidemiology and BiostatisticsSchool of Public Health, Imperial College LondonLondonUK
| | - Graham G. Giles
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneVictoriaAustralia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, The University of MelbourneMelbourneVictoriaAustralia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash UniversityClaytonVictoriaAustralia
| | - Roger L. Milne
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneVictoriaAustralia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, The University of MelbourneMelbourneVictoriaAustralia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash UniversityClaytonVictoriaAustralia
| | - Antonio Agudo
- Unit of Nutrition and Cancer, Catalan Institute of Oncology ‐ ICO, Nutrition and Cancer Group, Bellvitge Biomedical Research Institute ‐ IDIBELL, L'Hospitalet de LlobregatBarcelonaSpain
| | - Dallas R. English
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneVictoriaAustralia
- Centre for Epidemiology and BiostatisticsMelbourne School of Population and Global Health, The University of MelbourneMelbourneVictoriaAustralia
| | - Pietro Ferrari
- Nutritional Methodology and Biostatistics Group, International Agency for Research on Cancer, World Health OrganizationLyonFrance
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