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Anthropometric and reproductive factors and risk of esophageal and gastric cancer by subtype and subsite: Results from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort |
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| Authors: | Harinakshi Sanikini David C Muller Marisa Sophiea Sabina Rinaldi Antonio Agudo Eric J Duell Elisabete Weiderpass Kim Overvad Anne Tjønneland Jytte Halkjær Marie-Christine Boutron-Ruault Franck Carbonnel Iris Cervenka Heiner Boeing Rudolf Kaaks Tilman Kühn Antonia Trichopoulou Georgia Martimianaki Anna Karakatsani Valeria Pala Domenico Palli Amalia Mattiello Rosario Tumino Carlotta Sacerdote Guri Skeie Charlotta Rylander María-Dolores Chirlaque López Maria-Jose Sánchez Eva Ardanaz Sara Regnér Tanja Stocks Bas Bueno-de-Mesquita Roel CH Vermeulen Dagfinn Aune Tammy YN Tong Nathalie Kliemann Neil Murphy Marc Chadeau-Hyam Marc J Gunter Amanda J Cross |
| Institution: | 1. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom;2. Section of Nutrition and Metabolism, International Agency for Research on Cancer, Lyon, France;3. Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain;4. Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Genetic Epidemiology Group, Folkhälsan Research Center, Faculty of Medicine, University of Helsinki, Helsinki, Finland;5. Department of Public Health, Aarhus University, Aarhus, Denmark;6. Danish Cancer Society Research Center, Copenhagen, Denmark;7. CESP, Faculté de Médecine, Université Paris-Sud, Villejuif, France Faculté de Médecine, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France Institut Gustave Roussy, Villejuif, France;8. CESP, Faculté de Médecine, Université Paris-Sud, Villejuif, France Faculté de Médecine, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France Institut Gustave Roussy, Villejuif, France Department of Gastroenterology, Bicêtre University Hospital, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France;9. Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke, Nuthetal, Germany;10. Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany;11. Hellenic Health Foundation, Athens, Greece;12. Hellenic Health Foundation, Athens, Greece Pulmonary Medicine Department, School of Medicine, National and Kapodistrian University of Athens, “ATTIKON” University Hospital, Haidari, Greece;13. Epidemiology and Prevention Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy;14. Cancer Risk Factors and Life-Style Epidemiology Unit, Institute for Cancer Research, Prevention and Clinical Network-ISPRO, Florence, Italy;15. Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy;16. Cancer Registry and Histopathology Department, "Civic - M. P. Arezzo" Hospital, ASP, Ragusa, Italy;17. Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), Turin, Italy;18. Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway;19. Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain Department of Health and Social Sciences, Murcia University, Murcia, Spain;20. Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs, GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain;21. Navarra Public Health Institute, Pamplona, Spain IdiSNA Navarra Institute for Health Research, Pamplona, Spain CIBER Epidemiology and Public Health CIBERESP, Madrid, Spain;22. Institution of Clinical Sciences Malmö, Skåne University Hospital, Lund University, Sweden;23. Department of Clinical Sciences, Lund University, Lund, Sweden;24. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia;25. Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands Julius Centre for Public Health Sciences and Primary Care, Utrecht University Medical Centre, Utrecht, The Netherlands;26. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom Department of Nutrition, Bjørknes University College, Oslo, Norway Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway;27. Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom |
| Abstract: | Obesity has been associated with upper gastrointestinal cancers; however, there are limited prospective data on associations by subtype/subsite. Obesity can impact hormonal factors, which have been hypothesized to play a role in these cancers. We investigated anthropometric and reproductive factors in relation to esophageal and gastric cancer by subtype and subsite for 476,160 participants from the European Prospective Investigation into Cancer and Nutrition cohort. Multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox models. During a mean follow-up of 14 years, 220 esophageal adenocarcinomas (EA), 195 esophageal squamous cell carcinomas, 243 gastric cardia (GC) and 373 gastric noncardia (GNC) cancers were diagnosed. Body mass index (BMI) was associated with EA in men (BMI ≥30 vs. 18.5–25 kg/m2: HR = 1.94, 95% CI: 1.25–3.03) and women (HR = 2.66, 95% CI: 1.15–6.19); however, adjustment for waist-to-hip ratio (WHR) attenuated these associations. After mutual adjustment for BMI and HC, respectively, WHR and waist circumference (WC) were associated with EA in men (HR = 3.47, 95% CI: 1.99–6.06 for WHR >0.96 vs. <0.91; HR = 2.67, 95% CI: 1.52–4.72 for WC >98 vs. <90 cm) and women (HR = 4.40, 95% CI: 1.35–14.33 for WHR >0.82 vs. <0.76; HR = 5.67, 95% CI: 1.76–18.26 for WC >84 vs. <74 cm). WHR was also positively associated with GC in women, and WC was positively associated with GC in men. Inverse associations were observed between parity and EA (HR = 0.38, 95% CI: 0.14–0.99; >2 vs. 0) and age at first pregnancy and GNC (HR = 0.54, 95% CI: 0.32–0.91; >26 vs. <22 years); whereas bilateral ovariectomy was positively associated with GNC (HR = 1.87, 95% CI: 1.04–3.36). These findings support a role for hormonal pathways in upper gastrointestinal cancers. |
| Keywords: | obesity reproductive hormones esophageal gastric cancer |