食管癌高发区1.5万队列人群内镜筛查与食管癌胃癌死亡研究

目的:磁县是我国北方食管癌高发区.河北医科大学第四医院肿瘤研究所自2001年开展40～69岁为目标人群的内镜碘染色队列筛查,以期降低食管癌高发区的发病率和死亡率.方法:2001年10月～2002年10月选择磁县4个乡,干预人群22016例,对照人群33410例,总覆盖人群5.5万,其中干预人群40～69岁中男性3 257例,女性3 339例,对照人群中男性4 299例,女性4 430例.干预人群采用内镜碘染色筛查,筛查率53.2%.内镜碘染色筛查食管鳞状上皮和贲门腺上皮原位癌及黏膜内癌97例,食管和贲门重度不典型增生102例;对照人群观察肿瘤自然发病率和死亡率.肿瘤发病死亡登记编码应用ICD-0-2.2008年6月～9月根据全县肿瘤发病死亡登记数据库,对该队列人群进行随访核实.结果:干预人群食管癌死亡133例,胃癌48例,对照组人群分别为259例和37例.男性食管癌死亡相对危险度RR=0.76,95%CI(0.59～0.98),P=0.038;女性RR=0.51,95%CI(0.35～0.75),P=0.000.男性胃癌死亡相对危险度RR=2.45,95%CI(1.4～4.29).P=0.010;女性RR=0.99,95%CI(0.47～1.99),P=0.906.结论:食管癌高发区内镜碘染色大人群队列筛查历经6年时间演变,男性和女性食管癌死亡危险度下降,有显著性差异,但内镜筛查对胃癌死亡危险未见到保护作用.     

兰州市2005～2008年胃癌、食管癌发病状况分析

[目的]了解2005～2008年兰州市居民胃癌、食管癌发病状况,确定重点防治人群,为制定胃癌、食管癌防治干预措施提供科学依据.[方法]采用肿瘤登记报告的方法,收集兰州市2005年1月1日至2008年12月31日常住人口中所有恶性肿瘤病例,对胃癌、食管癌登记报告资料进行统计分析.[结果] 2005～2008年兰州市共报告胃癌2 162例,食管癌608例,胃癌发病率30.82/10万(中标率25.29/10万),食管癌发病率8.67/10万(中标率7.30/10万),分别占全部恶性肿瘤的14.76％和4.15％,居恶性肿瘤发病第2位和第7位.胃癌和食管癌的高发年龄集中在50岁以后.2005～2008年,兰州市男、女性胃癌发病率均呈下降趋势,女性发病率下降趋势有统计学意义(趋势性x2=4.486,P=0.034),但男性发病率下降无统计学意义(趋势性x2=0.779,P=0.377);食管癌发病率男性略微下降,女性略微上升,但变化趋势均无统计学意义(女性趋势性x2=0.919,P=0.338;男性趋势性x2=0.699,P=0.403).[结论]尽管胃癌发病呈下降趋势,胃癌、食管癌对兰州居民危害严重,但仍是兰州市主要防治的肿瘤.胃癌和食管癌重点防治对象是50岁以上男性人群,应加强对该人群的定期筛查和健康教育.     

江苏省恶性肿瘤低发区食管癌危险因素研究

[目的]探讨江苏省恶性肿瘤低发地区食管癌发病的有关危险因素及保护因素.[方法]在江苏省恶性肿瘤低发的赣榆地区进行了食管癌1:1配对病例对照研究,共调查病例与对照各95例,应用条件Logistic回归对相关因素进行单因素和多因素分析.[结果]热烫饮食(OR=2.066,95%CI=1.116～3.828)、饮酒(OR=3.206,95%CI=1.866～5.509)为该地区食管癌发病的主要危险因素,而生吃大蒜(OR=0.423,95%CI=0.209～0.856)、喜食蔬菜(OR=0.485,95%CI=0.267～0.881)、喜食干果(OR=0.333,95%CI=0..168～0.660)和性格开朗(OR=0.469,95%CI=0.254～0.866)则为该地区食管癌的主要保护因素.[结论]在江苏肿瘤低发区热烫饮食、饮酒仍是食管癌的危险因素,而生吃大蒜、蔬菜、干果和性格开朗是保护因素.     

1988至2007年磁县食管癌和胃癌发病趋势分析

根据磁县肿瘤登记处数据,分析1988年-2007年食管癌胃癌发病趋势变化。方法:截取1988年-2007年发病数据库ICD编码C15.0～C15.9和C16.0～C16.9,采用y=α+βχ+ε线性模型,计算年度变化百分比（APC）。结果:食管癌发病总体呈现下降趋势,其男女合计总发病APC=-1.15%,P=0.002;女性APC=-1.47%,P=0.008;男性APC=-0.94%,P=0.119。胃癌发病呈上升趋势,男女合计总体胃癌APC=1.3%,男性APC=1.5%,差异均有统计学意义;女性APC=1.3%,P=0.083。亚部位分析贲门癌发病上升最为明显,占胃癌发病总数的40.0%,男女合计总发病APC=8.07%。其中女性6.51%,男性8.07%,差异均有统计学意义。食管癌、贲门癌2个解剖部位肿瘤合并分析,发病趋势下降,但是差异无统计学意义。结论:磁县近20年贲门癌发病增长最快,而食管癌发病下降,胃癌发病的上升与ICD编码规则关系密切。      

绿茶与消化系统恶性肿瘤流行病学研究的Meta分析

[目的]探讨绿茶与消化系统恶性肿瘤发生的关系。[方法]利用MEDLINE、EM-BASE、中国生物医学文献数据库、万方数据库,检索1979年1月～2010年1月国内外公开发表的关于绿茶与消化系统恶性肿瘤关系的病例对照研究和队列研究文献,利用R软件及其Meta程序包对检索结果进行综合分析。[结果]纳入本次Meta分析的文献共83篇。经Meta分析综合后,与不饮绿茶或饮绿茶较少者相比,饮绿茶较多者的相对危险度值及其95%可信区间为0.88(95%CI:0.81～0.95)。其中绿茶可以降低胃癌的发病风险,合并RR为0.73(95%CI:0.57～0.93),有统计学意义;绿茶对食管癌、结肠癌、胰腺癌的保护作用没有统计学意义,其合并RR分别为0.89(95%CI:0.71～1.13),0.96(95%CI:0.84～1.10),0.73(95%CI:0.45～1.19);而肝癌的结果0.77(95%CI:0.57～1.03)处于临界统计学意义的水平。此外,亚组分析提示绿茶对女性食管癌有保护作用,合并RR为0.32(95%CI:0.17～0.59)。绿茶与直肠癌合并的RR为1.10(95%CI:0.97～1.24),结果没有统计学意义。[结论]绿茶与消化系统恶性肿瘤之间有比较密切的关系,可能是胃癌、肝癌、食管癌(女性)等消化系统恶性肿瘤的保护因素之一。     

四川盐亭与河北磁县1988~2007年贲门癌发病趋势分析

[目的]根据四川盐亭和河北磁县肿瘤登记处数据,比较1988～2007年中国两个不同地域食管癌高发区贲门癌发病趋势的变化.[方法]截取1988～2007年发病数据库ICD编码C16.0,组织学诊断比例76.4％～78.8％.贲门癌的发病采用y=α+βx+ε线性模型,计算年度变化百分比(APC).[结果]四川盐亭1988年贲门癌中标率为11.04/10万,2007年17.66/10万;河北磁县则分别为7.62/10万和37.41/10万.四川盐亭贲门癌发病呈明显上升,男女合计贲门癌发病APC为5.89％,其中男性2.87％,女性2.84％,有统计学差异;河北磁县贲门癌发病的APC分别为7.66％、8.13％和6.46％(P=0.000).[结论]中国两个不同地域食管癌高发区人群20年贲门癌发病均呈现明显的增长趋势,发病显著增高的原因与ICD编码规则和内镜的临床广泛应用关系密切.     

吸烟与食管癌发病关系的前瞻性研究

目的:进一步探讨吸烟与食管癌发病的关系。方法:采用前瞻性队列的研究方法。随访对象为1986年—1991年中美合作林县营养干预试验中的普通人群组,所有受试对象符合试验条件并完成了基线调查的全部内容。该研究从1986年3月开始,随访截止到2001年12月31日,共15a。采用相对危险度(RR)等指标对吸烟的作用大小进行评估。结果:吸烟增加了食管癌发病的危险性,相对危险度RR=1.289(95%CI=1.133~1.466),P=0.000。吸烟指数与食管癌的发病率存在剂量反应关系,χ2=17.905,P=0.000。结论:在食管癌高发区林县,吸烟是食管癌发病的危险因素之一,并且随吸烟指数的增加食管癌发病的相对危险度呈增加的趋势。     

食管癌术后辅助治疗的Meta分析

[目的]探讨食管癌术后辅助治疗的价值.[方法]收集1995年至2011年期间发表的关于食管癌术后辅助治疗的随机对照研究文章,利用Stata12.0软件进行Meta分析.[结果]与单纯手术相比,术后辅助化疗患者的3年无进展生存率相对危险度(RR)为1.225 (95％CI:1.012～1.482,P=0.037),差异有统计学意义.而3、5年总生存率的RR值分别为0.899(95％CI:0.797～1.016,P=0.087),1.183(95％CI:0.97～1.442,P=0.098),差异无统计学意义.同样,与单纯手术相比,术后辅助放疗患者的3年总生存率的RR值为0.935 (95％CI:0.879～0.994,P=0.033),差异有统计学意义.而5年总生存率的RR值为0.988(95％CI:0.821～1.188,P=0.897),差异无统计学意义.Begg's与Egger试验检测P值均大于0.05,不存在发表偏倚.[结论]术后辅助化疗能延长食管癌患者术后的3年无进展生存率,术后辅助放疗不利于延长食管癌患者的3年总生存率.     

林州市2005年恶性肿瘤发病死亡资料分析

[目的]分析林州市2005年恶性肿瘤发病及死亡情况,为林州市肿瘤预防提供科学依据。[方法]对2005年的恶性肿瘤发病、死亡资料进行分析,计算发病、死亡数,粗发病率、中标率、世标率、累积率、构成比等,对登记质量考核指标进行了分析。[结果]男女恶性肿瘤发病率分别为217.79/10万和156.43/10万。男女恶性肿瘤死亡率分别为176.87/10万和127.67/10万。男性发病中标率前十位依次是食管癌、贲门癌、胃癌(不包括贲门癌)、气管支气管和肺癌、肝癌、结肠和直肠癌、脑瘤、白血病、胰腺癌、泌尿道肿瘤;女性发病中标率前十位依次是食管癌、贲门癌、胃癌(不包括贲门癌)、肝癌、结肠和直肠癌、气管支气管和肺癌、子宫癌、乳腺癌、白血病、骨癌。[结论]恶性肿瘤仍然是威胁林州人民的主要疾病,除食管癌、胃癌等有下降趋势外,肝癌、肺癌、乳腺癌、子宫癌、肠癌、胰腺癌等都有上升趁势。     

浙江省仙居县2010~2014年上消化道癌发病、死亡分析及早诊早治效果评价

[目的]分析2010～2014年仙居县上消化道癌(食管癌、胃癌)发病与死亡情况及上消化道癌早诊早治效果评价,为上消化道癌的防治提供科学依据.[方法]利用2010～2014年仙居县肿瘤登记数据中上消化道癌(食管癌、胃癌)发病、死亡数据和上消化道癌早诊早治项目筛查资料,分析仙居县近年上消化道癌发病、死亡水平及变化趋势、评价筛查效果.[结果]仙居县2010～2014年食管癌发病率为37.46/10万(男性44.62/10万,女性29.74/10万),死亡率为24.32/10万(男性29.77/10万,女性18.44/10万);胃癌发病率为82.48/10万(男性112.32/10万,女性50.25/10万),死亡率为52.80/10万(男性73.39/10万,女性30.57/10万).食管癌中标发病率APC为-10.0％(95％CI:-14.1％～.5.6％)、食管癌中标死亡率APC为-10.7％(95％CI:-20.2％～-0.1％)、胃癌中标发病率APC为-9.1％(95％CI:-15.1％～-2.8％)、胃癌中标死亡率APC为-8.6％(95％CI:-14.2％～-2.7％)均呈明显下降趋势,具有统计学意义.2010～2014年仙居上消化道癌早诊早治项目共完成临床筛查8532人,筛查任务完成率为100.38％,检出率为1.11％,早诊率为77.89％,治疗率为98.95％.[结论]仙居县上消化道癌发病、死亡虽然呈下降趋势,但形势依然严峻,上消化道癌筛查及早诊早治不断深入开展不仅对提高患者生存质量和生存时间有重要意义,更将对仙居县上消化道癌发病、死亡产生长远影响.     

Prospective study of serum selenium levels and incident esophageal and gastric cancers

BACKGROUND: From March 1986 through May 1991, we conducted a randomized nutritional intervention trial, the General Population Trial, in Linxian, China, a region with epidemic rates of squamous esophageal and adenomatous gastric cardia cancers. We found that participants who received selenium, beta-carotene, and vitamin E had significantly lower cancer mortality rates than those who did not. In the current study, we examined the relationship between selenium levels measured in pretrial (1985) sera from participants and the subsequent risk of developing squamous esophageal, gastric cardia, and gastric non-cardia cancers during the trial. METHODS: This study was designed and analyzed in accord with a stratified case-cohort sampling scheme, with the six strata defined by sex and three age categories. We measured serum selenium levels in 590 case subjects with esophageal cancer, 402 with gastric cardia cancers, and 87 with gastric non-cardia cancers as well as in 1062 control subjects. Relative risks (RRs), absolute risks, and population attributable risk for cancers were estimated on the basis of the Cox proportional hazards models. All statistical tests are two-sided. RESULTS: We found highly significant inverse associations of serum selenium levels with the incidence of esophageal (P: for trend <10(-4)) and gastric cardia (P: for trend <10(-6)) cancers. The RR and 95% confidence interval (CI) for comparison of highest to lowest quartile of serum selenium was 0.56 (95% CI = 0.44-0.71) for esophageal cancer and 0.47 (95% CI = 0.33-0.65) for gastric cardia cancer. The population proportion of these cancers that is attributable to low selenium levels was 26.4% (95% CI = 14.45-38.36). We found no evidence for a gradient of serum selenium associated with incidence of gastric non-cardia cancer (P: for trend =.96), with an RR of 1.07 (95% CI = 0.55-2.08) for the highest to lowest quartile of serum selenium. CONCLUSIONS: Our study supports findings from previous prospective studies and randomized trials that variations in selenium levels affect the incidence of certain cancers. In the United States, where intervention trials of selenium are in the planning stages, consideration should be given to including populations at high risk for squamous esophageal and gastric cardia cancers.     

The road to the discovery of the p53 protein: The Steiner Cancer Prize Award Lecture

Linxian, China has some of the highest rates of esophageal/gastric cardia cancer in the world. In 1983, esophageal balloon cytology screening was performed in 3 communes in northern Linxian. Of the participants, 10,066 with no evidence of cancer were followed prospectively for 71/2 years to evaluate the ability of the initial cytologc diagnoses to identify individuals at increased risk for developing cancer of the esophagus or gastric cardia. A total of 747 incident cases of esophageal or cardia cancer and 322 deaths due to these tumors were identified during the follow-up period and used in this analysis. The risks for esophageal or cardia cancer incidence and mortality increased in parallel with the presumed severity of the 1983 Chinese cytologic diagnoses. After adjusting for potential confounding factors, relative risks for esophageal or cardia cancer incidence, by initial cytologic diagnosis, were normal = 1.00 (reference), hyperplasia = 1.25, dysplasia 1 = 2.20, dysplasia 2 = 4.22 and near-cancer = 5.96. Our results suggest that esophageal balloon cytology, as performed and interpreted in Linxian in 1983, successfully identified individuals at increased risk for developing cancer of the esophagus or gastric cardia. © 1994 Wiley-Liss, Inc.     

Prospective study of tooth loss and incident esophageal and gastric cancers in China

Objective: To determine the association between tooth loss and the risk of developing esophageal squamous cell carcinoma, gastric cardia adenocarcinoma, or gastric non-cardia adenocarcinoma in a prospective study. Methods: Cox proportional hazards regression was used to examine these associations in a 28,868-person cohort followed prospectively for 5.25 years. The baseline questionnaire included questions regarding tooth loss, and individuals reporting lost teeth had their teeth counted by study personnel. The analytic cohort included 620 esophagus, 431 gastric cardia, and 102 gastric non-cardia cancer cases. Results: Tooth loss was associated with a significantly elevated risk of developing all three cancers. When examined as median splits, tooth loss was associated with a relative risk (RR) (95% confidence interval, CI) of 1.3 (1.1–1.6) in the esophagus, 1.3 (1.0–1.6) in the gastric cardia, and 1.8 (1.1–3.0) in the gastric non-cardia. Further analysis demonstrated that this increased risk was most strongly associated with the loss of the first few teeth and was primarily confined to the younger members of our cohort. Conclusions: In this cohort tooth loss increased the risk of developing upper gastrointestinal cancer. We hypothesize that this may be related to alterations in oral bacterial flora and subsequent increases in the in-vivo production of carcinogens such as nitrosamines.     

牙齿缺失对食管癌的生存分析

目的 探讨牙齿缺失与食管癌生存的关系.方法 采用前瞻性随访的方法,对来自林县营养干预试验一般人群的2743名食管癌患者随访观察24年,基线调查内容包括一般人口学信息、吸烟、饮酒、身高、体重、牙齿缺失状况等信息,Cox回归分析牙齿缺失与食管癌生存的关系.结果 5年随访研究结果表明,调整可能的混杂因素后,牙齿缺失暴露与食管...     

Family history of cancer and risk of esophageal and gastric cancers in the United States

The worldwide rates for histology- and subsite-specific types of esophageal and gastric cancer reveal strikingly divergent patterns. The contribution of environmental and genetic factors has been explored in several high-incidence areas, but data on genetic influences are scarce for Western countries. Using data from a multicenter, population-based, case-control study on 1,143 cases and 695 controls in the United States, we evaluated whether a family history of digestive or other cancers was associated with an increased risk of esophageal adenocarcinoma (n = 293), esophageal squamous cell carcinoma (n = 221), gastric cardia adenocarcinoma (n = 261) or non-cardia gastric adenocarcinoma (n = 368). After adjusting for other risk factors, individuals reporting a family history of digestive cancers experienced no increased risk of either type of esophageal cancer but they were prone to adenocarcinomas of the gastric cardia [odds ratio (OR) = 1.34, 95% confidence interval (CI) 0.91-1.97] and non-cardia segments (OR =1.46, 95% CI 1.03-2.08). This familial tendency, particularly for non-cardia gastric tumors, was largely explained by an association with family history of stomach cancer (OR = 2.52, 95% CI 1.50-4.23). In addition, family history of breast cancer was associated with increased risks of esophageal adenocarcinoma (OR = 1.74, 95% CI 1.07-2.83) and non-cardia gastric adenocarcinoma (OR = 1.76, 95% CI 1.09-2.82). Also seen were non-significant familial associations of esophageal squamous-cell cancer with prostate cancer as well as non-cardia gastric cancer with leukemia and brain tumors, though these relationships must be interpreted with caution. Our data point to the role of familial susceptibility to gastric cancer, but not to any form of esophageal cancer, in the United States.     

Helicobacter pylori seropositivity and subsite-specific gastric cancer risks in Linxian, China

BACKGROUND: Helicobacter pylori carriage (i.e., persistent exposure to the organism without gastric epithelial cell invasion) is an established risk factor for noncardia gastric cancer. However, its association with the risk of cancer of the gastric cardia is controversial. Consequently, we designed this prospective, nested case-control study to further explore the subsite-specific gastric cancer risks associated with H. pylori seropositivity (a surrogate marker for persistent exposure). METHODS: A total of 99 patients with gastric cardia cancer, 82 patients with noncardia gastric cancer, and 192 cancer-free subjects were selected from among the participants (n = 29 584) of a nutrition intervention trial previously conducted in Linxian, China. H. pylori seropositivity was determined by assaying for the presence of H. pylori whole cell and CagA antibodies in baseline serum samples from all subjects. Seropositivity was defined as one or both serum assays being positive. Odds ratios (ORs) for subsite-specific gastric cancer were estimated by multivariate logistic regression analyses. All statistical comparisons were two-sided (alpha =.05). RESULTS: H. pylori seropositivity rates for subjects with gastric cardia cancer, noncardia gastric cancer, and gastric cardia and noncardia cancers combined were 70% (P =.02), 72% (P: =.01), and 71% (P =.003) compared with 56% for cancer-free control subjects. OR estimates for H. pylori seropositivity were 1.87 (95% confidence interval [CI] = 1.10 to 3.17) for gastric cardia cancer, 2.29 (95% CI = 1.26 to 4.14) for noncardia gastric cancer, and 2.04 (95% CI = 1.31 to 3.18) for gastric cardia and noncardia cancers combined. CONCLUSIONS: H. pylori seropositivity was associated with increased risks for both gastric cardia cancer and noncardia gastric cancer in this well-characterized cohort. Thus, H. pylori carriage may increase the risk of cancer throughout the stomach.     

食管癌高发区贲门癌、胃癌流行强度分析及其对内镜筛查的启示

 目的 分析涉县等食管癌高发区贲门癌、胃癌的流行强度，明确其防治任务，探讨具体控制途径。方法 对比分析涉县、林县、磁县全人群肿瘤登记的食管癌、贲门癌、胃癌发病率与死亡率以及内镜筛查6233例40-69岁人群三种癌及癌前病变的检出率。结果 太行山南麓食管癌高发区食管癌、贲门癌和胃癌发病率或死亡率的合计占到全身恶性肿瘤的70％～80％。涉县2000-2004年贲门癌发病率男女性分别为69．9／10万和41．5／10万，死亡率男女性分别为54．3／10万和33．2／10万。高发区运用内镜碘染色指导活检技术筛查，食管鳞状上皮癌前病变及早期癌的检出率高，但贲门和胃腺上皮癌前病变及早期癌的检出率相对较低。结论 太行山南部食管癌高发区存在贲门癌和胃癌共同高发的现象，要想通过旱诊早治从整体上降低该地区上消化道癌的死亡率，必须加强内镜对贲门和胃腺上皮癌前病变及早期癌检出的研究。     

Nutrient intake and risk of subtypes of esophageal and gastric cancer.

Incidence rates for adenocarcinoma of the esophagus and gastric cardia have been rising rapidly. We examined nutrient intake as a risk factor for esophageal and gastric cancers in a population-based case-control study in Connecticut, New Jersey, and western Washington state. Interviews were completed for cases with histologically confirmed esophageal adenocarcinoma (n = 282), adenocarcinoma of the gastric cardia (n = 255), esophageal squamous cell carcinoma (n = 206), and noncardia gastric adenocarcinoma (n = 352), along with population controls (n = 687). Associations between nutrient intake and risk of cancer were estimated by adjusted odds ratios (ORs), comparing the 75th versus the 25th percentile of intake. The following nutrients were significantly inversely associated with risk of all four tumor types: fiber, beta-carotene, folate, and vitamins C and B6. In contrast, dietary cholesterol, animal protein, and vitamin B12 were significantly positively associated with risk of all four tumor types. Dietary fat [OR, 2.18; 95% confidence interval (CI), 1.27-3.76] was significantly associated with risk of esophageal adenocarcinoma only. Dietary nitrite (OR, 1.65; 95% CI, 1.26-2.16) was associated with noncardia gastric cancer only. Vitamin C supplement use was associated with a significantly lower risk for noncardia gastric cancer (OR, 0.60; 95% CI, 0.41-0.88). Higher intake of nutrients found primarily in plant-based foods was associated with a reduced risk of adenocarcinomas of the esophagus and gastric cardia, whereas higher intake of nutrients found primarily in foods of animal origin was associated with an increased risk.     

Food group intake and risk of subtypes of esophageal and gastric cancer

Incidence rates for adenocarcinomas of the esophagus and gastric cardia have been increasing rapidly, while rates for non-cardia gastric adenocarcinoma and esophageal squamous cell carcinoma have declined. We examined food group intake as a risk factor for subtypes of esophageal and gastric cancers in a multicenter, population-based case-control study in Connecticut, New Jersey and western Washington state. Associations between food groups and risk were estimated using adjusted odds ratios (OR), based on increasing intake of one serving per day. Total vegetable intake was associated with decreased risk of esophageal adenocarcinoma (OR = 0.85, 95% CI = 0.75, 0.96). Conversely, total meat intake was associated with increased risk of esophageal adenocarcinoma (OR = 1.43, 95% CI = 1.11, 1.83), gastric cardia adenocarcinoma (OR = 1.37, 95% CI = 1.08, 1.73) and noncardia gastric adenocarcinoma (OR = 1.39, 95% CI = 1.12, 1.71), with red meat most strongly associated with esophageal adenocarcinoma risk (OR = 2.49, 95% CI = 1.39, 4.46). Poultry was most strongly associated with gastric cardia adenocarcinoma (OR = 1.89, 95% CI = 1.15, 3.11) and noncardia gastric adenocarcinoma (OR = 1.90, 95% CI = 1.19, 3.03). High-fat dairy was associated with increased risk of both esophageal and gastric cardia adenocarcinoma. Higher intake of meats, particularly red meats, and lower intake of vegetables were associated with an increased risk of esophageal adenocarcinoma, while higher intake of meats, particularly poultry, and high-fat dairy was associated with increased risk of gastric cardia adenocarcinoma.     

Risk of gastroesophageal cancer among smokers and users of Scandinavian moist snuff

Although Scandinavian moist snuff ("snus"), no doubt, is a safer alternative to smoking, there is limited evidence against an association with gastroesophageal cancers. In a retrospective cohort study, we investigated esophageal and stomach cancer incidence among 336,381 male Swedish construction workers who provided information on tobacco smoking and snus habits within a health surveillance program between 1971 and 1993. Essentially complete follow-up through 2004 was accomplished through linkage to several nationwide registers. Multivariable Cox proportional hazards regression models estimated relative risks (RR) and 95% confidence intervals (CIs). Compared to never-users of any tobacco, smokers had increased risks for adenocarcinoma (RR = 2.3, 95% CI 1.4-3.7) and squamous cell carcinoma (RR = 5.2, 95% CI 3.1-8.6) of the esophagus, as well as cardia (RR = 2.1, 95% CI 1.5-3.0) and noncardia stomach (RR = 1.3, 95% CI 1.2-1.6) cancers. We also observed excess risks for esophageal squamous cell carcinoma (RR = 3.5, 95% CI 1.6-7.6) and noncardia stomach cancer (RR = 1.4, 95% CI 1.1-1.9) among snus users who had never smoked. Although confounding by unmeasured exposures, and some differential misclassification of smoking, might have inflated the associations, our study provides suggestive evidence for an independent carcinogenic effect of snus.