Abstract
STUDY OBJECTIVE: To study the association between socioeconomic status (SES) and stomach cancer incidence (cardia and non-cardia) and the role of lifestyle factors in explaining this association. DESIGN: Prospective cohort study on diet and cancer that started in 1986. Data were collected by means of a self administered questionnaire. SETTING: Population originating from 204 municipalities in the Netherlands. PARTICIPANTS: 58,279 men aged 55-69 years. After 4.3 years of follow up, 162 incident stomach cancer cases were detected (49 cardia and 113 non-cardia cases). MAIN RESULTS AND CONCLUSIONS: After adjustment for age, a lower overall stomach cancer risk was found for men with the highest attained level of education (RR highest/lowest level = 0.54, 95% CI 0.33, 0.89, trend, p = 0.02). This association became less strong after additional adjustment for smoking, intake of vitamin C, beta carotene, alcohol and coffee, family history of stomach cancer, and history of stomach disorders (RR = 0.61, 95% CI 0.34, 1.07, trend, p = 0.11). No clear association was found between occupation based SES indicators and stomach cancer risk. Analyses per subsite of stomach cancer revealed that for people with the highest level of education the age adjusted rate ratio for cardia cancer changed from 0.37 (95% CI = 0.13, 1.00) to 0.60 (95% CI = 0.19, 1.87) after additional adjustment for lifestyle variables, whereas the rate ratio for non-cardia cancer (RR = 0.59, 95% CI 0.33, 1.05) did not change after additional adjustment.
Full Text
The Full Text of this article is available as a PDF (137.0 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Baquet C. R., Horm J. W., Gibbs T., Greenwald P. Socioeconomic factors and cancer incidence among blacks and whites. J Natl Cancer Inst. 1991 Apr 17;83(8):551–557. doi: 10.1093/jnci/83.8.551. [DOI] [PubMed] [Google Scholar]
- Block G., Sorenson A. Vitamin C intake and dietary sources by demographic characteristics. Nutr Cancer. 1987;10(1-2):53–65. doi: 10.1080/01635588709513940. [DOI] [PubMed] [Google Scholar]
- Choi S. Y., Kahyo H. Effect of cigarette smoking and alcohol consumption in the etiology of cancers of the digestive tract. Int J Cancer. 1991 Sep 30;49(3):381–386. doi: 10.1002/ijc.2910490312. [DOI] [PubMed] [Google Scholar]
- Cipriani F., Buiatti E., Palli D. Gastric cancer in Italy. Ital J Gastroenterol. 1991 Sep-Oct;23(7):429–435. [PubMed] [Google Scholar]
- Cuello C., Correa P., Haenszel W. Socio-economic class differences in cancer incidence in Cali, Colombia. Int J Cancer. 1982 Jun 15;29(6):637–643. doi: 10.1002/ijc.2910290607. [DOI] [PubMed] [Google Scholar]
- De Stefani E., Correa P., Fierro L., Carzoglio J., Deneo-Pellegrini H., Zavala D. Alcohol drinking and tobacco smoking in gastric cancer. A case-control study. Rev Epidemiol Sante Publique. 1990;38(4):297–307. [PubMed] [Google Scholar]
- Dockerty J. D., Marshall S., Fraser J., Pearce N. Stomach cancer in New Zealand: time trends, ethnic group differences and a cancer registry-based case-control study. Int J Epidemiol. 1991 Mar;20(1):45–53. doi: 10.1093/ije/20.1.45. [DOI] [PubMed] [Google Scholar]
- Ferraroni M., Negri E., La Vecchia C., D'Avanzo B., Franceschi S. Socioeconomic indicators, tobacco and alcohol in the aetiology of digestive tract neoplasms. Int J Epidemiol. 1989 Sep;18(3):556–562. doi: 10.1093/ije/18.3.556. [DOI] [PubMed] [Google Scholar]
- Forman D., Newell D. G., Fullerton F., Yarnell J. W., Stacey A. R., Wald N., Sitas F. Association between infection with Helicobacter pylori and risk of gastric cancer: evidence from a prospective investigation. BMJ. 1991 Jun 1;302(6788):1302–1305. doi: 10.1136/bmj.302.6788.1302. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Goldbohm R. A., Hertog M. G., Brants H. A., van Poppel G., van den Brandt P. A. Consumption of black tea and cancer risk: a prospective cohort study. J Natl Cancer Inst. 1996 Jan 17;88(2):93–100. doi: 10.1093/jnci/88.2.93. [DOI] [PubMed] [Google Scholar]
- Gray J. R., Coldman A. J., MacDonald W. C. Cigarette and alcohol use in patients with adenocarcinoma of the gastric cardia or lower esophagus. Cancer. 1992 May 1;69(9):2227–2231. doi: 10.1002/1097-0142(19920501)69:9<2227::aid-cncr2820690903>3.0.co;2-q. [DOI] [PubMed] [Google Scholar]
- Hansson L. E., Baron J., Nyrén O., Bergström R., Wolk A., Adami H. O. Tobacco, alcohol and the risk of gastric cancer. A population-based case-control study in Sweden. Int J Cancer. 1994 Apr 1;57(1):26–31. doi: 10.1002/ijc.2910570106. [DOI] [PubMed] [Google Scholar]
- Hansson L. E., Baron J., Nyrén O., Bergström R., Wolk A., Lindgren A., Adami H. O. Early-life risk indicators of gastric cancer. A population-based case-control study in Sweden. Int J Cancer. 1994 Apr 1;57(1):32–37. doi: 10.1002/ijc.2910570107. [DOI] [PubMed] [Google Scholar]
- Hoey J., Montvernay C., Lambert R. Wine and tobacco: risk factors for gastric cancer in France. Am J Epidemiol. 1981 Jun;113(6):668–674. doi: 10.1093/oxfordjournals.aje.a113146. [DOI] [PubMed] [Google Scholar]
- Inoue M., Tajima K., Hirose K., Kuroishi T., Gao C. M., Kitoh T. Life-style and subsite of gastric cancer--joint effect of smoking and drinking habits. Int J Cancer. 1994 Feb 15;56(4):494–499. doi: 10.1002/ijc.2910560407. [DOI] [PubMed] [Google Scholar]
- Jedrychowski W., Wahrendorf J., Popiela T., Rachtan J. A case-control study of dietary factors and stomach cancer risk in Poland. Int J Cancer. 1986 Jun 15;37(6):837–842. doi: 10.1002/ijc.2910370607. [DOI] [PubMed] [Google Scholar]
- La Vecchia C., Negri E., Franceschi S., Gentile A. Family history and the risk of stomach and colorectal cancer. Cancer. 1992 Jul 1;70(1):50–55. doi: 10.1002/1097-0142(19920701)70:1<50::aid-cncr2820700109>3.0.co;2-i. [DOI] [PubMed] [Google Scholar]
- Liberatos P., Link B. G., Kelsey J. L. The measurement of social class in epidemiology. Epidemiol Rev. 1988;10:87–121. doi: 10.1093/oxfordjournals.epirev.a036030. [DOI] [PubMed] [Google Scholar]
- Palli D., Bianchi S., Decarli A., Cipriani F., Avellini C., Cocco P., Falcini F., Puntoni R., Russo A., Vindigni C. A case-control study of cancers of the gastric cardia in Italy. Br J Cancer. 1992 Feb;65(2):263–266. doi: 10.1038/bjc.1992.52. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Palli D., Galli M., Caporaso N. E., Cipriani F., Decarli A., Saieva C., Fraumeni J. F., Jr, Buiatti E. Family history and risk of stomach cancer in Italy. Cancer Epidemiol Biomarkers Prev. 1994 Jan-Feb;3(1):15–18. [PubMed] [Google Scholar]
- Parsonnet J. Helicobacter pylori and gastric cancer. Gastroenterol Clin North Am. 1993 Mar;22(1):89–104. [PubMed] [Google Scholar]
- Powell J., McConkey C. C. Increasing incidence of adenocarcinoma of the gastric cardia and adjacent sites. Br J Cancer. 1990 Sep;62(3):440–443. doi: 10.1038/bjc.1990.314. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pukkala E., Teppo L. Socioeconomic status and education as risk determinants of gastrointestinal cancer. Prev Med. 1986 Mar;15(2):127–138. doi: 10.1016/0091-7435(86)90083-6. [DOI] [PubMed] [Google Scholar]
- Sterling T. D., Weinkam J. J. Smoking patterns by occupation, industry, sex, and race. Arch Environ Health. 1978 Nov-Dec;33(6):313–317. doi: 10.1080/00039896.1978.10667354. [DOI] [PubMed] [Google Scholar]
- Taylor D. N., Blaser M. J. The epidemiology of Helicobacter pylori infection. Epidemiol Rev. 1991;13:42–59. doi: 10.1093/oxfordjournals.epirev.a036078. [DOI] [PubMed] [Google Scholar]
- Trichopoulos D., Ouranos G., Day N. E., Tzonou A., Manousos O., Papadimitriou C., Trichopoulos A. Diet and cancer of the stomach: a case-control study in Greece. Int J Cancer. 1985 Sep 15;36(3):291–297. [PubMed] [Google Scholar]
- Van den Brandt P. A., Schouten L. J., Goldbohm R. A., Dorant E., Hunen P. M. Development of a record linkage protocol for use in the Dutch Cancer Registry for Epidemiological Research. Int J Epidemiol. 1990 Sep;19(3):553–558. doi: 10.1093/ije/19.3.553. [DOI] [PubMed] [Google Scholar]
- Vågerö D., Persson G. Occurrence of cancer in socioeconomic groups in Sweden. An analysis based on the Swedish Cancer Environment Registry. Scand J Soc Med. 1986;14(3):151–160. doi: 10.1177/140349488601400308. [DOI] [PubMed] [Google Scholar]
- Williams J., Clifford C., Hopper J., Giles G. Socioeconomic status and cancer mortality and incidence in Melbourne. Eur J Cancer. 1991;27(7):917–921. doi: 10.1016/0277-5379(91)90147-6. [DOI] [PubMed] [Google Scholar]
- Williams R. R., Horm J. W. Association of cancer sites with tobacco and alcohol consumption and socioeconomic status of patients: interview study from the Third National Cancer Survey. J Natl Cancer Inst. 1977 Mar;58(3):525–547. doi: 10.1093/jnci/58.3.525. [DOI] [PubMed] [Google Scholar]
- Wu-Williams A. H., Yu M. C., Mack T. M. Life-style, workplace, and stomach cancer by subsite in young men of Los Angeles County. Cancer Res. 1990 May 1;50(9):2569–2576. [PubMed] [Google Scholar]
- Yang P. C., Davis S. Epidemiological characteristics of adenocarcinoma of the gastric cardia and distal stomach in the United States, 1973-1982. Int J Epidemiol. 1988 Jun;17(2):293–297. doi: 10.1093/ije/17.2.293. [DOI] [PubMed] [Google Scholar]
- Zurayk H., Halabi S., Deeb M. Measures of social class based on education for use in health studies in developing countries. J Epidemiol Community Health. 1987 Jun;41(2):173–179. doi: 10.1136/jech.41.2.173. [DOI] [PMC free article] [PubMed] [Google Scholar]
- van den Brandt P. A., Goldbohm R. A., van 't Veer P., Volovics A., Hermus R. J., Sturmans F. A large-scale prospective cohort study on diet and cancer in The Netherlands. J Clin Epidemiol. 1990;43(3):285–295. doi: 10.1016/0895-4356(90)90009-e. [DOI] [PubMed] [Google Scholar]
- van den Brandt P. A., van't Veer P., Goldbohm R. A., Dorant E., Volovics A., Hermus R. J., Sturmans F. A prospective cohort study on dietary fat and the risk of postmenopausal breast cancer. Cancer Res. 1993 Jan 1;53(1):75–82. [PubMed] [Google Scholar]