Abstract
Comparative epidemiological studies with ecological and case‐control approaches in high‐ and low‐epidemic areas of China have provided us with much evidence with regard to risk and benefit in the environment. To clarify how dietary factors are involved in esophageal and stomach cancer development, we performed a case‐control study in a low‐epidemic area, and compared the findings with those obtained earlier for a high‐epidemic area for stomach cancer in the same Jiangsu Province, China. We recruited 199 and 187 cases with esophageal and stomach cancers, respectively, and 333 population‐based common controls. Odds ratios (ORs) for esophageal and stomach cancers were calculated with adjustment for potential confounding factors, using an unconditional logistic model. Current and former smoking elevated the OR for esophageal cancer, along with high intake of pickled vegetables and broiled meat, while decreased ORs were observed for frequently consumed raw vegetables and garlic. With regard to stomach cancer, ORs were increased with frequent consumption of salty fish, leftover gruel, and broiled meat, and lowered by snap bean consumption. The present risk factors were common to the previously obtained results in the high‐epidemic area, and similarly distributed in each general population. While more protective factors were observed in the high‐epidemic area, their penetrance was much greater in the low‐epidemic area. The present study thus suggests that frequent vegetable and garlic consumption contributes to low mortality rates for esophageal and stomach cancers in a low‐epidemic area, counteracting similar exposure levels for risk factors as in the high‐epidemic area
.
Keywords: Dietary factors, Stomach cancer, Esophageal cancer
Full Text
The Full Text of this article is available as a PDF (82.3 KB).
REFERENCES
- 1. ) Parkin , D. , Muir , C. , Whelan , S. , Ferlay , J. , Raymond , L. and Young , J. “ Cancer Incidence in Five Continents, Vol. VII ,“ IARC Sci. Publ. No. 143 , pp. 822 – 823 ( 1997. ). IARC; , Lyon . [Google Scholar]
- 2. ) Li , L. D. , Lu , F. Z. , Zhang , S. W. , Mu , R. , Sun , X. D. , Huang–Pu , X. M. , Sun , J. , Zhou , Y. S. , Ou–Yang , L. H. , Rao , K. Q. , Chen , Y. D. , Sun , A. M. , Xue , Z. F. and Xia , Y.Trends of cancer mortality rate in China within 20 years and prediction in the future . Chin. J. Oncol. , 19 , 3 – 9 ( 1997. ) ( in Chinese ). [Google Scholar]
- 3. ) Lu , J. B. and Qin , Y. M.Correlation between high salt intake and mortality rates for oesophageal and gastric cancers in Henan Province . Chin. Int. J. Epidemiol. , 16 , 171 – 176 ( 1987. ). [DOI] [PubMed] [Google Scholar]
- 4. ) Hu , J. F. , Zhang , S. F. , Jia , E. M. , Wang , Q. Q. , Liu , S. D. , Liu , Y. Y. , Wu , Y. P. and Cheng , Y. T.Diet and cancer of the stomach: a case–control study in China . Int. J. Cancer , 41 , 331 – 335 ( 1988. ). [DOI] [PubMed] [Google Scholar]
- 5. ) You , W. C. , Blot , W. J. , Chang , Y. S. , Ershow , A. G. , Yang , Z. T. , An , Q. , Henderson , B. , Xu , G. W. , Fraumeni , J. F. , Jr. and Wang , T. G.Diet and high risk of stomach cancer in Shandong, China . Cancer Res. , 48 , 3518 – 3523 ( 1988. ). [PubMed] [Google Scholar]
- 6. ) Kneller , R. W. , Gao , Y. T. , McLaughlin , J. K. , Gao , R. N. , Blot , W. J. , Liu , M. H. , Sheng , J. P. and Fraumeni , J. F. , Jr.Occupational risk factors for gastric cancer in Shanghai, China . Am. J. Ind. Med. , 18 , 69 – 78 ( 1990. ). [DOI] [PubMed] [Google Scholar]
- 7. ) You , W. C. , Chang , Y. S. , Yang , Z. T. , Zhang , L. , Xu , G. W. , Blot , W. J. , Kneller , R. , Keefer , L. K. and Fraumeni , J. F. , Jr.Etiological research on gastric cancer and its precursor lesions in Shandong, China . IARC Sci. Publ , 105 , 33 – 38 ( 1991. ). [PubMed] [Google Scholar]
- 8. ) Wang , R.The epidemiological study of subtype risk factors of gastric cancer . Chin. J. Epidemiol , 14 , 295 – 299 ( 1993. ) ( in Chinese ). [PubMed] [Google Scholar]
- 9. ) Gao , C.‐M. , Takezaki , T. , Ding , J.‐H. , Li , M.‐S. and Tajima , K.Protective effect of allium vegetables against both esophageal and stomach cancer: a simultaneous case‐referent study of a high‐epidemic area in Jiangsu Province, China . Jpn. J. Cancer Res. , 90 , 614 – 621 ( 1999. ). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10. ) Ji , B. T. , Chow , W. H. , Yang , G. , McLaughlin , J. K. , Zheng , W. , Shu , X. O. , Jin , R , Gao , R. N. , Gao , Y. T. and Fraumeni , J. F. , Jr.Dietary habits and stomach cancer in Shanghai, China . Int. J. Cancer , 76 , 659 – 664 ( 1998. ). [DOI] [PubMed] [Google Scholar]
- 11. ) You , W. C , Blot , W. J. , Chang , Y. S. , Ershow , A. , Yang , Z. T. , An , Q. , Henderson , B. E. , Fraumeni , J. F. , Jr. and Wang , T. G.Allium vegetables and reduced risk of stomach cancer . J. Natl. Cancer Inst , 81 , 162 – 164 ( 1989. ). [DOI] [PubMed] [Google Scholar]
- 12. ) World Cancer Research Fund in Association with American Institute for Cancer Research . Oesophagus . In “ Food, Nutrition and the Prevention of Cancer: a Global Perspective ,“ pp. 118 – 129 ( 1997. ). American Institute for Cancer Research; , Washington , D.C. [Google Scholar]
- 13. ) Takezaki , T. , Gao , C. M. , Ding , J. H. , Liu , T. K. , Li , M. S. and Tajima , K.Comparative study of lifestyles of residents in high and low risk areas for gastric cancer in Jiangsu Province, China; with special reference to allium vegetables . J. Epidemiol. , 9 , 297 – 305 ( 1999. ). [DOI] [PubMed] [Google Scholar]
- 14. ) Buiatti , E. , Palli , D. , Decarli , A. , Amadori , D. , Avellini , C. , Bianchi , S. , Biserni , R. , Cipriani , F. , Cocco , P. , Giacosa , A. , Marubini , E. , Puntoni , R. , Vindigni , C. , Fraumeni , J. F. , Jr. and Blot , W.A case–control study of gastric cancer and diet in Italy . Int. J. Cancer , 44 , 611 – 616 ( 1989. ). [DOI] [PubMed] [Google Scholar]
- 15. ) Breslow , N. E. and Day , N. E. “ Statistical Methods in Cancer Research. Vol. 1 ,“ IARC Sci. Publ. ( 1980. ). IARC; , Lyon . [PubMed] [Google Scholar]
- 16. ) Wynder , E. L. and Bross , I. J.A study of etiological factors in cancers of the esophagus . Cancer , 14 , 389 – 413 ( 1961. ). [DOI] [PubMed] [Google Scholar]
- 17. ) Tuyns , A. J. , Pequignot , G. , Tuyns , A. J. , Pequignot , G. and Jensen , O. M.Esophageal cancer in Ille–et–Vilaine in relation to levels of alcohol and tobacco consumption. Risks are multiplying . Bull. Cancer , 64 , 45 – 60 ( 1977. ). [PubMed] [Google Scholar]
- 18. ) Hirayama , Diet T.and cancer . Nutr. Cancer , 1 , 67 – 81 ( 1979. ). [Google Scholar]
- 19. ) Takezaki , T. , Shinoda , M. , Hatooka , S. , Hasegawa , Y. , Nakamura , S. , Hirose , K. , Inoue , M. , Hamajima , N. , Kuroishi , T. , Matsuura , H. and Tajima , K.Subsite–specific risk factors for hypopharyngeal and esophageal cancer (Japan) . Cancer Causes Control , 11 , 597 – 608 ( 2000. ). [DOI] [PubMed] [Google Scholar]
- 20. ) Hu , J. , Nyren , O. , Wolk , A. , Bergstrom , R. , Yuen , J. , Adami , H. O. , Quo , L. , Li , H. , Huang , G. , Xu , X. , Zhoa , F. , Chen , Y. , Wang , C. , Qin , H. , Hu , C. and Li , Y.Risk factors for oesophageal cancer in northeast China . Int. J. Cancer , 57 , 38 – 46 ( 1994. ). [DOI] [PubMed] [Google Scholar]
- 21. ) Gao , Y. T. , McLaughlin , J. K. , Blot , W. J. , Ji , B. T. , Benichou , J. , Dai , Q. and Fraumeni , J. F. , Jr.Risk factors for esophageal cancer in Shanghai, China. I. Role of cigarette smoking and alcohol drinking . Int. J. Cancer , 58 , 192 – 196 ( 1994. ). [DOI] [PubMed] [Google Scholar]
- 22. ) Yu , Y. , Taylor , P. R. , Li , J. Y. , Dawsey , S. M. , Wang , G. Q. , Quo , W. D. , Wang , W. , Liu , B. Q. , Blot , W. J. , Shen , Q. and Li , B.Retrospective cohort study of risk‐factors for esophageal cancer in Linxian, People's Republic of China . Cancer Causes Control , 4 , 195 – 202 ( 1993. ). [DOI] [PubMed] [Google Scholar]
- 23. ) World Health Organization . Tobacco or Health: a Global Status Report. World Health Organization, Geneva ( 1997. ).
- 24. ) Brewers and Licensed Retailers Association . “ Statistical Handbook. A Compilation of Drinks Industry Statistics “ ( 1997. ). Brewing Publ. Ltd. , London . [Google Scholar]
- 25. ) Li , J. Y. , Ershow , A. G. , Chen , Z. J. , Wacholder , S. , Li , G. Y. , Quo , W. , Li , B. and Blot , W. J.A case–control study of cancer of the esophagus and gastric cardia in Linxian . Int. J. Cancer , 43 , 755 – 761 ( 1989. ). [DOI] [PubMed] [Google Scholar]
- 26. ) Kabat , G. C. , Ng , S. K. and Wynder , E. L.Tobacco, alcohol intake, and diet in relation to adenocarcinoma of the esophagus and gastric cardia . Cancer Causes Control , 4 , 123 – 132 ( 1993. ). [DOI] [PubMed] [Google Scholar]
- 27. ) Inoue , M. , Tajima , K. , Hirose , K. , Kuroishi , T. , Gao , C. M. and Kitoh , T.Life–style and subsite of gastric cancer‐ joint effect of smoking and drinking habits . Int. J. Cancer , 56 , 494 – 499 ( 1994. ). [DOI] [PubMed] [Google Scholar]
- 28. ) International Agency for Research on Cancer . Pickled vegetables . IARC Monogr. Eval. Carcinog. Risks Hum. , 56 , 83 – 113 ( 1993. ). [PMC free article] [PubMed] [Google Scholar]
- 29. ) Lee , J. K. , Park , B. J. , Yoo , K. Y. and Ahn , Y. O.Dietary factors and stomach cancer: a case‐control study in Korea . Int. J. Epidemiol. , 24 , 33 – 41 ( 1995. ). [DOI] [PubMed] [Google Scholar]
- 30. ) Dich , J. , Jarvinen , R. , Knekt , P. and Penttila , P. L.Dietary intakes of nitrate, nitrite and NDMA in the Finnish Mobile Clinic Health Examination Survey . Food Addit. Contam. , 13 , 541 – 552 ( 1996. ). [DOI] [PubMed] [Google Scholar]
- 31. ) Lijinsky , W.N‐Nitroso compounds in the diet . Mutat. Res. , 443 , 129 – 138 ( 1999. ). [DOI] [PubMed] [Google Scholar]
- 32. ) World Cancer Research Fund in Association with American Institute for Cancer Research . Stomach . In “ Food, Nutrition and the Prevention of Cancer: a Global Perspective ,“ pp. 148 – 175 ( 1997. ). American Institute for Cancer Research; , Washington , D.C. [Google Scholar]
- 33. ) de Stefani , E. , Munoz , N. , Esteve , J. , Vasallo , A. , Victora , C. G. and Teuchmann , S.Mate drinking, alcohol, tobacco, diet, and esophageal cancer in Uruguay . Cancer Res. , 50 , 426 – 431 ( 1990. ). [PubMed] [Google Scholar]
- 34. ) Castelletto , R. , Castellsague , X. , Munoz , N. , Iscovich , J. , Chopita , N. and Jmelnitsky , A.Alcohol, tobacco, diet, mate drinking, and esophageal cancer in Argentina . Cancer Epidemiol. Biomarkers Prev. , 3 , 557 – 564 ( 1994. ). [PubMed] [Google Scholar]
- 35. ) de Stefani , E. , Boffetta , P. , Mendilaharsu , M. , Carzoglio , J. and Deneo Pellegrini , H.Dietary nitrosamines, heterocyclic amines, and risk of gastric cancer: a case‐control study in Uruguay . Nutr. Cancer , 30 , 158 – 162 ( 1998. ). [DOI] [PubMed] [Google Scholar]
- 36. ) Weisburger , J. H.Eat to live, not live to eat . Nutrition , 16 , 767 – 773 ( 2000. ). [DOI] [PubMed] [Google Scholar]
- 37. ) Bockler , R. , Meyer , H. and Schlag , P.An experimental study on bacterial colonization, nitrite and nitrosamine production in the operated stomach . J. Cancer Res. Clin. Oncol , 105 , 62 – 66 ( 1983. ). [DOI] [PubMed] [Google Scholar]
- 38. ) Stockbruegger , R. W.Bacterial overgrowth as a consequence of reduced gastric acidity . Scand. J. Gastroenterol. , 111 ( Suppl ), 7 – 16 ( 1985. ). [DOI] [PubMed] [Google Scholar]
- 39. ) Haenszel , W. , Kurihara , M. , Locke , F. B. , Shimuzu , K. and Segi , M.Stomach cancer in Japan . J. Natl. Cancer Inst. , 56 , 265 – 274 ( 1976. ). [DOI] [PubMed] [Google Scholar]
- 40. ) Segal , I. , Reinach , S. G.and de Beer, M. Factors associated with oesophageal cancer in Soweto, South Africa . Br. J. Cancer , 58 , 681 – 686 ( 1988. ). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 41. ) Dorant , E. , Van den Brandt , P. A. , Goldbohm , R. A. , Hermus , R. J. J. and Sturmans , F.Garlic and its significance for the prevention of cancer in humans: a critical view . Br. J. Cancer , 67 , 424 – 429 ( 1993. ). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 42. ) Koch , H. P.Toxicity, side effects, and unwanted effects of garlic . In “ Garlic, The Science and Therapeutic Application of Allium sativum L. and Related Species, 2nd ed. ,“ ed. Koch H. P. and Lawson L. D. , pp. 221 – 233 ( 1996. ). Williams and Wilkins; , Baltimore . [Google Scholar]