National Key R&D Program of China, PUMC Youth Fund and the Fundamental Research Funds for the Central Universities, and Major State Basic Innovation Program of the Chinese Academy of Medical Sciences.

Although the association for esophageal cancer with tobacco smoking and alcohol drinking has been well established, the risk appears to be less strong in China. To provide more evidence on the effect of smoking and alcohol consumption with esophageal cancer in China, particularly among Chinese women, a population-based case–control study has been conducted in Jiangsu, China, from 2003 to 2007. A total of 1,520 cases and 3,879 controls were recruited. Unconditional multivariate logistic regression analysis was applied. Results showed that the odds ratio (OR) and confidence interval (CI) for ever smoking and alcohol drinking were 1.57 (95% CI: 1.34–1.83) and 1.50 (95% CI: 1.29–1.74). Dose–response relationships were observed with increased intensity and longer duration of smoking/drinking. Risk of smoking and alcohol drinking at the highest joint level was 7.32 (95% CI: 4.58–11.7), when compared to those never smoked and never drank alcohol. Stratifying by genders, smoking and alcohol drinking increased the risk among men with an OR of 1.74 (95% CI: 1.44–2.09) and 1.76 (95% CI: 1.48–2.09); however, neither smoking nor alcohol consumption showed a significant association among women. In conclusion, smoking and alcohol drinking were associated with esophageal cancer risk among Chinese men, but not among Chinese women.

Although the major risk factors for liver cancer have been established, preventive factors for liver cancer have not been fully explored. We evaluated the association between raw garlic consumption and liver cancer in a large population-based case-control study in Eastern China. The study was conducted in Jiangsu, China, from 2003 to 2010. A total of 2011 incident liver cancer cases and 7933 randomly selected population-controls were interviewed. Epidemiological data including raw garlic intake and other exposures were collected, and serum markers of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection were assayed. Overall, eating raw garlic twice or more per week was inversely associated with liver cancer, with an adjusted odds ratio (aOR) of 0.77 (95% confidence interval (CI): 0.62–0.96) compared to those ingesting no raw garlic or less than twice per week. In stratified analyses, high intake of raw garlic was inversely associated with liver cancer among Hepatitis B surface antigen (HBsAg) negative individuals, frequent alcohol drinkers, those having history of eating mold-contaminated food or drinking raw water, and those without family history of liver cancer. Marginal interactions on an additive scale were observed between low raw garlic intake and HBsAg positivity (attributable proportion due to interaction (AP) = 0.31, 95% CI: -0.01–0.62) and heavy alcohol drinking (AP = 0.28, 95% CI: 0.00–0.57). Raw garlic consumption is inversely associated with liver cancer. Such an association shed some light on the potential etiologic role of garlic intake on liver cancer, which in turn might provide a possible dietary intervention to reduce liver cancer in Chinese population.

Protective effect of garlic on the development of cancer has been reported in vitro and in vivo experimental studies, however, few human epidemiological studies have evaluated the relationship. A population-based case-control study has been conducted in a Chinese population from 2003 to 2010, with the aim to explore the association between raw garlic consumption and lung cancer. Epidemiological data were collected by face-to-face interviews using a standard questionnaire among 1,424 lung cancer cases and 4,543 healthy controls. Unconditional logistic regression was employed to estimate adjusted odds ratios (OR) and their 95% confidence intervals (CIs), and to evaluate ratio of odds ratios (ROR) for multiplicative interactions between raw garlic consumption and other risk factors. After adjusting for potential confounding factors, raw garlic consumption of ≥ 2 times per week is inversely associated with lung cancer (OR = 0.56, 95% CI = 0.44-0.72) with a monotonic dose-response relationship (p for trend <0.001). Furthermore, strong interactions at either additive and/or multiplicative scales were observed between raw garlic consumption and tobacco smoking (Synergy Index (SI) = 0.70, 95% CI = 0.57-0.85; and ROR = 0.78, 95% CI = 0.67-0.90), as well as high-temperature cooking oil fume (ROR = 0.77, 95% CI = 0.59-1.00). In conclusion, protective association between intake of raw garlic and lung cancer has been observed with a dose-response pattern, suggesting that garlic may potentially serve as a chemopreventive agent for lung cancer. Effective components in garlic in lung cancer chemoprevention warrant further in-depth investigation.

Alcohol drinking is a major risk factor for esophageal cancer (EC) and the metabolism of ethanol has been suggested to play an important role in esophageal carcinogenesis. Epidemiologic studies, including genome-wide association studies (GWAS), have identified single nucleotide polymorphisms (SNPs) in alcohol dehydrogenases (ADHs) and aldehyde dehydrogenases (ALDHs) to be associated with esophageal cancer. Using a population-based case-control study with 858 EC cases and 1,081 controls conducted in Jiangsu Province, China, we aimed to provide further information on the association of ADH1B (rs1229984), ADH1C (rs698) and ALDH2 (rs671) polymorphisms with esophageal cancer in a Chinese population. Results showed that ADH1B (rs1229984) was associated with EC with odds ratios (ORs) of 1.34 (95% confidence interval: 1.08-1.66) for G-allele carriers compared to A/A homozygotes. No heterogeneity was detected on this association across different strata of alcohol drinking and tobacco smoking. Statistical interactions between ALDH2 (rs671) and alcohol drinking on EC susceptibility in both additive and multiplicative scales were observed. Compared to G/G homozygotes, A-allele carriers were positively associated with EC among moderate/heavy drinkers (OR=1.64, 1.12-2.40) and inversely associated with EC among never/light drinks (OR=0.75, 0.54-1.03). In addition, statistical interaction between ALDH2 and ADH1B polymorphisms on EC susceptibility among never/light drinkers was indicated. We did not observe association of ADH1C polymorphism with EC. In conclusion, our findings indicated that ADH1B (rs1229984) was associated with esophageal cancer independent of alcohol drinking and tobacco smoking status and alcohol drinking interacted with ALDH2 (rs671) on esophageal cancer susceptibility in this high-risk Chinese population.

A population-based case-control study on esophageal cancer has been conducted since 2003 in Jiangsu Province, China. The aim of this analysis is to provide further evidence on the relationship between family history of cancer in first-degree relatives (FH-FDRs) and the risk of esophageal cancer, and to explore the joint effects for FH-FDR with major lifestyle risk factors. A total of 1,520 cases and 3,879 controls were recruited. Unconditional logistic regression was applied for evaluating independent association as well as potential interactions between FH-FDR and lifestyle risk factors on the risk of esophageal cancer. Population attributable fraction (PAF) was calculated to quantify the proportion of cases attributable to risk factors. Results showed that with a FH-FDR of any malignant tumor or esophageal cancer, there is a 1.64-and 2.22-fold risk of esophageal cancer, respectively. Association was increased when there was more than one affected FDR (OR 5 3.14) and younger age at diagnosis of relatives. Exposure of both FH-FDR and lifestyle risk factors strongly associated with esophageal cancer. Significant superadditivity interaction was found for FH-FDR with fast eating speed and diets low in fruits and vegetables. The estimation of PAF indicated that the majority of cases were attributed to lifestyle risk factors. In conclusion, it was found that FH-FDR significantly increases the risk of esophageal cancer and could modify the effect of certain lifestyle risk factors. If comprehensive lifestyle interventions are carried out within high-risk populations, there is a high probability of curbing occurrences of esophageal cancer.Esophageal cancer is one of the most common cancers worldwide, with $462,000 new cases and 386,000 deaths each year. China is an area with one of the highest incidences of esophageal cancer worldwide. Each year, about one-half of the cases of esophageal cancer that occur in the world are estimated to be in China. 1 According to the results of a national mortality retrospective survey conducted in 2006, esophageal cancer was the fourth leading cause of cancer death in China, with a national average age-standardized mortality of 15.2/100,000. 2 Squamous cell carcinoma of the esophagus remains the predominant histological subtype, representing more than 95% of total cases in the Chinese population. 3 The etiology of esophageal cancer shows that it is multifactorial. A number of studies have suggested that lifestyle factors are significant to the development of this disease. Tobacco smoking and alcohol consumption are responsible for a high fraction of esophageal cancer occurrence; more than 90% of cases could be attributed to these two factors in Western countries. 4 Dietary factors such as ingestion of hot foods and drinks, fast eating speed, nutrition deficiency and high intake of carcinogens from pickled vegetables have been suggested to contribute to most cases of esophageal cancer in high-risk areas such as China and Iran. 5,6 Moreover, genetics and other endogenous factors may also ...

Although tobacco smoking has been reported as a risk factor for liver cancer, few studies have specifically explored the association among Chinese females and the potential interaction between smoking and other risk factors. A population-based case-control study was conducted and 2,011 liver cancer cases and 7,933 healthy controls were enrolled in Jiangsu, China from 2003 to 2010. Epidemiological data were collected, and serum hepatitis B surface antigen (HBsAg) and anti-HCV antibody were measured. Unconditional logistic regression was used to examine association and potential interaction, while semi-Bayes (SB) method was employed to make estimates more conservative. The prevalence of serum HBsAg positivity was 43.2% among cases and 6.5% among controls. The adjusted odds ratios (OR) for ever smoking were 1.62 (95% confidence interval [CI]: 1.33-1.96) among male and 0.82 (95% CI: 0.53-1.26) among female. Age at first cigarette, duration of smoking and pack-years of smoking were all significantly associated with liver cancer among men. Compared to HBsAg-negative never smokers, the adjusted ORs were 1.25 (95% CI: 1.03-1.52) for HBsAg-negative ever smokers, 7.66 (95% CI: 6.05-9.71) for HBsAg-positive never smokers, and 15.68 (95% CI: 12.06-20.39) for HBsAg-positive ever smokers. These different odds ratios indicated super-additive (RERI: 7.77, 95% CI: 3.81-11.73) and super-multiplicative interactions (ROR: 1.64, 95% CI: 1.17-2.30) between hepatitis B virus (HBV) infection and tobacco smoking. Most associations and interactions detected remained statistically significant after SB adjustments. Tobacco smoking and HBV infection positively interact in the development of liver cancer.

Objective: Cancer is a major public health burden both globally and in China. The most common cancer-related deaths in China are attributable to cancers of the lung, liver, stomach, and esophagus. Previous epidemiologic studies on cancer in China have often been limited by small sample sizes, inconsistent measurements, and lack of precise and accurate data. The Jiangsu Four Cancers (JFC) Study is a population-based case-control study conducted in an effort to obtain consistent and high quality data to investigate the life style, behavioral, environmental, and genetic factors associated with the four major cancers in China. The objective of this paper is to describe the overall design of the JFC Study and report selected findings on the major risk factors of cancers. Methods: Epidemiologic data were collected from 2003 to 2010 through in-person interviews using a structured questionnaire, and blood samples were drawn. Unconditional logistic regression was used to estimate the associations of putative risk factors with risks of cancers of the lung, liver, stomach, and esophagus. Results: The Study included 2,871 lung cancer cases, 2,018 liver cancer cases, 2,969 esophageal cancer cases, 2,216 stomach cancer cases, and 8,019 community controls. Low educational level, low income level, tobacco smoking, alcohol drinking, and family history of cancer were confirmed as risk factors of these major cancers. Conclusions: The JFC Study is one of the largest case-control studies of cancers in the Chinese population and will serve as a rich resource for future research on the four major cancers in China.