Lifetime alcohol intake, drinking patterns over time and risk of stomach cancer: A pooled analysis of data from two prospective cohort studies

Abstract

Alcohol consumption is causally linked to several cancers but the evidence for stomach cancer is inconclusive. In our study, the association between long‐term alcohol intake and risk of stomach cancer and its subtypes was evaluated. We performed a pooled analysis of data collected at baseline from 491 714 participants in the European Prospective Investigation into Cancer and Nutrition and the Melbourne Collaborative Cohort Study. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for incident stomach cancer in relation to lifetime alcohol intake and group‐based life course intake trajectories, adjusted for potential confounders including Helicobacter pylori infection. In all, 1225 incident stomach cancers (78% noncardia) were diagnosed over 7 094 637 person‐years; 984 in 382 957 study participants with lifetime alcohol intake data (5 455 507 person‐years). Although lifetime alcohol intake was not associated with overall stomach cancer risk, we observed a weak positive association with noncardia cancer (HR = 1.03, 95% CI: 1.00‐1.06 per 10 g/d increment), with a HR of 1.50 (95% CI: 1.08‐2.09) for ≥60 g/d compared to 0.1 to 4.9 g/d. A weak inverse association with cardia cancer (HR = 0.93, 95% CI: 0.87‐1.00) was also observed. HRs of 1.48 (95% CI: 1.10‐1.99) for noncardia and 0.51 (95% CI: 0.26‐1.03) for cardia cancer were observed for a life course trajectory characterized by heavy decreasing intake compared to light stable intake (Phomogeneity = .02). These associations did not differ appreciably by smoking or H pylori infection status. Limiting alcohol use during lifetime, particularly avoiding heavy use during early adulthood, might help prevent noncardia stomach cancer. Heterogeneous associations observed for cardia and noncardia cancers may indicate etiologic differences.

Alcohol intake trajectories during the life course and risk of alcohol‐related cancer: A prospective cohort study

“…26 We have previously shown associations for heavy alcohol intake over the lifetime with subtypes of stomach cancer using semiparametric group-based trajectory modeling. 27 Although most cohort studies have relied upon baseline alcohol intake (ie, intake closer to study enrolment) for their exposure variable, 10 we have demonstrated that baseline alcohol intake could be low for male former heavy drinkers. Our analyses using intake trajectories during the life course have also shown that using baseline intake alone is likely to miss risky drinking behaviors in early adult life especially in men (eg, TR5 early decreasing heavy and TR2 stable light trajectories had similar baseline alcohol intakes but contrasting intakes in early adulthood) for whom the model fit was also slightly better with the additional information provided by the trajectories.…”

“…These findings were based on only 89 cancer deaths, risks for men and women were not assessed separately and the drinking patterns did not take into account the exact amount of alcohol consumed 26 . We have previously shown associations for heavy alcohol intake over the lifetime with subtypes of stomach cancer using semiparametric group‐based trajectory modeling 27 . Although most cohort studies have relied upon baseline alcohol intake (ie, intake closer to study enrolment) for their exposure variable, 10 we have demonstrated that baseline alcohol intake could be low for male former heavy drinkers.…”

Association between type 2 diabetes mellitus and gastric cancer: A Mendelian randomization study

“…In terms of alcohol drinking, previous studies revealed that chronic alcohol drinking could combine HP infection with IL-10 (interleukin-10) inhibition to induce gastric tumorigenesis [38] . Additionally, alcohol consumption could lead to direct cellular injury and gene mutation by enhancing the penetration of carcinogens into cells [39] .…”

The Increasing Burden of Cancer Among Women and in Rural Areas: A Retrospective Population-Based Study

“…The top 3 to 6 common cancers are gastric, liver, colorectal, and esophageal cancers in Anhui Province, which are infection-related and poverty-related cancers. These cancers are associated with unhealthy lifestyles, such as alcohol consumption, 17 pickled foods, 18 eating hot food, 19 and chronic infectious agents. 20 In order to address this public health concern, the Huaihe Valley Cancer Early Diagnosis and Treatment Program has been providing screening services for upper gastrointestinal and liver cancers in Anhui Province since 2007.…”