A case-control study of gastric cancer in Venezuela

Abstract

A case-control study to evaluate risk factors for gastric cancer was carried out among 292 cases of gastric cancer and 485 controls in a high-risk area of Venezuela. Subjects were interviewed using a structured questionnaire, which elicited information on residential history, socio-economic status, family history of gastric diseases, smoking, drinking and dietary habits. Habitual diet was estimated from a meal-structured food frequency questionnaire on 75 food items. There was a strong inverse association with social class, as measured by education and by indicators of poverty. The results of the dietary analysis suggest that a diet high in starch and low in meat, fish and fresh vegetables increases risk of gastric cancer. A protective effect was observed for frequent consumption of allium vegetables. Inverse associations were found with height, which may reflect nutritional status in childhood, and with refrigerator use in the first two decades of life. Alcohol and tobacco consumption was investigated among males only, since the prevalence of alcohol and tobacco use was very low in females. Alcohol drinkers were at higher risk than non-drinkers and there was a small excess risk for current smokers compared with never smokers. There was some evidence of familial aggregation of gastric cancer. These findings will have important implications in planning preventive strategies for gastric cancer in Venezuela. © Gastric cancer is the second most common cancer in the world. Although gastric cancer rates are decreasing in most populations, the absolute number of cases is increasing due to aging of the population. It has been estimated that there were 700,000 new cases in 1980, 755,000 in 1985 and 1,000,000 in 1990. [1][2][3] In most populations the disease is rapidly fatal. The 5-year survival rate is less than 20% and has improved little in the last few decades. 4 Among males, the cumulative incidence of gastric cancer to age 74 varies from about 1% in the United States to 10% in Japan, with rates being about 50% lower in females. 5 In Venezuela, stomach cancer is the first cause of death from cancer in males and the third in females after cervix and breast. 6 The cumulative mortality to age 74 in 1990 was 1.7% in males and 0.85% in females. The highest rates are found in the Andean region (states of Tachira, Merida, Trujillo and Lara). In Tachira State, cumulative mortality from stomach cancer to age 74 in 1993 was 4.1% in males and 2.2% in females. No previous case-control studies have been conducted to determine the causes of gastric cancer in this high-risk population.Although the etiology of gastric cancer is not well understood, the long-term decline in gastric cancer rates in developed countries suggests an important role of environmental risk factors. 7 In particular, migrant studies suggest that exposures or habits acquired early in life are important. 8 A diet high in salt, carbohydrate and foods rich in nitrate or nitrite and their derivatives has been associated with an increase in risk. Conversely, a de...

The role of diet and other environmental factors in the causation of gastric cancer in Iran—A population based study

“…This finding is in agreement with 2 casecontrol studies which reported 2.4-3.0 times increase in the risk with dairy product consumption. 17,76 However, this association was not observed in other case-control and cohort studies. The real cause behind this association is not clear, however, this association could be a consequence rather than a cause of the disease, because cases may drink more milk to control symptoms of the disease such as dyspepsia.…”

“…Our finding is in agreement with reports of several case-control studies. 17,60,64,65 Prospective study on allium vegetables and GC is limited to a cohort study which reported an inverse association between onion and GC. 66 Moreover, this study did not find any evidence to support a protective role for raw vegetables.…”

Body Mass and Physical Activity and Risk of Gastric Cancer in a Population-Based Cohort Study in Norway

“…Although BMI is linked with an overall increase in the risk of cancer in general, results from casecontrol studies have indicated, rather, that a low BMI is associated with an increased risk of gastric cancer (7,8,(29)(30)(31), whereas results from prospective studies have yielded contradictory results (3,6,(9)(10)(11)(12)(13)(14)32). The lack of association between overweight or obesity and the risk of noncardia gastric cancer found in our study is in sharp contrast to the strong link that has been established between BMI and gastric cardia and esophageal adenocarcinoma (4-6).…”

“…Whereas evidence for a positive association between obesity and risk of gastric cardia cancer has accumulated over recent years (4)(5)(6), epidemiologic findings concerning the relation between body mass index (BMI) and risk of noncardia gastric cancer have been inconsistent (2). There are indications of an inverse association between BMI and noncardia gastric cancer, but prospective studies have been sparse, and there is an obvious risk of bias in studies where mortality data are being used or where weight is reported retrospectively or with too short a latency interval between exposure and the gastric cancer (7)(8)(9)(10)(11)(12)(13)(14). A high physical activity level has been shown to be protective against several cancers, but the small number of investigations of the relation between physical activity and risk of gastric cancer has prevented any firm conclusions from being drawn for this particular tumor.…”

3rd BRAZILIAN CONSENSUS ON Helicobacter pylori

“…Furthermore, epidemiological data on gastric cancer is incomplete in many regions, and non-invasive methods for diagnosing the infection are not widely available. (173) and case-control studies conducted in Asia (188) , Europe (47,61) and Latin America (149) , including Brazil (147) , show that first-degree relatives of gastric cancer carriers have a 2 to 3 times higher risk of developing neoplasia, so search and eventual eradication of bacteria in this population is fully justified. Metachronous tumors in the gastric remnant have been described in up to 10% of patients undergoing gastric, endoscopic or surgical resection for early gastric cancer (182,187,194) .…”