The association between alcohol consumption and risk of gastric cancer remains controversial. Moreover, prospective data on the role of alcoholic beverage type are sparse. We prospectively investigated the association between total alcohol (ethanol) intake as well as specific alcoholic beverages and risk of gastric cancer in the Swedish Mammography Cohort, a population-based cohort of 61,433 women. Alcohol intake and other dietary exposures were assessed at baseline (1987)(1988)(1989)(1990) and again in 1997 using a foodfrequency questionnaire. Incident gastric cancer cases were ascertained through the Swedish Cancer Register. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). During 966,807 person-years of follow-up, through June 2005, 160 incident cases of gastric cancer occurred. Total alcohol intake was not significantly associated with risk of gastric cancer. Compared with nondrinkers, the multivariate HR of gastric cancer for women with an alcohol intake of 40 g or more per week was 1.33 (95% CI, 0.79-2.25). Consumption of medium-strong/strong beer was associated with a statistically significant increased risk of gastric cancer; the multivariate HR for women who consumed more than one serving of mediumstrong/strong beer per week (median, 2.5 drinks/week) was 2.09 (95% CI, 1.11-3.93; p-trend 5 0.02) compared with no consumption. Consumption of light beer, wine, and hard liquor was not significantly associated with gastric cancer risk. Our findings suggest that constituents of beer other than alcohol may be associated with an increased risk of gastric cancer. ' 2006 Wiley-Liss, Inc.Key words: alcohol; alcoholic beverages; beer; cohort studies; ethanol; gastric cancer; nitrosamines; nitroso compounds; prospective studies Epidemiologic studies on alcohol intake and risk of gastric cancer have yielded inconsistent results. An extensive review by the World Cancer Research Fund of articles published to 1996 concluded that alcohol is probably not related to gastric cancer as a whole, but may possibly increase the risk of cancer of the gastric cardia specifically.1 Case-control 2-12 and cohort studies 13-15 on alcohol and gastric cancer published since that review have found either no significant association 3,[5][6][7][11][12][13][14][15] or a statistically significant increased risk of overall [8][9][10] or noncardia gastric cancer 2,4 associated with high alcohol consumption. Despite a large number of epidemiological studies concerning the relation between alcohol consumption and risk of gastric cancer, most have been case-control investigations, which are more susceptible to systematic bias than prospective cohort studies. On the other hand, most previous cohort studies [13][14][15][16][17][18][19][20][21] have been limited by a small number of cases, ranging from 13 to 122. To our knowledge, only 2 cohort studies 15,22 have investigated alcoholic beverage type in relation to gastric cancer risk.Clarifying the role of alcohol consumption in gastric car...