Is Opium a Real Risk Factor for Esophageal Cancer or Just a Methodological Artifact? Hospital and Neighborhood Controls in Case-Control Studies

Shakeri, Ramin; Kamangar, Farin; Nasrollahzadeh, Dariush; Nouraie, Mehdi; Khademi, Hooman; Etemadi, Arash; Islami, Farhad; Marjani, Haji-Amin; Fahimi, Saman; Sepehr, Alireza; Rahmati, Atieh; Abnet, Christian C.; Dawsey, Sanford M.; Brennan, Paul; Boffetta, Paolo; Malekzadeh, Reza; Majdzadeh, Reza

doi:10.1371/journal.pone.0032711

Cited by 36 publications

(47 citation statements)

References 23 publications

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“…Strengths of our study include enrolling biopsy-proven gastric adenocarcinoma cases and population-based controls (53) , and administration of a reliable and validated questionnaire. Our study also has some limitations.…”

Section: Discussionmentioning

confidence: 99%

Multiplex H. pylori Serology and Risk of Gastric Cardia and Noncardia Adenocarcinomas

et al. 2015

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The reported associations with gastric adenocarcinoma and seropositivity to different H. pylori antigens using multiplex serology have not been consistent across studies. We aimed to investigate the association between fifteen different multiplex serology antigens and the risk of gastric cardia (GCA) and gastric non-cardia (GNCA) adenocarcinomas in northeastern Iran, a population with high rates of gastric adenocarcinoma. We included 272 cases of gastric adenocarcinoma (142 GCA, 103 GNCA, and 27 unspecified) and 524 controls who were individually matched to cases for age, sex, and place of residence in a population-based case-control study. Seropositivity to H. pylori was assessed using both multiplex serology and H. pylori IgG ELISA. 95% of controls were seropositive to H. pylori. Of the 15 antibodies in the multiplex assay, 11 showed no significant association with gastric adenocarcinomas. CagA and VacA were associated with a significantly increased risk of all gastric adenocarcinoma and GNCA in multivariate models. Surprisingly, GroEL and NapA were significantly associated with a reduced risk of these tumors. Only CagA antigen was associated with significantly elevated risk of GCA. We found no associations between H. pylori seropositivity overall either by whole-cell ELISA test or multiplex serology, likely due to the high prevalence of seropositivity. Individual antigen testing showed that CagA positivity was associated with increased risk of both noncardia and cardia adenocarcinoma, which is similar to some other Asian populations, while two antigens were associated with lower risk of gastric cancer. This latter result was unexpected and should be re-tested in other populations.

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Section: Discussionmentioning

confidence: 99%

Multiplex H. pylori Serology and Risk of Gastric Cardia and Noncardia Adenocarcinomas

et al. 2015

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“…Cohort participants completed general and food frequency questionnaires similar to those for cases (see below), and gave blood, hair and nail samples. We have previously shown that controls from this cohort correctly reflect opium use in the neighborhoods of cancer cases, and compared to hospital controls, they provide more accurate estimates of cancer risks due to opium or tobacco consumption 11 .…”

Section: Methodsmentioning

confidence: 86%

“…Regular use of opium has been reported to be associated with increased risk of several cancers, including esophageal cancer 9-11 , laryngeal cancer 12 , bladder cancer 13-15 , and lung cancer 16 , but to our knowledge no epidemiologic studies of opium use and gastric cancer have been published. About 0.3-0.5% of the world’s population in the 15-64 year old age group, between 12 and 21 million people, used opiates at least once in 2009 17 .…”

Section: Introductionmentioning

confidence: 96%

Opium: An emerging risk factor for gastric adenocarcinoma

Shakeri

Malekzadeh

Etemadi

et al. 2013

Intl Journal of Cancer

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Opium use has been associated with higher risk of cancers of the esophagus, bladder, larynx, and lung; however, no previous study has examined its association with gastric cancer. There is also little information on the associations between hookah (water pipe) smoking or the chewing of tobacco products and the risk of gastric cancer. In a case-control study in Golestan Province of Iran, we enrolled 309 cases of gastric adenocarcinoma (118 noncardia, 161 cardia, and 30 mixed-location adenocarcinomas) and 613 matched controls. Detailed information on long-term use of opium, tobacco products, and other covariates were collected using structured and validated lifestyle and food frequency questionnaires. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were obtained using conditional logistic regression models. Opium use was associated with an increased risk of gastric adenocarcinoma, with an adjusted OR (95% CI) of 3.1 (1.9 – 5.1), and this increased risk was apparent for both anatomic subsites (cardia and noncardia). There was a dose-response effect, and individuals with the highest cumulative opium use had the strongest association (OR: 4.5; 95%CI: 2.3-8.5). We did not find a statistically significant association between the use of any of the tobacco products and risk of gastric adenocarcinoma, overall or by anatomic subsite. We showed, for the first time, an association between opium use and gastric adenocarcinoma. Given that opium use is a traditional practice in many parts of the world, these results are of public health significance.

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“…For example, cases were confirmed based on histopathological diagnosis history to prevent the misclassification bias. Also, population based neighbor control was used to control the confounding effects of socioeconomic factors, exposure to the environmental risk factors and other potential unknown confounders that may confound the associations (47). Moreover, as an advantage, the validity and reliability of the questionnaire in this study were verified for Iranian population (33).…”

Section: Discussionmentioning

confidence: 99%

Opium Use and Risk of Lower Gastrointestinal Cancers: Population-Based Case-Control Study in South of Iran

Lankarani¹,

Khosravizadegan²,

Naghibzadeh‐Tahami³

et al. 2017

Int J Cancer Manag

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Background: Colorectal cancers, including colon, rectum and anus, are relatively prevalent in Iran. Use of opium and its derivatives is also considerably prevalent in some areas in Iran. Objectives: The aim of this study was to assess the association between use of opium and its derivatives, and incidence of lower gastrointestinal (LGI) cancers. Methods: This study was a matched case-control study in Shiraz (south of Iran). Cases were the new colorectal cancers from cancer registry center of Shiraz University of Medical Sciences and controls were selected from healthy volunteers of cases' neighbors matched for age and gender (2 controls per 1 case). Data related to consumption of opium and its derivatives, smoking, alcohol use and diet status were collected through a structured questionnaire. The conditional logistic regression models were used to assess all associations. Results: 160 cases and 320 controls participated in the present study with non-response rate less than 9 %. Opium use was associated with increased risk of colorectal cancer (adjusted OR = 4.4; 95% CI: 2.2 -8.8). Also, a dose-response association was observed between cumulative consumption of opium and the colorectal cancer incidence (OR = 3.8; 95% CI: 1.5 -9.1), and (OR = 4.6; 95% CI: 1.7 -12.0) for low and high use, respectively. Also, the significant dose-response association was observed for low (OR = 3.4; 95% CI: 1.2 -9.2) and high (OR = 7.7; 95% CI: 1.5 -38.6) opium use with presence of colon cancer. Conclusions:The results of this study showed that opium use can be an important risk factor for colorectal cancer in Iran.

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Is Opium a Real Risk Factor for Esophageal Cancer or Just a Methodological Artifact? Hospital and Neighborhood Controls in Case-Control Studies

Cited by 36 publications

References 23 publications

Multiplex H. pylori Serology and Risk of Gastric Cardia and Noncardia Adenocarcinomas

Multiplex H. pylori Serology and Risk of Gastric Cardia and Noncardia Adenocarcinomas

Opium: An emerging risk factor for gastric adenocarcinoma

Opium Use and Risk of Lower Gastrointestinal Cancers: Population-Based Case-Control Study in South of Iran

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