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 (P homogeneity = .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.
Highlights
Stomach cancer is the fifth most common cancer with an estimated 1 033 701 incident cases (5.7% of all cancers) worldwide in 2018.1 Due to its high fatality, it is the third leading cause of death from cancer,[1] with modest survival even in high-income countries.[2]
Stomach cancer incidenced by country for European Prospective Investigation into Cancer and Nutrition (EPIC) and by country of birth for Melbourne Collaborative Cohort Study (MCCS) are reported in Supplementary Table 1
We observed a weak positive dose-dependent association for lifetime alcohol intake limited to noncardia stomach cancer, which did not differ appreciably between men and women or by levels of smoking, body mass index or H pylori infection status
Summary
Stomach cancer is the fifth most common cancer with an estimated 1 033 701 incident cases (5.7% of all cancers) worldwide in 2018.1 Due to its high fatality, it is the third leading cause of death from cancer,[1] with modest survival even in high-income countries.[2]. We estimated associations for baseline and lifetime alcohol use with risk of stomach cancer and its subtypes, using retrospective information on consumption at various ages before recruitment in two large prospective studies. Alcohol consumption has been causally linked to several cancers, but results for stomach cancer have been inconclusive In this large, international study, the authors found a positive association between long-term, heavy drinking and noncardia stomach cancer. International study, the authors found a positive association between long-term, heavy drinking and noncardia stomach cancer This association persisted when data were adjusted for potentially confounding factors such as smoking, body mass index, and Helicobacter pylori infection. A weak inverse association was observed with cardia cancer, suggesting that there may be etiologic differences between non-cardia vs. cardia subtypes
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