A multiethnic population-based study of smoking, alcohol and body size andrisk of adenocarcinomas of the stomach and esophagus (United States)

Objectives: Since the 1970s incidence rates for esophageal and gastric card ia adenocarcinomas have risen substantially, particularly among white males in the United States. Reasons for the increase of these tumor types are no t well understood. We sought to determine the role of smoking, alcohol use, and body size characteristics in the etiology of esophageal, gastric cardi a, and distal gastric adenocarcinomas. Materials and methods: A population-based case-control study that included Whites, African-Americans, Latinos and Asian-Americans diagnosed with incid ent esophageal (n = 222), gastric cardia (n = 277), and distal gastric aden ocarcinomas (n = 443), and 1356 control subjects was conducted in Los Angel es County. Unconditional logistic regression was used to calculate odds rat ios (ORs), as an estimate of the relative risk, and corresponding 95% confi dence intervals (CIs) for the three tumor types of interest. Results: After adjustment for age, gender, race, birthplace, and education, current cigarette smoking was a significant risk factor for all tumor type s; the association was strongest for esophageal adenocarcinomas (OR = 2.80, 95% CI = 1.8-4.3), intermediate for gastric cardia adenocarcinomas (OR = 2 .12, 95% CI = 1.5-3.1), and weaker for distal gastric adenocarcinomas (OR = 1.50, 95% CI = 1.1-2.1). For esophageal adenocarcinomas only, cigarette sm oking had a long-lasting deleterious effect, even 20 years after smoking ce ssation. Alcohol use was not associated with an increased risk of these tum or types. Risks of esophageal and gastric cardia adenocarcinomas also incre ased statistically significantly in a dose-dependent manner with increasing body mass index measured at ages 20 and 40 years and recently. The positiv e associations with smoking and body mass index were generally consistent w hen evaluated separately for Whites, non-Whites, males, and females. Conclusions: Cigarette smoking and high body mass index are significant, in dependent risk factors for esophageal and gastric cardia adenocarcinomas. S tudies designed to understand the mechanisms whereby smoking and high body mass influence these tumor types are needed.