Association between Childhood and Adulthood Risk Factors and Risk of Gastric Cancer: A Hospital-Based Case-Control Study in Iran
-
Kazem Zendehdel
,
Maryam Hadji
,
Fatemeh Toorang
,
Neda Amni
,
Fatemeh Mirfazli
,
Sourabh Zamani
,
Elham Kamlai-Hakim
,
Mahsa Fithian
,
Bahareh Sasanfar
,
Rana Daroudi
,
Fatemeh Shakeri
,
Farin Kamangar
Abstract
Background: Gastric cancer (GC) is the most common cancer among Iranian men. This study aimed to investigate the association between early and late lifestyle risk factors and GC among the Iranian population. Methods: A hospital-based case-control study recruited gastric cancer (GC) patients from the Cancer Institute in 2010-2012. Controls were healthy visitors to be frequency-matched based on sex, age, and residential place and were not visiting the oncology wards. We collected exposure to various risk factors before the diagnosis in patients and prior to the interview in controls. Additionally, we obtained information on socioeconomic factors during childhood. Logistic regression models were employed to estimate the odds ratio (OR) and 95% confidence intervals (CI) for various potential risk factors. Results: The study included a total of 212 GC patients and 287 controls. The average age of cases was 60.2 years, and controls were 53.48. Participants with a family history of GC had a 3.8-fold higher risk of GC than those without a family history (OR=3.98, 95% CI 1.86, 8.50). In addition, the odds of GC was significantly higher in cigarette smokers compared to non-smokers (OR=1.98, 95% CI 1.01-3.46). We observed an inverse association between GC by education (P trend <0.001). Individuals reported coffee consumption had a lower risk of GC (OR=0.45, 95% CI: 0.26, 0.77) as compared to non-coffee users. The study found that individuals with medium (OR=0.45, 95% CI 0.23-0.87) and high (OR=0.33, 95% CI: 0.45-0.71) intake of vegetables and high intake of fruit (OR=0.43, 95% CI 0.45-0.71) had lower odds of GC, while higher consumption of red meat (OR=4.33, 95% CI 2.15-8.77) had higher odds of GC. Analysis of factors related to the childhood period showed that lack of access to tap water increased the odds of GC compared to using tap water (OR: 3.35, 95% CI: 1.74, 6.44). We did not observe any significant associations between helicobacter pylori infection, opium use, waterpipe smoking, alcohol consumption, obesity, and other early life risk factors and the risk of GC. Conclusion The occurrence of GC is influenced by several factors, including family history of GC, dietary habits, and socioeconomic status during both childhood and adulthood.
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2. Roshandel G, Ferlay J, Ghanbari-Motlagh A, Partovipour E, Salavati F, Aryan K, et al. Cancer in Iran 2008 to 2025: Recent incidence trends and short-term predictions of the future burden. Int J Cancer. 2021;149.
3. Zendehdel K, Marzban M, Nahvijou A, Jafari N. Six-fold difference in the stomach cancer mortality rate between northern and southern Iran. Arch Iran Med. 2012;15.
4. Nemati S, Saeedi E, Lotfi F, Nahvijou A, Mohebbi E, Ravankhah Z, et al. National surveillance of cancer survival in Iran (IRANCANSURV): Analysis of data of 15 cancer sites from nine population-based cancer registries. Int J Cancer. 2022;
5. Khedmat H, Panahian M, Mashahdian M, Rajabpour MV, Zendehdel K. Prognostic factors and survival in stomach cancer - Analysis of 15 years of data from a referral hospital in iran and evaluation of international variation. Onkologie. 2011;34.
6. Malekzadeh R, Sotoudeh M, Derakhshan MH, Mikaeli J, Yazdanbod A, Merat S, et al. Prevalence of gastric precancerous lesions in Ardabil, a high incidence province for gastric adenocarcinoma in the northwest of Iran. J Clin Pathol [Internet]. J Clin Pathol; 2004 [cited 2023 May 28];57:37–42. Available from: https://pubmed.ncbi.nlm.nih.gov/14693833/
7. Chen MJ, Wu DC, Ko YC, Chiou YY. Personal history and family history as a predictor of gastric cardiac adenocarcinoma risk: a case-control study in Taiwan. Am J Gastroenterol [Internet]. Am J Gastroenterol; 2004 [cited 2023 May 28];99:1250–7. Available from: https://pubmed.ncbi.nlm.nih.gov/15233662/
8. Poorolajal J, Moradi L, Mohammadi Y, Cheraghi Z, Gohari-Ensaf F. Risk factors for stomach cancer: a systematic review and meta-analysis. Epidemiol Health. 2020;42:e2020004.
9. Montazeri Z, Nyiraneza C, El-Katerji H, Little J. Waterpipe smoking and cancer: Systematic review and meta-analysis. Tob Control. 2017.
10. Mamtani R, Cheema S, Sheikh J, Al Mulla A, Lowenfels A, Maisonneuve P. Cancer risk in waterpipe smokers: a meta-analysis. Int J Public Health. 2017;62.
11. Carcinogenicity of opium consumption. Lancet Oncol [Internet]. Lancet Oncol; 2020 [cited 2023 May 28];21:1407–8. Available from: https://pubmed.ncbi.nlm.nih.gov/33038940/
12. Sun D, Lei L, Xia C, Li H, Cao M, He S, et al. Sociodemographic disparities in gastric cancer and the gastric precancerous cascade: A population-based study. Lancet Reg Health West Pac [Internet]. Elsevier; 2022 [cited 2023 May 28];23. Available from: /pmc/articles/PMC8958536/
13. Fontana V, Decensi A, Orengo MA, Parodi S, Torrisi R, Puntoni R. Socioeconomic status and survival of gastric cancer patients. Eur J Cancer [Internet]. Elsevier; 1998 [cited 2023 May 6];34:537–42. Available from: http://www.ejcancer.com/article/S0959804997100983/fulltext
14. Hadji M, Mortazavi M, Saberi S, Esmaieli M, Amini N, Akrami R, et al. Helicobacter pylori acquisition rates and the associated risk factors amongst newlywed couples; a prospective cohort study in Tehran, Iran. Microbes Infect. Elsevier Masson; 2022;24:104974.
15. Kim J, Wang TC. Helicobacter pylori and Gastric Cancer. Gastrointest Endosc Clin N Am [Internet]. Gastrointest Endosc Clin N Am; 2021 [cited 2023 May 28];31:451–65. Available from: https://pubmed.ncbi.nlm.nih.gov/34053633/
16. Pounder RE, Ng D. The prevalence of Helicobacter pylori infection in different countries. Aliment Pharmacol Ther. 1995;9 Suppl 2:33–9.
17. Tsang SH, Avilés-Santa ML, Abnet CC, Brito MO, Daviglus ML, Wassertheil-Smoller S, et al. Seroprevalence and Determinants of Helicobacter pylori Infection in the Hispanic Community Health Study/Study of Latinos. Clin Gastroenterol Hepatol [Internet]. Clin Gastroenterol Hepatol; 2022 [cited 2023 May 28];20:e438–51. Available from: https://pubmed.ncbi.nlm.nih.gov/33667677/
18. Mousavi SM, Sundquist K, Hemminki K. Does the risk of stomach cancer remain among second-generation immigrants in Sweden? Gastric Cancer. 2012;15:213–5.
19. Akbarpour E, Sadjadi A, Derakhshan MH, Roshandel G, Alimohammadian M. Gastric Cancer in Iran: An Overview of Risk Factors and Preventive Measures. Arch Iran Med [Internet]. Arch Iran Med; 2021 [cited 2023 May 28];24:556–67. Available from: https://pubmed.ncbi.nlm.nih.gov/34488321/
20. Toorang F, Sasanfar B, Razeghi Jahromi S, Ebrahimpour Koujan S, Narmcheshm S, Rafei A, et al. Validation of Diet History Questionnaire in Assessing Energy and Nutrient Intakes of Iranian Population. Iran J Public Health. 2019;48:1074–81.
21. Hosmer DW, Lemeshow S, Sturdivant RX. Applied Logistic Regression: Third Edition. Applied Logistic Regression: Third Edition [Internet]. wiley; 2013 [cited 2023 Nov 26];1–510. Available from: https://onlinelibrary.wiley.com/doi/book/10.1002/9781118548387
22. Shin CM, Kim N, Yang HJ, Cho S Il, Lee HS, Kim JS, et al. Stomach cancer risk in gastric cancer relatives: interaction between Helicobacter pylori infection and family history of gastric cancer for the risk of stomach cancer. J Clin Gastroenterol [Internet]. J Clin Gastroenterol; 2010 [cited 2023 May 30];44:e34–9. Available from: https://pubmed.ncbi.nlm.nih.gov/19561529/
23. Dhillon PK, Farrow DC, Vaughan TL, Chow WH, Risch HA, Gammon MD, et al. Family history of cancer and risk of esophageal and gastric cancers in the United States. Int J Cancer [Internet]. Int J Cancer; 2001 [cited 2023 May 30];93:148–52. Available from: https://pubmed.ncbi.nlm.nih.gov/11391635/
24. Islami F, Ann ;, Sauer G, Miller KD, Siegel RL, Fedewa SA, et al. Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States. CA Cancer J Clin [Internet]. American Cancer Society; 2018 [cited 2023 May 26];68:31–54. Available from: https://onlinelibrary.wiley.com/doi/full/10.3322/caac.21440
25. Praud D, Rota M, Pelucchi C, Bertuccio P, Rosso T, Galeone C, et al. Cigarette smoking and gastric cancer in the Stomach Cancer Pooling (StoP) Project. Eur J Cancer Prev. 2018;27:124–33.
26. Ladeiras-Lopes R, Pereira AK, Nogueira A, Pinheiro-Torres T, Pinto I, Santos-Pereira R, et al. Smoking and gastric cancer: systematic review and meta-analysis of cohort studies. Cancer Causes Control. 2008;19:689–701.
27. Waziry R, Jawad M, Ballout RA, Akel M Al, Akl EA. The effects of waterpipe tobacco smoking on health outcomes: an updated systematic review and meta-analysis. Int J Epidemiol [Internet]. Int J Epidemiol; 2017 [cited 2022 Dec 12];46:32–43. Available from: https://pubmed.ncbi.nlm.nih.gov/27075769/
28. Song H, Shen X, Chu Q, Zheng X. Coffee consumption is not associated with the risk of gastric cancer: An updated systematic review and meta-analysis of prospective cohort studies. Nutr Res. 2022;102:35–44.
29. Aguilar LE, Jang SR, Park CH, Lee KM. Supramolecular Caffeic Acid and Bortezomib Nanomedicine: Prodrug Inducing Reactive Oxygen Species and Inhibiting Cancer Cell Survival. Pharmaceutics. 2020;12.
30. Traganos F, Kapuscinski J, Gong J, Ardelt B, Darzynkiewicz RJ, Darzynkiewicz Z. Caffeine prevents apoptosis and cell cycle effects induced by camptothecin or topotecan in HL-60 cells. Cancer Res. 1993;53:4613–8.
31. Naemi Kermanshahi M, Safaei E, Tutunchi H, Naghshi S, Mobarak S, Asadi M, et al. Fruit and vegetable intake in relation to gastric cancer risk: A comprehensive and updated systematic review and dose-response meta-analysis of cohort studies. Front Nutr. 2023;10:973171.
32. Ferro A, Costa AR, Morais S, Bertuccio P, Rota M, Pelucchi C, et al. Fruits and vegetables intake and gastric cancer risk: A pooled analysis within the Stomach cancer Pooling Project. Int J Cancer. 2020;147:3090–101.
33. Drake IM, Davies MJ, Mapstone NP, Dixon MF, Schorah CJ, White KLM, et al. Ascorbic acid may protect against human gastric cancer by scavenging mucosal oxygen radicals. Carcinogenesis [Internet]. Carcinogenesis; 1996 [cited 2023 Nov 26];17:559–62. Available from: https://pubmed.ncbi.nlm.nih.gov/8631145/
34. Akyön Y. Effect of antioxidants on the immune response of Helicobacter pylori. Clin Microbiol Infect [Internet]. Clin Microbiol Infect; 2002 [cited 2023 Nov 26];8:438–41. Available from: https://pubmed.ncbi.nlm.nih.gov/12199857/
35. Zhang J, Wu D, Vikash, Song J, Wang J, Yi J, et al. Hesperetin Induces the Apoptosis of Gastric Cancer Cells via Activating Mitochondrial Pathway by Increasing Reactive Oxygen Species. Dig Dis Sci. 2015;60:2985–95.
36. Hyson DA. A comprehensive review of apples and apple components and their relationship to human health. Adv Nutr. 2011;2:408–20.
37. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Biological agents. IARC Monogr Eval Carcinog Risks Hum. 2012;100:1–441.
38. Zhu H, Yang X, Zhang C, Zhu C, Tao G, Zhao L, et al. Red and processed meat intake is associated with higher gastric cancer risk: a meta-analysis of epidemiological observational studies. PLoS One. 2013;8:e70955.
39. Ferro A, Rosato V, Rota M, Costa AR, Morais S, Pelucchi C, et al. Meat intake and risk of gastric cancer in the Stomach cancer Pooling (StoP) project. Int J Cancer. 2020;147:45–55.
40. Ward HA, Gayle A, Jakszyn P, Merritt M, Melin B, Freisling H, et al. Meat and haem iron intake in relation to glioma in the European Prospective Investigation into Cancer and Nutrition study. Eur J Cancer Prev. 2018;27:379–83.
41. Van Hecke T, Vossen E, Hemeryck LY, Vanden Bussche J, Vanhaecke L, De Smet S. Increased oxidative and nitrosative reactions during digestion could contribute to the association between well-done red meat consumption and colorectal cancer. Food Chem. 2015;187:29–36.
42. Chiang VS-C, Quek S-Y. The relationship of red meat with cancer: Effects of thermal processing and related physiological mechanisms. Crit Rev Food Sci Nutr. 2017;57:1153–73.
43. Demeyer D, Mertens B, De Smet S, Ulens M. Mechanisms Linking Colorectal Cancer to the Consumption of (Processed) Red Meat: A Review. Crit Rev Food Sci Nutr. 2016;56:2747–66.
44. Uthman OA, Jadidi E, Moradi T. Socioeconomic position and incidence of gastric cancer: a systematic review and meta-analysis. J Epidemiol Community Health (1978). 2013;67:854–60.
45. Karimi P, Islami F, Anandasabapathy S, Freedman ND, Kamangar F. Gastric cancer: descriptive epidemiology, risk factors, screening, and prevention. Cancer Epidemiol Biomarkers Prev. 2014;23:700–13.
46. Eichelberger L, Murphy G, Etemadi A, Abnet CC, Islami F, Shakeri R, et al. Risk of gastric cancer by water source: evidence from the Golestan case-control study. PLoS One [Internet]. PLoS One; 2015 [cited 2023 May 28];10. Available from: https://pubmed.ncbi.nlm.nih.gov/26023788/
47. Boeing H, Frentzel‐Beyme R, Berger M, Berndt V, Göres W, Körner M, et al. Case-control study on stomach cancer in Germany. Int J Cancer [Internet]. Int J Cancer; 1991 [cited 2023 May 30];47:858–64. Available from: https://pubmed.ncbi.nlm.nih.gov/2010228/
48. Demirer T, Icli F, Uzunalimoglu O, Kucuk O. Diet and stomach cancer incidence. A case-control study in Turkey. Cancer. 1990;65:2344–8.
49. Pounder RE, Ng D. The prevalence of Helicobacter pylori infection in different countries. Aliment Pharmacol Ther. 1995;9 Suppl 2:33–9.
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| Files | ||
| Issue | Vol 16 No 3 (2024) | |
| Section | Original Articles | |
| Keywords | ||
| Gastric Cancer Risk Factors Iran | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Zendehdel K, Hadji M, Toorang F, Amni N, Mirfazli F, Zamani S, Kamlai-Hakim E, Fithian M, Sasanfar B, Daroudi R, Shakeri F, Kamangar F. Association between Childhood and Adulthood Risk Factors and Risk of Gastric Cancer: A Hospital-Based Case-Control Study in Iran. Basic Clin Cancer Res. 2025;16(3):133-144.
