Hematopoietic cancer and peptic ulcer: a multicenter case-control study.
Helicobacter pylori has been suggested as a cause of gastric carcinoma and gastric non-Hodgkin's lymphoma (NHL). In a previous cohort study, a relative risk of six for gastric NHL was reported among subjects who tested positive for anti-H.pylori antibodies. The association between peptic ulcer and NHL has been studied in a population-based case-control investigation on hemato-lymphopoietic malignancies in Italy, based on face-to-face interviews to 2671 cases and 1718 controls (refusal rates 10 and 19%, respectively). Subjects who reported a diagnosis of peptic ulcer had a relative risk of 5.6 [95% confidence interval (CI) 3.8-8.0] for gastric NHL, whereas the estimate for non-gastric NHL was 1.3 (1.0-1.6). The association with recent diagnosis of ulcer was stronger, but the odds ratio (OR) was as high as 2.1 (95% CI 1.1-4.2) after >/=20 years since such diagnosis. After exclusion of the last 2 years before the diagnosis of NHL, and of ulcers diagnosed before 1978 (when gastroscopy became common in Italy), the OR was still 5.3 (95% CI 3.0-9.2). We found a strong effect modification by educational level, with ORs for ulcer more elevated in higher social groups. Gender was an effect modifier (OR = 4.1 in males, 9.2 in females; P = 0.03 for heterogeneity). The association with other gastrointestinal pathologies was much lower and statistically not significant. Almost all gastric lymphomas were B-cell NHLs of intermediate grade according to the working formulation; the majority belonged to the mucosa-associated lymphoid tissue (MALT) type. The association with ulcer was much stronger among MALT lymphomas, but only for recent ulcer diagnoses (2-10 years). Our study shows an increased risk for gastric NHL, very similar to the estimate reported in a previous cohort study. The risk was higher among more educated subjects.
Vineis
P
P
Unit of Cancer Epidemiology, Ospedale S. Giovanni and CPO-Piemonte, via Santena 7, I-10126 Torino, Unit of Epidemiology, National Cancer Institute, Milano, Italy.
Crosignani
P
P
Sacerdote
C
C
Fontana
A
A
Masala
G
G
Miligi
L
L
Nanni
O
O
Ramazzotti
V
V
Rodella
S
S
Stagnaro
E
E
Tumino
R
R
Viganò
C
C
Vindigni
C
C
Costantini
A S
AS
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D004522:Educational Status; D005260:Female; D016481:Helicobacter Infections / Q000150:complications*; D016480:Helicobacter pylori; D006801:Humans; D018442:Lymphoma, B-Cell, Marginal Zone / Q000150:complications / Q000382:microbiology; D008228:Lymphoma, Non-Hodgkin / Q000150:complications* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010437:Peptic Ulcer / Q000150:complications* / Q000382:microbiology; D012306:Risk; D012737:Sex Factors; D013274:Stomach Neoplasms / Q000150:complications* / Q000382:microbiology