title: Alcohol and tobacco use in relation to gastric cancer: a prospective study of men in Shanghai, China.
abstract: BACKGROUND
  Epidemiologic findings of tobacco and alcohol use in relation to gastric cancer are inconsistent. Well-designed prospective studies examining their relationship are sparse.
  
  
  METHODS
  The association between cigarette smoking/alcohol intake and gastric cancer risk was examined in a population-based prospective cohort of 18,244 middle-aged and older men in Shanghai, China, who were enrolled in the study during 1986-1989. After up to 20 years of follow-up, 391 incident gastric cancer cases were identified. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and corresponding 95% confidence intervals (95% CI).
  
  
  RESULTS
  Ever smokers experienced a statistically significant increased risk of gastric cancer (HR, 1.59; 95% CI, 1.27-1.99) compared with nonsmokers after adjustment for alcohol intake and other confounders. Among nondrinkers, smokers experienced 80% increased risk of gastric cancer (HR, 1.81; 95% CI,1.36, 2.41). Conversely, heavy drinkers experienced a statistically significant increase in risk of gastric cancer (HR, 1.46; 95% CI, 1.05-2.04) among all subjects and a statistically nonsignificant 80% increased risk among never smokers. Further adjustment for Helicobacter pylori serology, serum levels of beta-carotene and vitamin C, and urinary level of total isothiocyanates in combination with glutathione S-transferase (GST) M1 and GSTT1 genotypes did not materially change the associations between smoking/alcohol consumption and gastric cancer risk.
  
  
  CONCLUSIONS
  These results suggest that cigarette smoking and alcohol consumption may exert independent effects on the development of gastric cancer in this high-risk population.
  
  
  CONCLUSIONS
  Modification of these lifestyle choices may reduce the incidence of gastric cancer.
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Masonic Cancer Center, Minneapolis, Minnesota 55455, USA. moyx0022@umn.edu
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Moy
authors.forename: Yunhua
authors.initials: Y
authors.lastname: Fan
authors.forename: Renwei
authors.initials: R
authors.lastname: Wang
authors.forename: Yu-Tang
authors.initials: YT
authors.lastname: Gao
authors.forename: Mimi C
authors.initials: MC
authors.lastname: Yu
authors.forename: Jian-Min
authors.initials: JM
authors.lastname: Yuan
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology*; D015992:Body Mass Index; D002681:China / Q000453:epidemiology; D015331:Cohort Studies; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*; D013274:Stomach Neoplasms / Q000453:epidemiology* / Q000209:etiology / Q000652:urine