The association of cigarette smoking with gastric cancer: the multiethnic cohort study.
OBJECTIVE
The purpose of this study is to investigate the association of cigarette smoking with gastric cancer.


METHODS
Over 215,000 men and women, representing five ethnic groups (African Americans, Japanese Americans, Latino Americans, Native Hawaiians, and Whites), completed a mailed questionnaire, 1993-1996. After an average follow-up of 7.3 years, 454 men and 242 women were diagnosed with gastric adenocarcinoma. Cox proportional hazard models were used to calculate multivariate-adjusted hazard ratios and 95% confidence intervals.


RESULTS
Current cigarette smokers had elevated hazard ratios compared with never smokers among men (HR = 1.98; 95% CI 1.46-2.70) and women (HR = 1.78; 95% CI 1.23-2.57). This positive association was consistent across all five ethnicities. Former smokers had an elevated risk among men, but not among women. There was a significant trend by intensity (cigarettes per day) and duration (years) of smoking among all current smokers. After separation by anatomic location of their tumor, ever smokers had a higher risk for gastric cardia cancer (HR = 2.86; 95% CI 1.66-4.93) than for distal gastric cancer (HR = 1.52; 95% CI 1.25-1.86) among men and women combined. Analysis by histologic tumor type showed a stronger association between current smoking and the intestinal type.


CONCLUSIONS
Overall, this study shows an association of current cigarette smoking with gastric cancer in both sexes, consistency of this effect across five ethnic groups, evidence for a dose-response effect of smoking in both sexes, a stronger effect for cardia than for distal gastric cancer, and a stronger association for intestinal than for diffuse gastric cancer.
Epidemiology Program, University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI 96813, USA. abe@cc.hawaii.edu
Abraham M Y
AM
Nomura
Lynne R
LR
Wilkens
Brian E
BE
Henderson
Meira
M
Epplein
Laurence N
LN
Kolonel
D000368:Aged; D015331:Cohort Studies; D005260:Female; D006254:Hawaii / Q000453:epidemiology; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology* / Q000208:ethnology*; D013274:Stomach Neoplasms / Q000453:epidemiology* / Q000208:ethnology* / Q000209:etiology; D011795:Surveys and Questionnaires