Diet and lifestyle factors and risk of subtypes of esophageal and gastric cancers: classification tree analysis.
OBJECTIVE
Although risk factors for squamous cell carcinoma of the esophagus and adenocarcinomas of the esophagus (EA), gastric cardia (GC), and other (noncardia) gastric (OG) sites have been identified, little is known about interactions among risk factors. We sought to examine interactions of diet, other lifestyle, and medical factors with risks of subtypes of esophageal and gastric cancers.


METHODS
We used classification tree analysis to analyze data from a population-based case-control study (1095 cases, 687 controls) conducted in Connecticut, New Jersey, and western Washington State.


RESULTS
Frequency of reported gastroesophageal reflux disease symptoms was the most important risk stratification factor for EA, GC, and OG, with dietary factors (EA, OG), smoking (EA, GC), wine intake (GC, OG), age (OG), and income (OG) appearing to modify the risk of these cancer sites. For esophageal squamous cell carcinoma, smoking was the most important risk stratification factor, with gastroesophageal reflux disease, income, race, noncitrus fruit, and energy intakes further modifying risk.


CONCLUSIONS
Various combinations of risk factors appear to interact to affect risk of each cancer subtype. Replication of these data mining analyses are required before suggesting causal pathways; however, the classification tree results are useful in partitioning risk and mapping multilevel interactions among risk variables.
Department of Health and Nutrition Sciences, Montclair State University, Montclair, NJ. Electronic address: silveras@mail.montclair.edu.
Stephanie A
SA
Navarro Silvera
Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT.
Susan T
ST
Mayne
Department of Epidemiology, University of North Carolina, Chapel Hill, NC.
Marilie D
MD
Gammon
Department of Epidemiology, University of Washington, Seattle, 98195 WA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, 98109 WA.
Thomas L
TL
Vaughan
Department of Epidemiology, The University of Texas, MD Anderson Cancer Center, Houston, TX.
Wong-Ho
WH
Chow
Department of Statistics and Actuarial Science, School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
Joel A
JA
Dubin
Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT.
Robert
R
Dubrow
Department of Epidemiology, University of Washington, Seattle, 98195 WA.
Janet L
JL
Stanford
Department of Pathology, Yale School of Medicine, New Haven, CT.
A Brian
AB
West
Department of Pathology, Columbia University, New York, NY.
Heidrun
H
Rotterdam
International Epidemiology Institute, Rockville, MD.
William J
WJ
Blot
Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT.
Harvey A
HA
Risch
D000230:Adenocarcinoma / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000209:etiology; D016022:Case-Control Studies; D003237:Connecticut / Q000453:epidemiology; D004032:Diet; D004938:Esophageal Neoplasms / Q000453:epidemiology* / Q000209:etiology; D005247:Feeding Behavior; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications; D006801:Humans; D015994:Incidence; D008019:Life Style; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009515:New Jersey / Q000453:epidemiology; D012307:Risk Factors; D013223:Statistics as Topic; D013274:Stomach Neoplasms / Q000453:epidemiology* / Q000209:etiology; D011795:Surveys and Questionnaires; D014861:Washington / Q000453:epidemiology; D055815:Young Adult
CART; Classification tree; Diet; Esophageal adenocarcinoma; Gastric cardia adenocarcinoma; Gastroesophageal reflux disease