title: Helicobacter pylori infection, chronic corpus atrophic gastritis and pancreatic cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort: A nested case-control study.
abstract: The association between H. pylori infection and pancreatic cancer risk remains controversial. We conducted a nested case-control study with 448 pancreatic cancer cases and their individually matched control subjects, based on the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, to determine whether there was an altered pancreatic cancer risk associated with H. pylori infection and chronic corpus atrophic gastritis. Conditional logistic regression models were applied to calculate odds ratios (ORs) and corresponding 95% confidence intervals (CIs), adjusted for matching factors and other potential confounders. Our results showed that pancreatic cancer risk was neither associated with H. pylori seropositivity (OR = 0.96; 95% CI: 0.70, 1.31) nor CagA seropositivity (OR = 1.07; 95% CI: 0.77, 1.48). We also did not find any excess risk among individuals seropositive for H. pylori but seronegative for CagA, compared with the group seronegative for both antibodies (OR = 0.94; 95% CI: 0.63, 1.38). However, we found that chronic corpus atrophic gastritis was non-significantly associated with an increased pancreatic cancer risk (OR = 1.35; 95% CI: 0.77, 2.37), and although based on small numbers, the excess risk was particularly marked among individuals seronegative for both H. pylori and CagA (OR = 5.66; 95% CI: 1.59, 20.19, p value for interaction < 0.01). Our findings provided evidence supporting the null association between H. pylori infection and pancreatic cancer risk in western European populations. However, the suggested association between chronic corpus atrophic gastritis and pancreatic cancer risk warrants independent verification in future studies, and, if confirmed, further studies on the underlying mechanisms.
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
authors.forename: Jiaqi
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
authors.forename: Ulrika
authors.initials: U
authors.lastname: Zagai
authors.affiliation: Department of Public Health and Clinical Nutrition, Umeå University, Umeå, Sweden.
authors.forename: Göran
authors.initials: G
authors.lastname: Hallmans
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
authors.forename: Olof
authors.initials: O
authors.lastname: Nyrén
authors.affiliation: Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Engstrand
authors.affiliation: Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD.
authors.forename: Rachael
authors.initials: R
authors.lastname: Stolzenberg-Solomon
authors.affiliation: Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Duell
authors.affiliation: Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark.
authors.forename: Kim
authors.initials: K
authors.lastname: Overvad
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Verena A
authors.initials: VA
authors.lastname: Katzke
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Rudolf
authors.initials: R
authors.lastname: Kaaks
authors.affiliation: Prevention and Implementation Group, Section of Early Detection and Prevention, Section of Nutrition and Metabolism, International Agency for Research on Cancer, Lyon, France.
authors.forename: Mazda
authors.initials: M
authors.lastname: Jenab
authors.affiliation: Prevention and Implementation Group, Section of Early Detection and Prevention, Section of Nutrition and Metabolism, International Agency for Research on Cancer, Lyon, France.
authors.forename: Jin Young
authors.initials: JY
authors.lastname: Park
authors.affiliation: Prevention and Implementation Group, Section of Early Detection and Prevention, Section of Nutrition and Metabolism, International Agency for Research on Cancer, Lyon, France.
authors.forename: Raul
authors.initials: R
authors.lastname: Murillo
authors.affiliation: Hellenic Health Foundation, Athens, Greece.|WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Antonia
authors.initials: A
authors.lastname: Trichopoulou
authors.affiliation: Hellenic Health Foundation, Athens, Greece.|WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.|Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA.
authors.forename: Pagona
authors.initials: P
authors.lastname: Lagiou
authors.affiliation: Hellenic Health Foundation, Athens, Greece.|WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Christina
authors.initials: C
authors.lastname: Bamia
authors.affiliation: Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors.forename: Kathryn E
authors.identifier: 0000-0003-3345-7333
authors.initials: KE
authors.lastname: Bradbury
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
authors.forename: Elio
authors.initials: E
authors.lastname: Riboli
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.
authors.forename: Dagfinn
authors.initials: D
authors.lastname: Aune
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom.|Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.
authors.forename: Konstantinos K
authors.initials: KK
authors.lastname: Tsilidis
authors.affiliation: Translational Research Laboratory, IDIBELL-Catalan Institute of Oncology, Barcelona, Spain.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Capellá
authors.affiliation: Unit of Nutrition and Cancer. Cancer Epidemiology Research Program. Catalan Institute of Oncology-IDIBELL. L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Agudo
authors.affiliation: Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Krogh
authors.affiliation: Cancer Risk Factors and Life-Style Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Palli
authors.affiliation: Dipartimento di medicina clinica e chirurgia Federico II, Naples, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Panico
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.|Department of Community Medicine, University of Tromsø, The Arctic University of Norway, Tromsø, Norway.|Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway.|Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland.
authors.forename: Elisabete
authors.initials: E
authors.lastname: Weiderpass
authors.affiliation: Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: Anne
authors.initials: A
authors.lastname: Tjønneland
authors.affiliation: Danish Cancer Society Research Center, Copenhagen, Denmark.
authors.forename: Anja
authors.initials: A
authors.lastname: Olsen
authors.affiliation: Andalusian School of Public Health, Instituto De Investigación Biosanitaria Ibs, Granada, Spain.
authors.forename: Begoña
authors.initials: B
authors.lastname: Martínez
authors.affiliation: Andalusian School of Public Health, Instituto De Investigación Biosanitaria Ibs, Granada, Spain.|CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.|Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs, Granada, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Redondo-Sanchez
authors.affiliation: Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain.|CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.|Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain.
authors.forename: Maria-Dolores
authors.initials: MD
authors.lastname: Chirlaque
authors.affiliation: Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Petra
authors.initials: P
authors.lastname: Hm Peeters
authors.affiliation: Department of Surgery, Institution of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
authors.forename: Sara
authors.initials: S
authors.lastname: Regnér
authors.affiliation: Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Björn
authors.initials: B
authors.lastname: Lindkvist
authors.affiliation: Molecular and Genetic Epidemiology Unit, Human Genetics Foundation, Turin, Italy.
authors.forename: Alessio
authors.identifier: 0000-0001-5774-0905
authors.initials: A
authors.lastname: Naccarati
authors.affiliation: CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.|Navarra Public Health Institute, Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Pamplona, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Ardanaz
authors.affiliation: CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.|Public Health Division of Gipuzkoa, Regional Government of the Basque Country, Spain.
authors.forename: Nerea
authors.initials: N
authors.lastname: Larrañaga
authors.affiliation: Hormones and Women's Health Team, INSERM, Centre for Research in Epidemiology and Population Health (CESP), U1018, Nutrition, Villejuif, F-94805, France.|Université Paris Sud, UMRS 1018, Villejuif, F-94805, France.|Institut Gustave Roussy, Villejuif, F-94805, France.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Boutron-Ruault
authors.affiliation: Department of Gastroenterology and Pancreatology, Beaujon Hospital, University Paris 7, Clichy, France.
authors.forename: Vinciane
authors.initials: V
authors.lastname: Rebours
authors.affiliation: Université Paris Sud and Gastroenterology Unit, Hôpitaux Universitaires Paris Sud, CHU de Bicêtre, AP-HP, Le Kremlin Bicêtre, France.
authors.forename: Amélie
authors.initials: A
authors.lastname: Barré
authors.affiliation: Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.|Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands.|Department of Epidemiology and Biostatistics, The School of Public Health, Imperial College London, London, United Kingdom.|Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: H B As
authors.initials: HB
authors.lastname: Bueno-de-Mesquita
authors.affiliation: Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.|The Medical Biobank at Umeå University, Umeå, Sweden.
authors.forename: Weimin
authors.initials: W
authors.lastname: Ye
mesh_terms: D000328:Adult; D000368:Aged; D000942:Antigens, Bacterial / Q000235:genetics* / Q000302:isolation & purification; D001426:Bacterial Proteins / Q000235:genetics* / Q000302:isolation & purification; D016022:Case-Control Studies; D005260:Female; D005757:Gastritis, Atrophic / Q000453:epidemiology / Q000235:genetics / Q000382:microbiology*; D016481:Helicobacter Infections / Q000453:epidemiology / Q000235:genetics / Q000382:microbiology*; D016480:Helicobacter pylori / Q000302:isolation & purification* / Q000472:pathogenicity; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D010190:Pancreatic Neoplasms / Q000453:epidemiology / Q000235:genetics / Q000382:microbiology*
chemical_list: D000942:Antigens, Bacterial; D001426:Bacterial Proteins; C080866:cagA protein, Helicobacter pylori
keywords: EPIC cohort; H. pylori infection; chronic corpus atrophic gastritis; nested case-control study; pancreatic cancer risk