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Discovering the causes of cancer and the means of prevention

Gastrointestinal Cancer

Metabolic Epidemiology Branch

Gastric and esophageal cancers are the 2nd and 6th most common causes of cancer death in the world, respectively, and together they kill over 1 million people each year. DCEG investigators' participation in UGI cancer research began with the Nutrition Intervention Trials (1985-1991) in Linxian, China, two randomized multivitamin/mineral supplementation trials in a population with some of the highest rates of esophageal squamous cell carcinoma (ESCC) and gastric cardia cancer in the world.  DCEG investigators have since expanded their research to include:

  • Etiologic studies of ESCC (focused on polycyclic aromatic hydrocarbon (PAH) exposure) and gastric cancer (focused on the effects of H. pylori and gut hormones) 
  • Genetic studies (including genome-wide association studies) of esophageal and gastric cancer 
  • Development of an endoscopic early detection and treatment program for esophageal squamous dysplasia, the precursor of ESCC, which is now used to screen 100,000 adults in China each year

Pancreatic and Liver Cancers

Pancreatic and liver cancers are rapidly fatal tumors that cause a substantial public health burden worldwide. Occurring in metabolically important organs, many dietary and metabolic hypotheses have been posited for these cancers. Epidemiologic studies are challenging, both because of concerns about biases related to latent disease and because most cohort studies lack substantial case numbers. In order to evaluate risk factors for these cancers, MEB investigators have taken advantage of prospective data from DCEG cohorts, clinical studies of disease progression, and pooled consortia. 

Recent findings for pancreatic cancer have included positive associations with insulin resistance, total and saturated fat, and vitamin D status, and inverse associations with adiponectin, sRAGE, and, in genome wide association studies, loci at 9q34 (ABO blood group), 13q22.1, 1q32.1 (NR5A2), and 5p15.33 (CLPMIL and TERT).  

Recent findings for liver cancer have included positive associations with red meat and total and saturated fat, and inverse associations with coffee, white meat, and vitamin D status. Analyses of insulin, glucose and serum iron are currently underway, and future studies will be aimed at understanding the mechanisms behind the observed associations with coffee and vitamin D. 

Selected studies include: