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Gastric and Esophageal Cancers Largely Attributable to Preventable Exposures

, by DCEG Staff

Smoking is a universal risk factor for the common types of esophageal and gastric cancer

Tobacco smoking, obesity, alcohol consumption, and other modifiable risk factors contribute to a large proportion of cases of esophageal and gastric cancers in the U.S., according to a study published April 2021 in the journal, American Journal of Gastroenterology. These findings highlight significant opportunities to reduce the burden of these cancers.

Christian Abnet, Ph.D., M.P.H., chief of the Metabolic Epidemiology Branch, and collaborators used data from 490,605 people enrolled in the National Institutes of Health-AARP Diet and Health Study cohort from 1995 to 2011.  They studied the four primary types of esophageal and gastric cancers—esophageal squamous cell carcinoma (ESCC), esophageal adenocarcinoma (EAC), gastric cardia adenocarcinoma (GCA), and gastric noncardia adenocarcinoma (GNCA)— and made contemporary risk estimates for risk factors including tobacco smoking, obesity, alcohol consumption, and gastroesophageal reflux disease (GERD). An important limitation was that they could not assess exposure to Helicobacter pylori.  The investigators then used the National Health Interview Survey and other sources to estimate the frequency of these exposures in US adults, which allowed them to estimate the fraction of these cancers caused by each exposure. 

Smoking was associated with more than half of ESCC cases, more than a third of EAC and GCA cases, and a tenth of GNCA cases, making it a universal risk factor for the common types of cancer in the esophagus and stomach. In addition, obesity and GERD were associated with more than half of EAC cases and a third of GCA cases, while alcohol consumption was associated with a fifth of ESCC cases. 

These preventable exposures represent critical targets for cancer prevention efforts. Not smoking, moderate alcohol drinking at most, and maintaining a healthy weight are important ways to reduce the risk of these cancers and for your overall health. 

Reference:
Wang, SM et al. Population attributable risks of subtypes of esophageal and gastric cancers in the United States. Am J Gastroenterol 2021.
 

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