Abstract
Objective: The incidence of esophageal adenocarcinoma has risen rapidly in the past two decades, for unknown reasons. The goal of this analysis was to determine whether gastroesophageal reflux disease (GERD) or the medications used to treat it are associated with an increased risk of esophageal or gastric cancer, using data from a large population-based case–control study.
Methods: Cases were aged 30–79 years, newly diagnosed with esophageal adenocarcinoma (n = 293), esophageal squamous cell carcinoma (n = 221), gastric cardia adenocarcinoma (n = 261), or non-cardia gastric adenocarcinoma (n = 368) in three areas with population-based tumor registries. Controls (n = 695) were chosen by random digit dialing and from Health Care Financing Administration rosters. Data were collected using an in-person structured interview.
Results: History of gastric ulcer was associated with an increased risk of non-cardia gastric adenocarcinoma (OR 2.1, 95% CI 1.4–3.2). Risk of esophageal adenocarcinoma increased with frequency of GERD symptoms; the odds ratio in those reporting daily symptoms was 5.5 (95% CI 3.2–9.3). Ever having used H2 blockers was unassociated with esophageal adenocarcinoma risk (OR 0.9, 95% CI 0.5–1.5). The odds ratio was 1.3 (95% CI 0.6–2.8) in long-term (4 or more years) users, but increased to 2.1 (95% CI 0.8–5.6) when use in the 5 years prior to the interview was disregarded. Risk was also modestly increased among users of antacids. Neither GERD symptoms nor use of H2 blockers or antacids was associated with risk of the other three tumor types.
Conclusions: Individuals with long-standing GERD are at increased risk of esophageal adenocarcinoma, whether or not the symptoms are treated with H2blockers or antacids.
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References
Blot WJ, Devesa SS, Kneller RW, Fraumeni JF (1991) Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 265: 1287–1289.
Gammon MD, Schoenberg JB, Ahsan H, et al. (1997) Tobacco, alcohol, and socioeconomic status and adenocarcinomas of the esophagus and gastric cardia. J Natl Cancer Inst 89: 1277–1284.
Chow W-H, Finkle WD, McLaughlin JK, Frankl H, Ziel HK, Fraumeni JF Jr (1995) The relation of gastroesophageal reflux disease and its treatment to adenocarcinomas of the esophagus and gastric cardia. JAMA 274: 474–477.
Lagergren J, Bergstrom R, Lindgren A, Nyren O (1999) Symp-tomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 340: 825–831.
Chow W-H, Blot WJ, Vaughan TL, et al. (1998) Body mass index and risk of adenocarcinomas of the esophagus and gastric cardia. J Natl Cancer Inst 90: 150–155.
Kabat GC, Ng SKC, Wynder EL (1993) Tobacco, alcohol intake, and diet in relation to adenocarcinoma of the esophagus and gastric cardia. Cancer Causes Control 4: 123–132.
Brown LM, Silverman DT, Pottern LM, et al. (1994) Adenocar-cinoma of the esophagus and esophagogastric junction in white men in the United States: alcohol, tobacco,and socioeconomic factors. Cancer Causes Control 5: 333–340.
Vaughan TL, Davis S, Kristal A, Thomas DB (1995) Obesity, alcohol, and tobacco as risk factors for cancers of the esophagus and gastric cardia: adenocarcinoma versus squamous cell carcino-ma. Cancer Epidemiol Biomarkers Prev 4: 85–92.
Vaughan TL, Farrow DC, Hansten PD, et al. (1998) Risk of esophageal and gastric adenocarcinoma in relation to use of calcium channel blockers, asthma drugs and other medications that promote gastroesophageal reflux. Cancer Epidemiol Biomark-ers Prev 7: 749–756.
Wang HH, Hsieh CC, Antonioli DA (1994) Rising incidence rate of esophageal adenocarcinoma and use of pharmaceutical agents that relax the lower esophageal sphincter (United States). Cancer Causes Control 5: 573–578.
Anonymous (1998) Top 200 drugs of 1997. Pharm Times,April.
Elder JB, Ganguli PC, Gillespie IE (1979) Cimetidine and gastric cancer. Lancet 1: 1005–1006.
Foster AB, Jarman M, Manson D, Schulten HR (1980) Structure and reactivity of nitrosocimetidine. Cancer Lett 9: 47–52.
Moller H, Lindvig K, Klefter R, Mosbech J, Moller Jensen O (1989) Cancer occurrence in a cohort of patients treated with cimetidine. Gut 30: 1558–1562.
Moller H, Nissen A, Mosbech J (1992) Use of cimetidine and other peptic ulcer drugs in Denmark 1977–1990 with analysis of the risk of gastric cancer among cimetidine users. Gut 33: 1166–1169.
LaVecchia C, Negri E, Davanzo B, Franceschi S (1990) Histamine-2–receptor antagonists and gastric cancer risk. Lancet 336: 355–357.
LaVecchia C, Negri E, Franceschi S, D'Avanzo B (1992) Hista-mine-2–receptor antagonists and gastric cancer: update and note on latency and covariates. Nutrition 8: 177–181.
Colin-Jones DG, Langman MJS, Lawson DH, Logan RFA, Paterson KR, Vessey MP (1991) Post-cimetidine surveillance for up to ten years: incidence of carcinoma of the stomach and oesophagus. Q J Med 78: 13–19.
Johnson AG, Jick SS, Perera DR, Jick H (1996) Histamine-2 receptor antagonists and gastric cancer. Epidemiology 7: 434–436.
Schumacher MC, Jick SS, Jick H, Feld D (1990) Cimetidine use and gastric cancer. Epidemiology 1: 251–254.
Farrow DC, Vaughan TL, Hansten PD, et al. (1998). Use of aspirin and other non-steroidal anti-inflammatory drugs and risk of esophageal and gastric cancer. Cancer Epidemiol Biomarkers Prev 7: 97–102.
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Farrow, D.C., Vaughan, T.L., Sweeney, C. et al. Gastroesophageal reflux disease, use of H2 receptor antagonists, and risk of esophageal and gastric cancer. Cancer Causes Control 11, 231–238 (2000). https://doi.org/10.1023/A:1008913828105
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DOI: https://doi.org/10.1023/A:1008913828105