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Ann Epidemiol. 2014 Jan;24(1):50-7. doi: 10.1016/j.annepidem.2013.10.009. Epub 2013 Oct 18.

Diet and lifestyle factors and risk of subtypes of esophageal and gastric cancers: classification tree analysis.

Author information

  • 1Department of Health and Nutrition Sciences, Montclair State University, Montclair, NJ. Electronic address:
  • 2Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT.
  • 3Department of Epidemiology, University of North Carolina, Chapel Hill, NC.
  • 4Department of Epidemiology, University of Washington, Seattle, 98195 WA; Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, 98109 WA.
  • 5Department of Epidemiology, The University of Texas, MD Anderson Cancer Center, Houston, TX.
  • 6Department of Statistics and Actuarial Science, School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
  • 7Department of Epidemiology, University of Washington, Seattle, 98195 WA.
  • 8Department of Pathology, Yale School of Medicine, New Haven, CT.
  • 9Department of Pathology, Columbia University, New York, NY.
  • 10International Epidemiology Institute, Rockville, MD.



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.


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.


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.


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.

Copyright © 2014 Elsevier Inc. All rights reserved.


CART; Classification tree; Diet; Esophageal adenocarcinoma; Gastric cardia adenocarcinoma; Gastroesophageal reflux disease

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