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Cancer Prev Res (Phila). 2019 Oct;12(10):667-674. doi: 10.1158/1940-6207.CAPR-19-0238. Epub 2019 Jul 26.

Smoking, Helicobacter Pylori Serology, and Gastric Cancer Risk in Prospective Studies from China, Japan, and Korea.

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Department of Population Health Sciences, Duke University and Cancer Control and Population Sciences Program, Duke Cancer Institute, Durham, North Carolina.
Infections and Cancer Epidemiology, Research Program in Infection, Inflammation, and Cancer, German Cancer Research Center (DFKZ), Heidelberg, Germany.
Department of Epidemiology, University of North Carolina Gillings School of Global Public Health and Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina.
Department of Cancer Epidemiology, Moffitt Cancer Center and Research Institute, Tampa, Florida.
Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan.
Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center and Ingram Cancer Center, Vanderbilt University, Nashville, Tennessee.
National Cancer Institute, National Institutes of Health, Rockville, Maryland.
Seoul National University, Seoul, Republic of Korea.
National Cancer Center of Korea, Seoul, Republic of Korea.
Department of Epidemiology and Health Promotion, Institute for Health Promotion, Graduate School of Public Health, Yonsei University, Seoul, Korea.
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Peking University Health Science Center, Beijing, China.
Department of Population Health Sciences, Duke University and Cancer Control and Population Sciences Program, Duke Cancer Institute, Durham, North Carolina.


Smoking is an established risk factor for gastric cancer development. In this study, we aimed to assess prospectively the association of smoking with gastric cancer risk in 1,446 non-cardia gastric cancer cases and 1,796 controls from China, Japan, and Korea with consideration of Helicobacter pylori infection as a potential effect modifier. Applying logistic regression models stratified by study and adjusted for age and sex we found that current, but not former, smoking was significantly associated with gastric cancer risk [OR = 1.33; 95% confidence interval (CI), 1.07-1.65]. However, the association was significant only in H. pylori sero-positive individuals determined by 3 different sero-markers: overall sero-positivity, sero-positivity to the onco-protein CagA, and sero-positivity to the gastric cancer associated sero-marker HP0305 and HP1564. Specifically, a significant interaction was found when stratifying by HP0305/HP1564 (P interaction = 0.01) with a 46% increased risk of gastric cancer among HP0305/HP1564 sero-positive current smokers (95% CI, 1.10-1.93) as opposed to no increased gastric cancer risk among HP0305/HP1564 sero-negative current smokers (OR = 0.93; 95% CI, 0.65-1.33). We confirmed that current smoking is associated with an increased gastric cancer risk, however, only among individuals that are simultaneously sero-positive for the leading causal factor for gastric cancer, H. pylori.

[Available on 2020-04-01]

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