Tobacco and Public Health - TCSC Indonesia

Chapter 24
Smoking and stomach cancer
David Zaridze
Incidence and mortality from stomach cancer is declining practically in all countries.
Nevertheless stomach cancer remains the second most common cause of death from
cancer in the world, accounting for about one million cases annually (Parkin et al.
1999). Incidence and mortality from stomach cancer are high in Japan, Korea, China,
Russia, in Columbia, and other countries of South America, and are low in North
America and western Europe (Pisani and Pisani 1999). Decline in the incidence of
stomach cancer is accompanied by increase in cancer of the gastric cardia (Devesa
et al. 1998; Botterweck et al. 2000).
Helicobacter pylori infection is causally associated with stomach cancer (IARC 1994).
It has been shown-that type of food storage, namely the lack of refrigeration is a major
risk factor for stomach cancer (World Cancer Research Fund 1997; Zaridze et al. 2002).
Diets low in fruits and vegetables decrease the risk of stomach cancer (Nomura et al.
1990; Kabat et al. 1993; World Cancer Research Fund 1997; De Stefani et al. 1998; Terry
et al. 1998; Mathew et al. 2000; Zaridze et al. 2002), while high salt intake has been
claimed to increase the risk (Nomura et al. 1990; World Cancer Research Fund 1997;
Zaridze et al. 2002). Alcohol consumption and especially consumption of liquors has
been found to increase the risk of gastric cancer and especially cancer of the gastric
cardia (Agudo et al. 1992; Hansson et al. 1994; Kabat et al. 1993; Gammon et al. 1997;
De Stefani et al. 1998; Lagergren et al. 2000; Zaridze et al. 2000).
Smoking has been found to be associated with an increase in the risk of stomach cancer
in many cohort and case–control studies reported from Asia, America, and Europe.
Thirteen cohort studies found a statistically significant association between smoking
and the risk of stomach cancer, relative risks ranging from 1.4 to 2.6 in current smokers.
These studies include American Cancer Society study (Hammond 1966), U.S. Veteran’s
cohort (Kahn 1966), Japanese cohort (Hirayma 1982), British doctors cohort study
(Doll et al. 1994), cohort of male Japanese physicians (Kono et al. 1987), six prefecture
study in Japan (Akiba and Hirayama 1990), cohort of American men of Japanese
ancestry (Nomura et al. 1990, 1995), cohort of American men of Scandinavian and
German descent (Kneller et al. 1991), cohort study of inhabitants of Aichi prefecture in
Japan (Kato et al. 1992a), cohort of inhabitants of five areas of Norway (Tverdal et al.
1993), cardiovascular risk factor study from Iceland (Tulinius et al. 1997), cohort of