Dietary factors and risk of subtypes of esophageal and gastric cancer

Background. Incidence rates for adenocarcinomas of the esophagus and gastric cardia have been increasing rapidly, while rates for non-cardia gastric adenocarcinoma and esophageal squamous cell carcinoma have declined. We examined dietary behaviors as risk factors for subtypes of esophageal and gastric cancers in a multi-center, population-based case-control study in Connecticut, New Jersey, and western Washington state.; Methods. Interviews were completed for cases with histologically confirmed esophageal adenocarcinoma, gastric cardia adenocarcinoma, esophageal squamous cell carcinoma, and non-cardia gastric adenocarcinoma and population-based controls. Multiple approaches were utilized for examining diet including nutrient analyses, food group analysis, and more sophisticated analyses of dietary patterns including principal components analyses and regression tree analyses to better characterize putative associations.; Results. Nutrient analyses revealed significant inverse associations between intake of beta-cryptoxanthin, lutein/zeaxanthin, lycopene, and total carotenoid and risk of esophageal adenocarcinoma. Further dietary analyses indicate that total vegetable intake was significantly inversely associated with risk of esophageal adenocarcinoma. As well, the fruit/vegetable pattern was inversely associated with risk of both subtypes of esophageal cancer. Conversely, meat intake was significantly associated with increased risk of esophageal adenocarcinoma and both cardia and non-cardia gastric adenocarcinoma, which was confirmed by pattern analysis. CART analyses found GERD to be the most important risk factor for esophageal adenocarcinoma and both cardia and non-cardia gastric adenocarcinoma CART analyses also found that intake of red meat, non-citrus fruits, and dark green and raw vegetables were important risk factors for esophageal adenocarcinoma.; Conclusion. These analyses provide evidence of an inverse association between fruit and vegetable consumption and both esophageal adenocarcinoma and squamous cell carcinoma and a positive association between red meat consumption and esophageal adenocarcinoma and between nitrites and gastric cardia adenocarcinoma. These findings also support the literature regarding GERD and adenocarcinomas of the esophagus and gastric cardia and between smoking and drinking and esophageal squamous cell carcinoma. As well they indicate that balancing positive behaviors, such as fruit and vegetable consumption, and negative behaviors may attenuate risk. Further, using multiple methodologies allows for the examination of diet at many levels and may provide a more practical and realistic means of developing prevention strategies.