Kneller R W, McLaughlin J K, Bjelke E, Schuman L M, Blot W J, Wacholder S, Gridley G, CoChien H T, Fraumeni J F
Division of Cancer Epidemiology, National Cancer Institute, Bethesda, MD 20892.
Cancer. 1991 Aug 1;68(3):672-8. doi: 10.1002/1097-0142(19910801)68:3<672::aid-cncr2820680339>3.0.co;2-t.
Demographic, smoking and dietary information was obtained from a cohort of 17,633 white American men, largely of Scandinavian and German descent, who responded to a mailed questionnaire in 1966. After 20 years of follow-up, 50% to 90% increases in mortality from stomach cancer (75 deaths) were found among foreign-born, their children, and among residents of the North Central states. An association was seen with low educational attainment and laboring or semiskilled occupations, primarily among immigrants and their children. Risk was evaluated in subjects who regularly smoked cigarettes (RR = 2.6, 95% CI = 1.1 to 5.8). A significant dose-response trend was observed, with subjects who smoked 30 or more cigarettes per day having more than a five-fold increased risk compared with those who never smoked. Elevated risks were also found for pipe smoking and smokeless tobacco use, but not for alcohol consumption. Analysis of dietary consumption of nine food groups revealed no significant associations with stomach cancer. However, total carbohydrate intake and a few individual food items (salted fish, bacon, cooked cereal, milk, and apples) were associated with increased risk. The findings of this prospective study of a high-risk population add to the limited evidence relating tobacco consumption to stomach cancer risk and suggest clues to ethnic, geographic, and dietary risk factors.
人口统计学、吸烟和饮食信息来自17633名美国白人男性组成的队列，他们大多有斯堪的纳维亚和德国血统，于1966年回复了一份邮寄问卷。经过20年的随访，发现外国出生者、他们的子女以及中北部各州居民的胃癌死亡率增加了50%至90%（75例死亡）。这种关联主要在移民及其子女中，与低教育程度以及体力劳动或半熟练职业有关。对经常吸烟的受试者进行风险评估（相对风险=2.6，95%置信区间=1.1至5.8）。观察到显著的剂量反应趋势，每天吸30支或更多香烟的受试者与从不吸烟者相比，风险增加了五倍多。吸烟斗和使用无烟烟草也有较高风险，但饮酒没有。对九种食物组的饮食消费分析显示，与胃癌没有显著关联。然而，总碳水化合物摄入量以及一些个别食物（咸鱼、培根、熟谷物、牛奶和苹果）与风险增加有关。这项对高危人群的前瞻性研究结果补充了关于烟草消费与胃癌风险关系的有限证据，并提示了种族、地理和饮食风险因素的线索。
