A possible link between famine exposure in early life and future risk of gastrointestinal cancers: Implications from age-period-cohort analysis

Abstract

The Chinese famine in 1958-1962 was one of the worst in human history, but its potential influence on cancer risks is uncertain. Using cancer incidence data in Shanghai, China, during 1983-2007, we calculated age-specific incidence rates of gastrointestinal cancers in birth cohorts exposed to the Chinese famine in different periods of life and a non-exposed reference cohort. Age-period-cohort regressions estimated the overall relative risks of gastrointestinal cancers in each birth cohort. A total of 212,098 new cases of gastrointestinal cancer were identified during the study period (129,233 males and 82,865 females), among whom 18,146 had esophageal cancer, 71,011 gastric cancer, 55,864 colorectal cancer, 42,751 liver cancer, 9,382 gallbladder cancer and 14,944 had pancreatic cancer. The risk of esophageal, gastric, colorectal and liver cancers was higher in cohorts exposed to the Chinese famine in early life than in the reference cohort, except for esophageal cancer in women. The risk of esophageal, liver and colorectal cancers was particularly high in men exposed to famine during early childhood (0-9 years). There were no clear associations between famine exposure and the risk of pancreatic or gallbladder cancer. This study suggests an increased risk of esophageal, gastric, liver and colorectal cancers associated with childhood exposure to the Chinese famine. These findings indicate a need for further investigations confirming the results and identifying the underlying mechanisms.

Time trends of esophageal and gastric cancer mortality in China, 1991–2009: an age-period-cohort analysis

“…A previous study also found that the risk of gastric cancer mortality in Zhaoyuan county population increased during the Chinese Great Famine period 19 . However, the cohort effect was much higher for esophageal cancer in urban males, which was in line with another study that used incidence data in Shanghai, China 20 . The particularly high effect for this group suggests that some other unknown factors may interact with famine exposure.…”

Early famine exposure and adult disease risk based on a 10-year prospective study of Chinese adults

“…Using data from the Dutch Famine Birth Cohort of 475 women, researchers reported that women who had been exposed to famine in utero had a non-significant higher incidence of self-reported breast cancer (10 cases) compared with unexposed women (five cases) (HR 2.6; 95% CI 0.9 to 7.7) 25. Another study based on the cancer incidence data between 1983 and 2007 from Shanghai Cancer Registry showed that the age-standardised incidence rates of oesophageal, gastric, colorectal and liver cancers were higher in cohorts exposed to the Chinese famine at ages 0–9 years than in a reference cohort conceived after the famine 6. In the present study, we found no association between prenatal famine exposure and total adult cancer risk either in the whole population or any predefined subpopulations.…”

“…The Chinese Great Famine between 1959 and 1961 caused millions of excess deaths 3. A few studies in recent years have explored the potential impacts of this famine on adult health, mostly on metabolic disorders and mental illness, and only a few on cancer and respiratory disease 4–6. Most of the studies were cross-sectional, in which survival bias is of particular relevance, and the prevalent cases that survive to be in the study may offer a distorted frequency of famine exposure.…”

Chinese Famine and the diabetes mellitus epidemic

“…Future studies can integrate regional data and test the interaction between famine severity and the famine exposure group. The ageperiod-cohort method 12 can also be used, which can separate the effect of famine from age.…”