Dose–response association between cigarette smoking and gastric cancer risk: a systematic review and meta-analysis

Abstract

This study aims at providing an accurate and up-to-date quantification of the dose-response association between cigarette smoking and gastric cancer (GC) risk, overall and by subsite. We conducted a systematic review and meta-analysis of casecontrol and cohort studies on the association between cigarette smoking and GC risk published up to January 2023. We estimated pooled relative risks (RR) of GC and its subsites according to smoking status, intensity, duration, and time since quitting. Among 271 eligible articles, 205 original studies were included in this meta-analysis. Compared with never smokers, the pooled RR for GC was 1.53 (95% confidence interval; CI 1.44-1.62; n = 92) for current and 1.30 (95% CI 1.23-1.37; n = 82) for former smokers. The RR for current compared with never smokers was 2.08 (95% CI 1.66-2.61; n = 21) for gastric cardia and 1.48 (95% CI 1.33-1.66; n = 8) for distal stomach cancer. GC risk nonlinearly increased with smoking intensity up to 20 cigarettes/day (RR:1.69; 95% CI 1.55-1.84) and levelled thereafter. GC risk significantly increased linearly with increasing smoking duration (RR: 1.31; 95% CI 1.25-1.37 for 20 years) and significantly decreased linearly with increasing time since quitting (RR: 0.65; 95% CI 0.44-0.95 for 30 years since cessation). The present meta-analysis confirms that cigarette smoking is an independent risk factor for GC, particularly for gastric cardia. GC risk increases with a low number of cigarettes up to 20 cigarettes/day and increases in a dose-dependent manner with smoking duration.

Stomach Cancer Prediction Model (SCoPM): An approach to risk stratification in a diverse U.S. population

“…Likewise, H . pylori infection [ 23 ], family history of gastric cancer in a first-degree relative [ 24 ], smoking [ 25 ], long-term proton pump inhibitor use [ 26 ] as well as prior history of gastric ulcer [ 27 ] are each well-established risk factors for stomach cancer. In contrast to these risk factors, the presence of a low hemoglobin may actually represent an early sign of gastric cancer with iron-deficiency anemia that may occur in the setting of atrophic gastritis or potentially directly from occult gastrointestinal hemorrhage from a gastric neoplasia.…”