Neglected role of hookah and opium in gastric carcinogenesis: A cohort study on risk factors and attributable fractions

Abstract

A recent study showed an association between hookah/opium use and gastric cancer but no study has investigated the relationships with gastric precancerous lesions. We examined the association between hookah/opium and gastric precancerous lesions and subsequent gastric cancer. In a population-based cohort study, 928 randomly selected, healthy, Helicobacter pylori infected subjects in Ardabil Province, Iran, were followed for 10 years. The association between baseline precancerous lesions and lifestyle risk factors (including hookah/opium) was analyzed using logistic regression and presented as odds ratios (ORs) and 95% confidence intervals (CIs). We also calculated hazard ratio (HRs) and 95%CIs for the associations of lifestyle risk factors and endoscopic and histological parameters with incident gastric cancers using Cox regression models. Additionally, the proportion of cancers attributable to modifiable risk factors was calculated. During 9,096 person-years of follow-up, 36 new cases of gastric cancer were observed (incidence rate: 3.96/1000 persons-years). Opium consumption was strongly associated with baseline antral (OR:3.2;95%CI:1.2–9.1) and body intestinal metaplasia (OR:7.3;95%CI:2.5–21.5). Opium (HR:3.2;95%CI:1.4–7.7), hookah (HR:3.4;95%CI:1.7–7.1) and cigarette use (HR:3.2;95%CI:1.4–7.5), as well as high salt intake, family history of gastric cancer, gastric ulcer and histological atrophic gastritis and intestinal metaplasia of body were associated with higher risk of gastric cancer. The fraction of cancers attributable jointly to high salt, low fruit intake, smoking (including hookah) and opium was 93% (95%CI:83–98). Hookah and opium use are risk factors for gastric cancer, as well as for precancerous lesions. Hookah, opium, cigarette and high salt intake are important modifiable risk factors in this high incidence gastric cancer area.

Waterpipe Tobacco Smoking and Gastric Cancer Risk among Vietnamese Men

“…Our findings are consistent with the result of hookah smoking in a previous Iranian study [7]. This Iranian cohort study reported more than three-fold higher GC risk in hookah smokers (relative risk = 3.4, 95%CI = 1.7–7.1) even after adjusting for the effects of other confounding factors, which might be because of the high-risk study population, namely H .…”

“…The Iranian study [7] also reported a significant increase of GC risk by cigarette smoking (relative risk = 3.2, 95%CI = 1.4–7.5) as reported in previous studies [24]. However, our study did not find the association between cigarette smoking and GC risk.…”

“…However, a recent cohort study reported that GC risk significantly increased to three-fold among hookah smokers in a specific cohort, Helicobacter pylori (H . pylori) -infected healthy subjects in Northwest Iran [7]. …”

Gastric Cancer: Descriptive Epidemiology, Risk Factors, Screening, and Prevention

“…While studies vary, overall the accumulated data suggest that smoking is a risk factor for both cardia and noncardia GC (33-35). Other forms of tobacco use, such as hookah use, have also been associated with higher risk of GC (36), although these associations have not been found in other studies (37) and need further confirmation.…”

“…Among these risk factors are poor oral hygiene and tooth loss (37, 113, 114), opium use (36, 115-117), infection with Ebstein-Barr virus (118, 119), and eating pickled vegetables (120). …”