Cancer Research UK : Stomach Cancer risk factors

Stomach Cancer risk factors

This section contains information on risk factors for stomach cancer including Helicobacter pylori, smoking and alcohol, diet, medical conditions and medications, family history, radiation and occupation.

Wide international variations in incidence and the dramatic falls seen across the developed world suggest that environmental factors are very important in gastric carcinogenesis.

Evidence suggests a large number of risk factors for stomach cancer and it is very likely that its aetiology is multifactorial with the importance of different risk factors varying across populations and between individuals. The universal demographic factors are old age, male gender and low socio-economic status (The rising rates of adenocarcinoma of the gastric cardia have been principally associated with higher socio-economic status).

Helicobacter pylori and severe chronic atrophic gastritis and Stomach cancer risk

Infection with Helicobacter pylori (H. pylori) is the most important known risk factor for stomach cancer.

H. pylori is a common bacterial infection, with particularly high prevalence in the developing world. Crowded living conditions, poor hygiene, large families and low socio-economic status are all associated with high rates of H. pylori infection.

Prevalence of H. pylori infection has been declining in the UK, which may explain the falling incidence of distal stomach cancer.1

H. pylori infection doubles the risk of stomach cancer and the risk is almost three-fold among those infected with cagA-positive H. pylori strains.2

Findings from the European Prospective Investigation into Cancer (EPIC) suggest that the increase in risk may be as much as seven-fold in those with evidence of long-term H. pylori infection.1

H. pylori can induce the pre-cancerous lesion severe chronic atrophic gastritis (SCAG), the first step in the chain of events leading from normal intestinal mucosa to adenocarcinoma. Eradication of H. pylori through treatment can cause regression of precursor lesions. SCAG increases the risk for cancers of the gastric cardia by around 11-fold and gastric non-cardia by three-fold. 1

Risk increases with the severity of gastric atrophy; people with severe multifocal atrophic gastritis have over 90 times increased risk of stomach cancer.3

There is evidence that H. pylori eradication may help prevent gastric cancer.4, 5,60-62

Find out more on Helicobacter pylori.

Smoking and alcohol and stomach cancer risk

Current smokers have around double the risk of stomach cancer compared to non-smokers and risk remains higher for 10-20 years after giving up.6, 7

The combined effect of smoking and H. pylori infection may be more than additive, with a 16–17-fold increased risk of gastric non-cardia cancer.8 It has been estimated that almost one in five stomach cancers in Europe are caused by smoking, with a higher proportion in men (22%) than women (14%).7 Nitrosamines are present in tobacco smoke, which may explain the increased risk.9

While alcohol has been extensively studied as a cause of stomach cancer there is no conclusive evidence that it increases risk. However, results from at least three studies suggest that heavy alcohol consumption may increase the risk of stomach cancer in heavy smokers.10,11,12

Diet and Stomach cancer risk

High fruit and vegetable intake is associated with a reduced risk of gastric cancer in both cohort and case-control studies.13, 59

High salt intake has been linked to risk of stomach cancer in a number of studies.59 Intake of salt is difficult to measure, but one of the most recent prospective studies to examine the relationship between salt intake and stomach cancer in Japan showed that risk is three times higher among individuals with a salt intake of 16g/day or more, compared to intakes of less than 10g/day. The risk increase with high salt intake was limited to subjects with H.pylori infection and atrophic gastritis.15

It is not clear whether salt intake at current normal levels in European countries is linked to stomach cancer risk. A recent Danish study found no clear associations between salt intake and stomach cancer risk, although there were suggestive associations particularly for people with stomach disorders.17 A Norwegian study found no association.63

Heavily salted foods are often high in N-nitroso compounds. There is limited evidence that individuals with high intakes of N-nitrosodimethylamine (NDMA) or nitrite have an increased risk of stomach cancer.19,20, 21

Processed meat was linked to stomach cancer risk in a recent meta-analysis.23 However, the World Cancer Research Fund deemed evidence on processed meat and stomach cancer limited.59 Results from the EPIC study suggest an association with processed meat consumption in subjects that are infected with H. pylori.26

Medical conditions and medications and stomach cancer risk

People diagnosed with gastro-oesophageal reflux disease (GORD) have a doubling in their risk of gastric cardia adenocarcinoma.30 People who have undergone surgery to correct acid reflux have five times the risk of gastric cardia cancer.31 People diagnosed with Barrett's oesophagus have an 18-fold risk increase.33

High BMI (Body Mass Index) is linked to a two-fold increased risk of gastric cardia adenocarcinoma. 21,34 Most studies show an association between high BMI and gastric reflux symptoms, and this might provide an explanation for the association of this type of stomach cancer with BMI.33 Around 13% of gastric cardia adenocarcinomas in the USA have been linked to people having a BMI of 27 or higher.21

H. pylori infection is linked with both gastric and duodenal ulcers but only gastric ulcer is associated with increased risk of stomach cancer, while the presence of duodenal ulcer appears to reduce risk.35,36 Patients who have undergone surgery for gastric ulcer have a lower risk than patients who have not received surgery.36 Both conditions respond well to the elimination of H. pylori and are becoming less common in populations where the prevalence of H. pylori is declining.37 Vagotomy - a surgical procedure to reduce acid secretion in the stomach - is associated with an increased risk of stomach cancer in the following 10 years.36 People who have part of their stomach surgically removed (partial gastrectomy) for a benign stomach condition, such as an ulcer, have an increased risk of stomach cancer, which is highest 15 or more years after the operation.65

Patients with pernicious anaemia – where there is severe gastric atrophy caused by an autoimmune condition – have two to three times increased risk of stomach cancer.38,39

The risk of being diagnosed with stomach cancer is increased in people with a previous diagnosis of oesophageal cancer, non-melanoma skin cancer, bowel cancer and non-Hodgkin’s lymphoma. In addition, men with a previous prostate, bladder or testis cancer and women with a previous ovarian, cervical or breast cancer have an increased risk of stomach cancer.40,41,64 Some of the risk increase may be related to treatment for the first cancer.

Regular use of aspirin and other non-steroidal anti-inflammatories (NSAIDS) is associated with a 30% reduction in risk of non-cardia stomach cancer.42 One study has shown a reduced risk of stomach cancer in women who have taken hormone replacement therapy (HRT).43

There is evidence that people with HIV/AIDS or who have undergone an organ transplant have a doubling in risk of stomach cancer.66

Family history and stomach cancer risk

Having a parent or sibling diagnosed with a stomach cancer increases risk 1.5-fold and three-fold respectively.41

Some of this increased risk may be environmental, as studies have shown elevated risk in spouses of stomach cancer patients,44 and that relatives of gastric cancer patients are twice as likely to be infected with H. pylori.45

Radiation and stomach cancer risk

Studies of atomic bomb survivors show that risk of stomach cancer is directly related to dose of radiation, with almost double the risk in people most heavily exposed to radiation from the atomic bombs in Japan.46 An increased risk has also been shown in people treated with radiotherapy for ankylosing spondylitis.47

Occupation and stomach cancer risk

Occupational exposure to metal dusts,48-54 and other types of dusts – such as from mining or quarrying or stone cutting52,55,56 – has been associated with an increased risk of gastric cancer in several studies.

References for stomach cancer risk factors

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