Worldwide, gastric cancer is the fifth most common cancer type and the seventh most common cause of cancer death, and oesophageal cancer ranks 11th in incidence and seventh in mortality (Global Cancer Observatory, 2022). The global burden of these cancer types is projected to rise substantially due to demographic shifts. This makes the identification of underlying risk factors for prevention a public health priority. Although the etiology of oesophageal cancer – particularly oesophageal adenocarcinoma – has attracted considerable interest, the relatively low number of cases in the EPIC cohort has led the Working Group to focus primarily on gastric cancer.
Gastric cancer is a multifactorial disease, with various factors contributing at different stages of the carcinogenic process. The pathogenesis may differ between cardia and non-cardia gastric cancers; however, Helicobacter pylori infection remains the most important risk factor for non-cardia gastric cancer and is also associated with cardia gastric cancer. In the nested case–control study of gastric cancer within EPIC, there are updated data on baseline H. pylori infection, as well as levels of pepsinogen I and II, which are serological markers of gastric atrophy.
In recent decades, the incidence of oesophageal adenocarcinoma has risen sharply across high-income countries, prompting growing public health concern. In many of these regions, its burden is increasing rapidly and has already overtaken – or is expected to overtake – that of oesophageal squamous cell carcinoma. This evolving pattern reflects a significant epidemiological shift in oesophageal cancer and highlights the importance of continued research to identify underlying mechanisms and risk factors for effective prevention.
The Working Group investigates the role of environmental factors – particularly diet, alcohol consumption, and tobacco smoking – and their potential interactions with host genetic susceptibility. In addition, it explores dietary patterns, especially those associated with inflammation and iron metabolism. More recently, the Working Group has examined the potential protective effects of bioactive compounds and micronutrients, such as polyphenols and selenium, and has expanded its research to include the potential role of metabolomics in understanding the development of these cancer types.
Selected publications
- Sanikini H, Biessy C, Rinaldi S, Navionis AS, Gicquiau A, Keski-Rahkonen P, et al. (2023). Circulating hormones and risk of gastric cancer by subsite in three cohort studies. Gastric Cancer. 26(6):969–987. https://doi.org/10.1007/s10120-023-01414-0 PMID:37455285
- Jayasekara H, MacInnis RJ, Lujan-Barroso L, Mayen-Chacon AL, Cross AJ, Wallner B, et al. (2021). Lifetime alcohol intake, drinking patterns over time and risk of stomach cancer: a pooled analysis of data from two prospective cohort studies. Int J Cancer. 148(11):2759–73. https://doi.org/10.1002/ijc.33504 PMID:33554339
- Sanikini H, Muller DC, Sophiea M, Rinaldi S, Agudo A, Duell EJ, et al. (2020). Anthropometric and reproductive factors and risk of esophageal and gastric cancer by subtype and subsite: results from the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Int J Cancer. 146(4):929–42. https://doi.org/10.1002/ijc.32386 PMID:31050823
- Agudo A, Cayssials V, Bonet C, Tjønneland A, Overvad K, Boutron-Ruault MC, et al. (2018). Inflammatory potential of the diet and risk of gastric cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Am J Clin Nutr. 107(4):607–16. https://doi.org/10.1093/ajcn/nqy002 PMID:29635497
- Jakszyn P, Fonseca-Nunes A, Lujan-Barroso L, Aranda N, Tous M, Arija V, et al. (2017). Hepcidin levels and gastric cancer risk in the EPIC-EurGast study. Int J Cancer. 141(5):945–51. https://doi.org/10.1002/ijc.30797 PMID:28543377
- Steffen A, Huerta JM, Weiderpass E, Bueno-de-Mesquita HB, May AM, Siersema PD, et al. (2015). General and abdominal obesity and risk of esophageal and gastric adenocarcinoma in the European Prospective Investigation into Cancer and Nutrition. Int J Cancer. 137(3):646–57. https://doi.org/10.1002/ijc.29432 PMID:25598323
- Sanikini H, Dik VK, Siersema PD, Bhoo-Pathy N, Uiterwaal CS, Peeters PH, et al. (2015). Total, caffeinated and decaffeinated coffee and tea intake and gastric cancer risk: results from the EPIC cohort study. Int J Cancer. 136(6):E720–30. https://doi.org/10.1002/ijc.29223 PMID:25236393
- Fonseca-Nunes A, Agudo A, Aranda N, Arija V, Cross AJ, Molina E, et al. (2015). Body iron status and gastric cancer risk in the EURGAST study. Int J Cancer. 137(12):2904–14. https://doi.org/10.1002/ijc.29669 PMID:26135329
- Buckland G, Travier N, Huerta JM, Bueno-de-Mesquita HB, Siersema PD, Skeie G, et al. (2015). Healthy lifestyle index and risk of gastric adenocarcinoma in the EPIC cohort study. Int J Cancer. 137(3):598–606. https://doi.org/10.1002/ijc.29411 PMID:25557932
- Espinosa-Parrilla Y, Muñoz X, Bonet C, Garcia N, Venceslá A, Yiannakouris N, et al. (2014). Genetic association of gastric cancer with miRNA clusters including the cancer-related genes MIR29, MIR25, MIR93 and MIR106: results from the EPIC-EURGAST study. Int J Cancer. 135(9):2065–76. https://doi.org/10.1002/ijc.28850 PMID:24643999
- Agudo A, Bonet C, Sala N, Muñoz X, Aranda N, Fonseca-Nunes A, et al. (2013). Hemochromatosis (HFE) gene mutations and risk of gastric cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Carcinogenesis. 34(6):1244–50. https://doi.org/10.1093/carcin/bgt045 PMID:23389292
Contact details/Working Group leader
Dr Paula Jakszyn
Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology
Nutrition and Cancer Group, Bellvitge Biomedical Research Institute (IDIBELL)
L’Hospitalet de Llobregat
Barcelona, Spain
paujak@iconcologia.net
Dr Jin Young Park
Lead, Gastric Cancer Prevention Team
Early Detection, Prevention, and Infections Branch
International Agency for Research on Cancer, Lyon, France
parkjy@iarc.who.int