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Anthropometrics and Colorectal Adenoma Risk Among Older Women
AGA Abstracts Sa1917 Epidemiology of Noncardia Gastric Adenocarcinoma in the United States Barry Schlansky, Amnon Sonnenberg Background and Aims. Although adenocarcinoma of the cardia (ICD-9 code 151.0) and adenocarcinoma of the stomach (ICD-9 codes 151.1-151.9) are two clearly distinct diseases, in epidemiologic statistics they are frequently grouped together. The aim of this study was to describe the current epidemiology of noncardia gastric cancer (GCA) in the United States. Methods. Three national databases were utilized to analyze GCA incidence, hospitalization, and mortality in the U.S. between 1997 and 2008. The Surveillance, Epidemiology, and End Results (SEER) database was used for incidence data, the Healthcare Costs and Utilization Project (HCUP) for hospitalization data, and the Wide-Ranging Online Data for Epidemiologic Research (WONDER) for mortality data. Annual population estimates were obtained from the U.S. Census Bureau. Population-based incidence, hospitalization, and mortality rates were adjusted to the U.S. 2000 population using the direct standardization method. Odds ratios (OR) and their 95% confidence intervals (CI) were calculated, using the MantelHaenszel method to adjust for confounding variables. Categorical variables were compared with Chi-square analysis. Results. Annually, GCA was associated with 19,090 incident cases, 17,284 hospitalizations for first-listed diagnoses, 31,353 hospitalizations for all-listed diagnoses, and 11,561 deaths. The incidence of GCA was greater in men than women (OR= 1.56, CI 1.53-1.59) and non-white than white race (OR=2.38, CI 2.33-2.43). Hospitalization for GCA was more common in men than women (OR=1.82, CI 1.81-1.83) and non-white than white race (OR=2.13, CI 2.10-2.15). Mortality from GCA was more common in men than women (OR=1.83, CI 1.81-1.86) and non-white than white race (OR=2.23, CI 2.202.26). In all three databases, GCA rates showed a marked age-dependent rise, with the highest rates observed in the oldest age group, 85+ (p<0.001). Hospitalization and mortality of GCA were greatest in the Northeast region of the U.S., followed by the South, West, and Midwest regions (p<0.001). Conclusions. Similar epidemiologic patterns were found among three different national databases. Older age, male gender, non-white race, and residence in the Northeast region of the U.S. were associated with an increased risk for noncardia gastric adenocarcinoma. These patterns may partly reflect underlying variations in exposure to H. pylori infection.
*RRs and 95% CIs adjusted for: age, smoking status, physical activity, exogenous estrogen use, age at menopause, history of diabetes mellitus, and daily intakes of total energy, total fat, red meat, fruits and vegetables, calcium, folate, vitamin E, and alcohol. Sa1919 Low Serum Ghrelin is Associated With an Increased Risk of Gastric Adenocarcinoma Gwen A. Murphy, Farin Kamangar, Sanford M. Dawsey, Frank Z. Stanczyk, Stephanie J. Weinstein, Philip R. Taylor, Jarmo Virtamo, Christian C. Abnet, Demetrius Albanes, Neal D. Freedman Background: Cancers of the upper gastrointestinal tract remain a significant cause of morbidity and mortality. Ghrelin is a hormone produced in the oxyntic glands of the stomach and it's concentration is known to decrease significantly under conditions of inflammation and atrophy, however, it's role in the etiology of gastric cancer has not been explored. To examine the relationship between serum ghrelin concentration and risk of gastric and esophageal cancers we conducted a nested case-control study within the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study cohort, in Finland. Methods: 82 esophageal squamous cell carcinomas (ESCC), 86 gastric cardia adenocarcinomas (GCA) and 174 gastric noncardia adenocarcinomas (GNCA) were matched (1:1) by age and date of blood draw to the controls from the ATBC study. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated using unconditional logistic regression with adjustment for potential confounders. Results: Lower concentrations of serum ghrelin were significantly associated with an increased risk of GCA and GNCA. For those individuals in the lowest quartile of serum ghrelin, compared to those in the highest, the multivariate ORs were 6.11 for GCA (95% CI: 1.41, 26.46) and 6.54 for GNCA (95% CI: 2.69, 15.90). These associations were dose dependent (P for trend = 0.008 and <0.0001, respectively) and independent of the effect of low pepsinogen/atrophy and Helicobacter pylori infection, the significance of these associations remained following exclusion of individuals who developed cancer within the first 5 years of the study. The crude association noted for low serum ghrelin and ESCC did not survive adjustment for potential confounders. Specifically, the addition of low serum pepsinogen I to the model nullified the significance of the association between low serum ghrelin and increased risk of ESCC. Conclusion: Lower serum concentrations of ghrelin were associated with a significantly increased risk of GCA and GNCA. The possible etiologic role for ghrelin in gastric cancer should be investigated in future studies.
Sa1918 Anthropometrics and Colorectal Adenoma Risk Among Older Women Amy S. Oxentenko, Robert Vierkant, Alice Wang, Aaron Folsom, Beth A. Virnig, James R. Cerhan, Paul J. Limburg Background: Obesity is a controversial risk factor for colorectal cancer among older women. To date, relatively few studies have reported associations between anthropometric parameters and premalignant colorectal adenomas (CRAs) in this population. To address this knowledge gap, we evaluated height, weight, body mass index (BMI) and waist-to-hip ratio (WHR) as predictors of CRA risk among subjects enrolled in the Iowa Women's Health Study (IWHS). Methods: The IWHS is a prospective cohort study of cancer and related endpoints among randomly selected Iowa women, ages 55-69 years of age and holding a valid drivers license at enrollment (1986). Height and weight were self-reported, while waist and hip circumferences were measured using a paper tape, by IWHS subjects at baseline. BMI (kg/m2) and WHR were derived from these variables. CRAs were identified from Medicare data for 19932004 (hospitalization, outpatient and carrier files), using ICD-9 codes 211.3 and 211.4. Exclusion criteria were defined as: never enrolled in both parts A and B of Medicare for at least one month on or after January 1, 1993; no response to 1992 IWHS follow-up questionnaire; prior malignancy (except non-melanoma skin cancer) or CRA; < 1 year of follow-up; or incomplete anthropometric data. Height, weight, BMI and WHR were analyzed by quartiles. Multivariate Cox regression models were fit to estimate relative risks (RRs) and 95% confidence intervals (CIs). Results: Complete anthropometric and CRA data were available for 25,865 subjects. During 224,564 person-years of follow-up, 5,460 women were identified with at least one newly diagnosed CRA. Height, weight, BMI and WHR were all positively associated with CRA risk (p ≤ 0.001 for each variable; see Table). Conclusions: Among IWHS subjects, multiple baseline anthropometric parameters were associated with increased CRA risk. These data support body size as a potentially modifiable risk factor for premalignant colorectal neoplaisa in older women.
Sa1920 Biomarkers of Oxidative Stress and Risk of Colorectal Cancer: A CohortNested Case-Control Study in the EPIC Database Anke M. Leufkens, Fränzel J. van Duijnhoven, Sjoukje Woudt, Peter D. Siersema, Hendrik B. Bueno-de-Mesquita Introduction: Oxidative stress is associated with the development of cancer. Prospective evidence for an association between oxidative stress biomarkers and risk of colorectal cancer (CRC) is not present. Aim: To investigate an association between blood concentrations of reactive oxygen and antioxidant capacity as indicators of oxidative stress and CRC. Methods: Pre-diagnostic serum levels of Reactive Oxygen Metabolites (ROM) and Ferric Reducing Ability of Plasma (FRAP) were studied in relation to CRC risk in a nested case-control study within the European Prospective Investigation into Cancer and nutrition (EPIC) cohort. A total of 1,230 CRC cases were matched to 1,230 controls (median follow-up 3.8 years). Incidence Rate Ratios (IRRs) and 95% confidence intervals (95%CI) were estimated using multivariate conditional logistic regression analysis. Results: ROM was associated with the overall risk of CRC (adjusted IRR for the highest compared to the lowest tertile 1.91, 95%CI 1.47-2.48) and with subsites of CRC (adjusted IRRs between 1.69 and 2.31, p <0.05). When
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AGA Abstracts
*RRs and 95% CIs adjusted for: age, smoking status, physical activity, exogenous estrogen use, age at menopause, history of diabetes mellitus, and daily intakes of total energy, total fat, red meat, fruits and vegetables, calcium, folate, vitamin E, and alcohol. Sa1919 Low Serum Ghrelin is Associated With an Increased Risk of Gastric Adenocarcinoma Gwen A. Murphy, Farin Kamangar, Sanford M. Dawsey, Frank Z. Stanczyk, Stephanie J. Weinstein, Philip R. Taylor, Jarmo Virtamo, Christian C. Abnet, Demetrius Albanes, Neal D. Freedman Background: Cancers of the upper gastrointestinal tract remain a significant cause of morbidity and mortality. Ghrelin is a hormone produced in the oxyntic glands of the stomach and it's concentration is known to decrease significantly under conditions of inflammation and atrophy, however, it's role in the etiology of gastric cancer has not been explored. To examine the relationship between serum ghrelin concentration and risk of gastric and esophageal cancers we conducted a nested case-control study within the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study cohort, in Finland. Methods: 82 esophageal squamous cell carcinomas (ESCC), 86 gastric cardia adenocarcinomas (GCA) and 174 gastric noncardia adenocarcinomas (GNCA) were matched (1:1) by age and date of blood draw to the controls from the ATBC study. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated using unconditional logistic regression with adjustment for potential confounders. Results: Lower concentrations of serum ghrelin were significantly associated with an increased risk of GCA and GNCA. For those individuals in the lowest quartile of serum ghrelin, compared to those in the highest, the multivariate ORs were 6.11 for GCA (95% CI: 1.41, 26.46) and 6.54 for GNCA (95% CI: 2.69, 15.90). These associations were dose dependent (P for trend = 0.008 and <0.0001, respectively) and independent of the effect of low pepsinogen/atrophy and Helicobacter pylori infection, the significance of these associations remained following exclusion of individuals who developed cancer within the first 5 years of the study. The crude association noted for low serum ghrelin and ESCC did not survive adjustment for potential confounders. Specifically, the addition of low serum pepsinogen I to the model nullified the significance of the association between low serum ghrelin and increased risk of ESCC. Conclusion: Lower serum concentrations of ghrelin were associated with a significantly increased risk of GCA and GNCA. The possible etiologic role for ghrelin in gastric cancer should be investigated in future studies.
Sa1918 Anthropometrics and Colorectal Adenoma Risk Among Older Women Amy S. Oxentenko, Robert Vierkant, Alice Wang, Aaron Folsom, Beth A. Virnig, James R. Cerhan, Paul J. Limburg Background: Obesity is a controversial risk factor for colorectal cancer among older women. To date, relatively few studies have reported associations between anthropometric parameters and premalignant colorectal adenomas (CRAs) in this population. To address this knowledge gap, we evaluated height, weight, body mass index (BMI) and waist-to-hip ratio (WHR) as predictors of CRA risk among subjects enrolled in the Iowa Women's Health Study (IWHS). Methods: The IWHS is a prospective cohort study of cancer and related endpoints among randomly selected Iowa women, ages 55-69 years of age and holding a valid drivers license at enrollment (1986). Height and weight were self-reported, while waist and hip circumferences were measured using a paper tape, by IWHS subjects at baseline. BMI (kg/m2) and WHR were derived from these variables. CRAs were identified from Medicare data for 19932004 (hospitalization, outpatient and carrier files), using ICD-9 codes 211.3 and 211.4. Exclusion criteria were defined as: never enrolled in both parts A and B of Medicare for at least one month on or after January 1, 1993; no response to 1992 IWHS follow-up questionnaire; prior malignancy (except non-melanoma skin cancer) or CRA; < 1 year of follow-up; or incomplete anthropometric data. Height, weight, BMI and WHR were analyzed by quartiles. Multivariate Cox regression models were fit to estimate relative risks (RRs) and 95% confidence intervals (CIs). Results: Complete anthropometric and CRA data were available for 25,865 subjects. During 224,564 person-years of follow-up, 5,460 women were identified with at least one newly diagnosed CRA. Height, weight, BMI and WHR were all positively associated with CRA risk (p ≤ 0.001 for each variable; see Table). Conclusions: Among IWHS subjects, multiple baseline anthropometric parameters were associated with increased CRA risk. These data support body size as a potentially modifiable risk factor for premalignant colorectal neoplaisa in older women.
Sa1920 Biomarkers of Oxidative Stress and Risk of Colorectal Cancer: A CohortNested Case-Control Study in the EPIC Database Anke M. Leufkens, Fränzel J. van Duijnhoven, Sjoukje Woudt, Peter D. Siersema, Hendrik B. Bueno-de-Mesquita Introduction: Oxidative stress is associated with the development of cancer. Prospective evidence for an association between oxidative stress biomarkers and risk of colorectal cancer (CRC) is not present. Aim: To investigate an association between blood concentrations of reactive oxygen and antioxidant capacity as indicators of oxidative stress and CRC. Methods: Pre-diagnostic serum levels of Reactive Oxygen Metabolites (ROM) and Ferric Reducing Ability of Plasma (FRAP) were studied in relation to CRC risk in a nested case-control study within the European Prospective Investigation into Cancer and nutrition (EPIC) cohort. A total of 1,230 CRC cases were matched to 1,230 controls (median follow-up 3.8 years). Incidence Rate Ratios (IRRs) and 95% confidence intervals (95%CI) were estimated using multivariate conditional logistic regression analysis. Results: ROM was associated with the overall risk of CRC (adjusted IRR for the highest compared to the lowest tertile 1.91, 95%CI 1.47-2.48) and with subsites of CRC (adjusted IRRs between 1.69 and 2.31, p <0.05). When
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AGA Abstracts