Risk factors for gastric cancer in Latin America: a meta-analysis
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Latin America has among the highest gastric cancer incidence rates in the world, for reasons that are still unknown. In order to identify region-specific risk factors for gastric cancer, we conducted a meta-analysis summarizing published literature.
Searches of PubMed and regional databases for relevant studies published up to December 2011 yielded a total of 29 independent case–control studies. We calculated summary odds ratios (OR) for risk factors reported in at least five studies, including socioeconomic status (education), lifestyle habits (smoking and alcohol use), dietary factors (consumption of fruits, total vegetables, green vegetables, chili pepper, total meat, processed meat, red meat, fish, and salt), and host genetic variants (IL1B-511T, IL1B-31C, IL1RN*2, TNFA-308A, TP53 codon 72 Arg, and GSTM1 null). Study-specific ORs were extracted and summarized using random-effects models.
Chili pepper was the only region-specific factor reported in at least five studies. Consistent with multifactorial pathogenesis, smoking, alcohol use, high consumption of red meat or processed meat, excessive salt intake, and carriage of IL1RN*2 were each associated with a moderate increase in gastric cancer risk. Conversely, higher levels of education, fruit consumption, and total vegetable consumption were each associated with a moderately decreased risk. The other exposures were not significantly associated. No prospective study data were identified.
Risk factor associations for gastric cancer in Latin America are based on case–control comparisons that have uncertain reliability, particularly with regard to diet; the specific factors identified and their magnitudes of association are largely similar to those globally recognized. Future studies should emphasize prospective data collection and focus on region-specific exposures that may explain high gastric cancer risk.
KeywordsEpidemiology Gastric cancer Latin America Meta-analysis Risk factors
The authors thank Nancy Terry, Biomedical Librarian at the U.S. National Institutes of Health Library, and Estela Santillán González, Librarian at the Dirección General de Epidemiologia in Mexico, for their help with reviewing the international (PubMed) and regional (LILIACS and SciELO) search strategies, respectively. This work was supported by the Intramural Research Program of the United States National Institutes of Health, National Cancer Institute, and the Oak Ridge Associated Universities’ Research Associates/Specialists Program.
Conflict of interest
All authors declare no conflict of interest.
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