Carcinogenesis, Vol. 20, No. 8, 1459-1464,
August 1999
© 1999 Oxford University Press
Molecular Epidemiology and Cancer Prevention |
Hematopoietic cancer and peptic ulcer: a multicenter case-control study
1 Unit of Cancer Epidemiology, Ospedale S. Giovanni and CPO-Piemonte, via Santena 7, I-10126 Torino,
2 Unit of Epidemiology, National Cancer Institute, Milano,
3 Local Health Unit, Novara,
4 National Cancer Institute, Genova,
5 Unit of Epidemiology, Centre for Oncologic Prevention (CSPO), Firenze,
6 Istituto Oncologico Romagnolo, Forlì,
7 National Cancer Institute, Istituto Regina Elena, Roma,
8 Azienda Ospedaliera, Verona,
9 Cancer Registry, Ragusa and
10 Institute of Pathology, University of Siena, Italy
Helicobacter pylori has been suggested as a cause of gastric carcinoma and gastric non-Hodgkin's lymphoma (NHL). In a previous cohort study, a relative risk of six for gastric NHL was reported among subjects who tested positive for anti-H.pylori antibodies. The association between peptic ulcer and NHL has been studied in a population-based case-control investigation on hemato-lymphopoietic malignancies in Italy, based on face-to-face interviews to 2671 cases and 1718 controls (refusal rates 10 and 19%, respectively). Subjects who reported a diagnosis of peptic ulcer had a relative risk of 5.6 [95% confidence interval (CI) 3.8–8.0] for gastric NHL, whereas the estimate for non-gastric NHL was 1.3 (1.0–1.6). The association with recent diagnosis of ulcer was stronger, but the odds ratio (OR) was as high as 2.1 (95% CI 1.1–4.2) after 
20 years since such diagnosis. After exclusion of the last 2 years before the diagnosis of NHL, and of ulcers diagnosed before 1978 (when gastroscopy became common in Italy), the OR was still 5.3 (95% CI 3.0–9.2). We found a strong effect modification by educational level, with ORs for ulcer more elevated in higher social groups. Gender was an effect modifier (OR = 4.1 in males, 9.2 in females; P = 0.03 for heterogeneity). The association with other gastrointestinal pathologies was much lower and statistically not significant. Almost all gastric lymphomas were B-cell NHLs of intermediate grade according to the working formulation; the majority belonged to the mucosa-associated lymphoid tissue (MALT) type. The association with ulcer was much stronger among MALT lymphomas, but only for recent ulcer diagnoses (2–10 years). Our study shows an increased risk for gastric NHL, very similar to the estimate reported in a previous cohort study. The risk was higher among more educated subjects.
Abbreviations: CI, confidence interval; CLL, chronic lymphocytic leukemia; HD, Hodgkin's disease; LL, lymphocytic leukemia; ML, myeloid leukemia; NHL, non-Hodgkin's lymphoma; OR, odds ratio
11 To whom correspondence should be addressed Email: paolo.vineis{at}unito.it
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