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Carcinogenesis Advance Access published online on March 29, 2006
Carcinogenesis, doi:10.1093/carcin/bgl019
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© The Author 2006. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org
Received January 17, 2006
Revised March 10, 2006
Accepted March 14, 2006

CARCINOGENESIS

Endogenous versus exogenous exposure to N-nitroso compounds and gastric cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC-EURGAST) study

Paula Jakszyn 1 *, Sheila Bingham 2, Guillem Pera 1, Antonio Agudo 1, Robert Luben 3, Ailsa Welch 3, Heiner Boeing 4, Giuseppe del Giudice 5, Domenico Palli 6, Calogero Saieva 6, Vittorio Krogh 7, Carlotta Sacerdote 8, Rosario Tumino 9, Salvatore Panico 10, Göran Berglund 11, Henrik Simán 11, Göran Hallmans 12, María José Sanchez 13, Nerea Larrañaga 14, Aurelio Barricarte 15, María Dolores Chirlaque 16, José R. Quirós 17, Timothy J. Key 18, Naomi Allen 18, Eiliv Lund 19, Fátima Carneiro 20, Jakob Linseisen 21, Gabriele Nagel 21, Kim Overvad 22, Anne Tjonneland 23, Anja Olsen 23, H. Bas Bueno-de-Mesquita 24, Marga O. Ocké 24, Petra H. M. Peeters 25, Mattijs E. Numans 25, Françoise Clavel-Chapelon 26, Antonia Trichopoulou 27, Claus Fenger 28, Roger Stenling 29, Pietro Ferrari 30, Mazda Jenab 30, Teresa Norat 30, Elio Riboli 31, and Carlos A. Gonzalez 1

1 Department of Epidemiology, Catalan Institute of Oncology, Barcelona, Spain
2 Medical Research Council, Dunn Human Nutrition Unit, Wellcome Trust/MRC Building, Cambridge, UK
3 Strangeways Research Laboratory, Cambridge, UK
4 German Institute of Human Nutrition, Potsdam-Rehbücke, Germany
5 IRIS Research Center, Chiron-Vaccines, Siena, Italy
6 Molecular and Nutritional Epidemiology Unit, CSPO - Scientific Institute of Tuscany
7 Epidemiology Unit, Istituto Tumori, Milan, Italy
8 University of Torino, Italy
9 Cancer Registry, Azienda Ospedaliera "Civile M.P. Arezzo", Ragusa, Italy
10 Dipartamento di Medicina Clinica e Sperimentale, Federico II University, Compagnia di San Paolo, Naples, Italy
11 Department of Medicine, University Hospital Malmo, Lund University Malmo, Sweden
12 Department of Nutritional Research, University of Umeå, Sweden
13 Andalusian School of Public Health, Granada, Spain
14 Department of Public Health of Guipuzkoa, San Sebastian, Spain
15 Public Health Institute of Navarra, Pamplona, Spain
16 Epidemiology Department, Health Council of Murcia, Spain
17 Public Health and Health Planning Directorate, Asturias, Spain
18 Cancer Epidemiology Unit, University of Oxford, UK
19 Institute of Community Medicine, University of Tromso, Norway
20 Institute of Molecular Pathology and Immunology of the University of Porto and Medical Faculty, Porto, Portugal
21 Division of Clinical Epidemiology, Deutsches Krebsforschungszentrum, Heidelberg, Germany
22 Department of Clinical Epidemiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
23 Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark
24 Center for Nutrition and Health, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
25 Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
26 INSERM, Institut Gustave Roussy, Villejuif, France
27 Department of Hygiene and Epidemiology, Medical School, University of Athens, Greece
28 Det Sundhedsvidenskabelige Fakultet, Syddansk Universitet, Denmark
29 Department of Medical Biosciences, University of Umea, Sweden
30 Nutrition and Hormones Group, International Agency for Research on Cancer, Lyon, France
31 Nutrition and Hormones Group, International Agency for Research on Cancer, Lyon, France; Department of Epidemiology and Public Health Imperial College, London, Uk

* To whom correspondence should be addressed.
Paula Jakszyn, E-mail: paujak{at}iconcologia.catsalut.net


  Abstract

The risk of gastric cancer (GC) associated with dietary intake of Nitrosodimethylamine (NDMA) and endogenous formation of Nitroso compounds (NOCs) was investigated in the European Prospective Investigation into Cancer and Nutrition (EPIC). The study included 521,457 individuals and 314 incident cases of GC that had occurred after 6.6 average years of follow up. An index of endogenous NOC formation (ENOC) was estimated using data of the iron content from meat intake and faecal apparent total NOCs formation according to previous published studies. Antibodies to Helicobacter pylori (Hp) and vitamin C levels were measured in a sub-sample of cases and matched controls included in a nested case-control within the cohort. Exposure to NDMA was less than 1 µg on average compared with 93 µg on average from ENOC. There was no association between NDMA intake and GC risk (HR 1.00; 95 % CI 0.7-1.43). ENOC was significantly associated with non cardia cancer risk (HR 1.42; 95 % CI 1.14-1.78 for an increase of 40ug/d) but not with cardia cancer (HR 0.96; 95 % CI 0.69-1.33). Although the number of not infected cases is low, our data suggests a possible interaction between ENOC and Hp infection (p for interaction =0.09). Moreover, we observed an interaction between plasma Vitamin C and ENOC (p < 0.01). Endogenous NOC formation may account for our previously reported association between red and processed meat consumption and gastric cancer risk.

Keywords: gastric cancer; N-nitrosocompounds; preformed nitrosamines; endogenous exposure.
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