ADENOCARCINOMAS OF THE ESOPHAGUS AND GASTRIC CARDIA

Within the last two decades, reported incidence rates of adenocarcinomas of the esophagus and gastric cardia have been increasing rapidly in many Westernized countries including the United States. In contrast, the incidence of squamous cell carcinomas of the esophagus has remained stable, and for adenocarcinomas elsewhere in the stomach, incidence has declined during this same time period. Other than a descriptive characterization, little is known about the epidemiology of esophageal and gastric cardia adenocarcinomas. Thus, the purpose of the proposed population-based case-control study is to identify risk factors for adenocarcinomas of the esophagus and gastric cardia. For comparison, risk factors will also be identified for squamous cell carcinoma of the esophagus and adenocarcinomas in the more distal stomach. This study is to be part of a multi-center collaboration with the National Cancer Institute (NCI) and other institutions as determined by NCI. A common protocol will be developed in cooperation with the other collaborators. In New Jersey, cases will be men and women who are between the ages of 20 and 79 years, are residents of a 15-county area in New Jersey, and are newly diagnosed during a 20-month period with one of the four study cancers that has been histologically confirmed as a primary neoplasm. All biologic specimens and other diagnostic materials of cases will be reviewed by the study pathologist. For cases of adenocarcinoma of the esophagus and gastric cardia, controls will be selected among residents of the same 15-county area and frequency matched by five-year age groups and sex. Controls will be used for more than one cancer in the analysis. Controls between the ages of 20 to 64 years will be identified using random digit dialing (RDD), and those 65 years and over will be identified using Health Care and Finance Administration (HCFA) rosters. In-person subject and next-of-kin interviews will be conducted by trained interviewers. Information will be obtained on possible risk factors for the four study cancers including use of tobacco and alcohol, usual adult diet, consumption of coffee and tea, occupational history, ionizing radiation exposure, history of certain medical conditions, and family history of cancer. In New Jersey, completed interviews are expected for 248 controls, and 124 cases of adenocarcinomas of the esophagus, 124 adenocarcinomas of the gastric cardia, 124 squamous cell carcinomas of the esophagus, and 124 adenocarcinomas elsewhere in the stomach. Results will be combined with data obtained from the other collaborating field institutions. Analyses will include calculation of crude and adjusted odds ratios and corresponding confidence intervals using logistic regression techniques. To the extent possible, effect modification by anatomic and histologic type will be examined.