gms | German Medical Science

27th German Cancer Congress Berlin 2006

German Cancer Society (Frankfurt/M.)

22. - 26.03.2006, Berlin

Socio-economic status and gastric cancer in the European Prospective Investigation into Cancer and Nutrition (EPIC-EURGAST)

Meeting Abstract

  • corresponding author presenting/speaker Gabriele Nagel - Universität, Ulm, Deutschland
  • Jakob Linseisen - Deutsches Krebsforschungszentrum, Heidelberg
  • Giuseppe Del Giudice - IRIS Research Center, Siena, Iltaly
  • Carlos A. González - Catalan Institute of Oncology, Barcelona, Spain
  • Elio Riboli - Imperial College London, UK

27. Deutscher Krebskongress. Berlin, 22.-26.03.2006. Düsseldorf, Köln: German Medical Science; 2006. DocPO210

The electronic version of this article is the complete one and can be found online at:

Published: March 20, 2006

© 2006 Nagel et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Background: In Western countries the incidence of gastric cancer is declining, except for the incidence of cardia gastric cancer (CGC), which has been steadily rising. Our purpose was to evaluate the association between socio-economic status (SES) and gastric adenocarcinoma (GAC) by anatomical subsite and histological subtype.

Methods: About 520,000 subjects participating in the EPIC cohort, mostly aged 35 to 70 years, were recruited in 10 European countries. Information on diet and lifestyle was collected at recruitment. After an average follow-up of 6.5 years, a total of 254 gastric, 59 oesophageal, and 17 adenocarcinoma of the gastro-oesophageal junction were identified, confirmed and classified by a panel of pathologists. Educational level and relative index of inequality (RII) were used as indicators of SES.

Results: Educational level was inversely associated with gastric adenocarcinoma [extreme categories, HR: 0.66, 95%-CI:0.43-0.99]. Compared to the lowest educational category the relative risk for the highest category was lower for cardia GAC [extreme categories, HR: 0.45, 95%-CI:0.22-0.95]. The inverse effect of educational level on GAC risk was stronger for cases with intestinal [extreme categories, HR: 0.37, 95%-CI: 0.18-0.77] than diffuse type gastric cancers. SES was non-significantly inversely associated with oesophageal adenocarinomas. RII-scores were also inversely associated with cardia GAC risk. Further adjustment for Helicobacter pylori (Hp) infection slightly attenuated the risk estimates between SES and gastric cancer, but the inverse association remained statistically significant.

Conclusion: An inverse association between educational level and the risk of gastric adenocarcinoma was found. The observed association was stronger for cardia and intestinal gastric cancer types. For RII, similar patterns of risk reduction were found. Adjustment for Hp infection slightly attenuated the SES-GAC association.