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Factors contributing to the underestimation of Helicobacter pylori-associated gastric cancer risk in a high-prevalence population

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Abstract

Objective

This study aimed to identify sources of underestimation of the association between Helicobacter pylori infection and non-cardia gastric cancer, in a high-risk European population.

Methods

Non-cardia gastric cancer patients (n = 420) recruited in two major hospitals in North of Portugal and population controls (n = 1,389) were evaluated. Whole-cell IgG antibodies against H. pylori were quantified by ELISA and Western Blot testing was conducted in a subsample (272 cases and 186 controls) allowing for the detection of current infection marker and CagA. Sex- and age-adjusted odds ratios (OR) and 95% confidence intervals (95% CI) were computed.

Results

When assessing infection by ELISA, the OR for its association with gastric cancer decreases and reverts as IgG titers increased, from 1.96 (95% CI: 1.09–3.54) for borderline positive results (16.0–21.9 RU/ml) to 0.52 (95% CI: 0.36–0.74) for the highest IgG levels (≥102.0 RU/ml). The same pattern was observed across strata of age and blood collection timing with stronger associations among younger subjects and those providing blood samples earlier after diagnosis. The presence of CagA (Western Blot) was associated with an increased risk of gastric cancer (OR = 11.32; 95% CI: 5.64–22.73).

Conclusion

The use of methods with low sensitivity to detect past infection leads to a substantial underestimation of gastric cancer risk in high-prevalence settings.

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Acknowledgments

Grants from Fundação para a Ciência e Tecnologia are gratefully acknowledged (PTDC/SAU-ESA/71517/2006, POCI/SAL-ESP/56126/2004, POCI/SAL-ESP/61685/2004, POCTI/ESP/35769/99, PRAXIS/2/2.1/SAU/1332/1995, SFRH/BD/36818/2007).

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Authors and Affiliations

  1. Department of Hygiene and Epidemiology, University of Porto Medical School, Porto, Portugal

    Bárbara Peleteiro, Nuno Lunet & Henrique Barros

  2. Institute of Public Health, University of Porto (ISPUP), Porto, Portugal

    Bárbara Peleteiro, Nuno Lunet & Henrique Barros

  3. Institute of Molecular Pathology and Immunology, University of Porto (IPATIMUP), Porto, Portugal

    Rita Barros

  4. Istituto di Ricerche Farmacologiche “Mario Negri”, Milan, Italy

    Carlo La Vecchia

  5. Istituto di Statistica Medica e Biometria, Università di Milano, Milan, Italy

    Carlo La Vecchia

  6. Serviço de Higiene e Epidemiologia, Faculdade de Medicina da Universidade do Porto, Al. Prof. Hernâni Monteiro, 4200-319, Porto, Portugal

    Bárbara Peleteiro

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  1. Bárbara Peleteiro
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  2. Nuno Lunet
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  3. Rita Barros
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Correspondence to Bárbara Peleteiro.

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Peleteiro, B., Lunet, N., Barros, R. et al. Factors contributing to the underestimation of Helicobacter pylori-associated gastric cancer risk in a high-prevalence population. Cancer Causes Control 21, 1257–1264 (2010). https://doi.org/10.1007/s10552-010-9553-2

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  • DOI: https://doi.org/10.1007/s10552-010-9553-2

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