Epidemiology and Health

Original Articles

Green Tea Consumption and Stomach Cancer Risk: A Meta-Analysis: Hyunseok Kang, Sun Young Rha, Kyung Won Oh, Chung Mo Nam; Epidemiol Health. 2010;32:e2010001. Published online April 26, 2010; DOI: https://doi.org/10.4178/epih/e2010001

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Abstract

<sec><title>OBJECTIVES</title>Green tea has been suggested to have a chemopreventive effect against various cancers including stomach cancer. The aim of this study is to elucidate the relationship between green tea consumption and stomach cancer risk by meta-analysis.</sec><sec><title>METHODS</title>Eighteen observational studies were identified using MEDLINE, THE COCHRANE LIBRARY, RISS, and a manual search. Summary relative risks/odds ratios (RR/ORs) for the highest versus non/lowest green tea consumption levels were calculated on the basis of fixed and random effect models. Subgroup analyses were used to examine heterogeneity across the studies.</sec><sec><title>RESULTS</title>The combined results indicate a reduced risk of stomach cancer with intake of green tea (RR/OR=0.86, 95% CI=0.74-1.00). Subgroup analysis with six studies that reported differences between the highest and lowest consumption levels equal to or greater than five cups/day revealed a statistically significant protective effect (RR/OR=0.68, 95% CI=0.53-0.87).</sec><sec><title>CONCLUSION</title>Green tea appears to play a protective role against the development of stomach cancer. The results also suggest that a higher level of green tea consumption might be needed for a clear preventive effect to appear. This conclusion, however, should be interpreted with caution because various biases can affect the results of a meta-analysis.</sec>

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An Analysis on the Factors Associated with Cancer Screening in a City.: Woon Nyung Roh, Won Chul Lee, Young Bok Kim, Yong Mun Park, Hong Jae Lee, Kwang Ho Meng; Korean J Epidemiol. 1999;21(1):81-92.

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Abstract PDF: Abstract
This study is aimed at preparing basic data required for establishment of a cancer screening program by examining the status of cancer screenings performed by residents in a community and the factors that have an effect on determination for a cancer screening by residents. Cervix, breast and stomach cancers were chosen as target cancers of the study due to the fact that merits of screening for these cancers have been proved by studies done in different countries. In order to find out the status of cancer screening and the factors having an effect on the determination for a cancer screening, 10 Dongs and a total of 1988 people were selected as study area and subjects by a random cluster sampling method, and the subjects were questioned on different aspects by questionnaires. Additionally, in order to find out how cancer screening is performed at medical facilities and how cancer screening is recommended by doctors, medical facilities doing cancer screening were also questioned. The results of the study are as follows: 1. In the case of the screening of the stomach cancer, 16.1% of male subjects and 25.6% of female subjects turned out to have had one or more screening for the cancer. In the cases of the breast and the cervical cancers, 21.6% and 62.6% of the subjects turned out to have had one or more screenings respectively. 2. As to the screening for the stomach cancer, there was a tendency that more of the subjects with lower level education, excepting those without education, had themselves screened for the cancer. Higher screening rates were shown by the subjects in higher ages, those who visited doctors regularly. 3. As to the screening rate by education levels, a high rate of screening was shown by the subjects with above-university education level and there was not a big difference between the screenings done for high school graduates and for those with lower education levels. Regarding the rates of screening by age groups the screening rate turned out to be higher with the higher ages. Screening rates, checked on the basis of the income levels, did not show a big differences between income levels. 4. The highest rate of screening for the breast cancer was shown by the subjects with postgraduate level of education and regarding the rate by income level, a slightly higher level was shown by the subjects with the monthly income of the 2,010,000 won, but the difference between the rates of screening by subjects at different income levels was overall not significant. 5. The rates for selecting the health screening facilities were higher in orders of the reasons that 1) they were close: 2) service was excellent and 3) equipment and facilities were good. Based on the above-mentioned results obtained by the study, it is anticipated that this study will play a vital role as basic data for the development and execution of cancer screening program for a community, and the analysis, done on the basis of the status of the cancer screening, of the factors related to the determination for the cancer screening showed that for the development of a cancer screening program, factors like income levels, education levels, whether people consult doctors regularly and the local government' care for health in a community should be considered, and in addition to which active participation of doctors in the program is also requested.; Summary

A Study on the Behavioral Factors Related to Stomach Cancer Screening among Adults in a Rural Area.: Young Bok KIM, Won Chul Lee; Korean J Epidemiol. 1999;21(1):20-30.

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The purpose of this study was to investigate the behavioral factors related to stomach cancer screening among adults in a rural area. The number of subjects were 270 who were consisted of 133(49.3%) of male and 137(50.7%) of female. To predict the behavior, we used the health belief model. Using methodology was self-questionnaire which included the perceived health status, the severity for stomach cancer, preventive knowledge for stomach cancer, the threat for stomach cancer, the experience of cue to action, the benefit of cancer screening and the barrier of participating screening. The associations between the behavioral factors and the experience and intention of examination of endoscopy were evaluated by the odds ratio(OR). The results were as follows : 1. 78.1% of subjects responded that they had the good health, and 56.3% of them perceived the severity of stomach cancer. The 49.6% of them were evaluated as the moderate on the preventive knowledge for stomach. Also 39.3% had the threat for stomach cancer, and 79.2% had the experience of cue to action. The almost of respondents thought the endoscopy as available method for stomach cancer screening. The major barrier factors on stomach cancer screening were fear to endoscopy, discomfort for endoscopy, high cost of examination and lack of time. 2. Although the experience for examination of endoscopy was showed to the difference by sex, age, educational level and BMI, it was not significant. However, the experience for examination of endoscopy was showed to the significant difference by the perceived health status(OR:3.47, 95% CI:1.27-9.51), the preventive knowledge for stomach cancer(OR:0.42, 95% CI:0.19-0.96) and the experience of cue to action(OR:2.57, 95% CI:1.05-6.34). 3. Also although the intention for examination of endoscopy was showed to the differences by sex, age and BMI, it was not significant. However, the intention for examination of endoscopy was showed to the significant difference by the benefit for endoscopy(OR:2.35, 95% CI:1.02-5.42) and the experience of stomach cancer screening(OR:3.47, 95% CI:1.78-6.78). In case of the preventive knowledge for stomach cancer and the experience of cue to action, it did not influence to the intention for examination of endoscopy.; Summary

Effect of Non-dietary Factors in the Etiology of Stomach Cancer.: Soo Yong Choi, Hye Sung Park, Hyun Sook Kim, Cha Kwon Chung; Korean J Epidemiol. 1998;20(1):102-112.

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Abstract PDF: Abstract
BACKGROUND
Stomach cancer is the most malignant neoplasm among Koreans. There are some studies on risk factors for cancer prevention. SUBJECTS AND METHODS: A case-control study was conducted at the Korea Cancer Center Hospital in Seoul between April and September in 1996. One hundred twenty-six stomach cancer patients confirmed by the histological diagnosis were compared with 234 control subjects mached by age, sex, and admission date. The questionnaire included information on sociodemographic characteristics, smoking and drinking habits, height, weight, family history of cancer, nutrient supplements intake etc. Associations of stomach cancer with con-dietary factors were evaluated. Multiple logistic regression models were used to estimate relative risks when controlling simultaneously for covariates.
RESULTS
Weight and body mass index(BMI, kg/m2) at diagnosis were significantly low in cases compared with controls. As non-dietary factors, smoking habits, alcoholic beverage, family gistory, physical activity, water supply, stress, vitamin suppliments and the use of functional foods were not associated with stomach cancer risk.
CONCLUSION
Our findings indicated that non-dietary factors were not associated with stomach cancer risk.; Summary

Effect of Dietary Factors in the Etiology of Stomach Cancer.: Hye Sung Park, Hyun Sook Kim, Soo Yong Choi, Cha Kwon Chung; Korean J Epidemiol. 1998;20(1):82-101.

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Abstract PDF: Abstract
BACKGROUND
Stomach cancer is the most malignant neoplasm among Koreans. There ane a number of epidemiological studies on dietary factors of stomach cancer in many countries. However, analytical studies on Korean dietary factors are very scarce. SUBJECTS AND METHODS: A case-control study was conducted at the Korea Cancer Center Hospital in Seoul between April and September in 1996. One hundred twenty-six stomach cancer patients confirmed by the histological diagnosis were compared with 234 control subjects matched by age, sex, and admission date. A food frequency questionnaire asking the consumption frequency of 85 selected food items was used to gather the information from all subjects via a face-to-face interview. Multiple logistic regression models were used to estimate relative risks when controlling simultaneously for covariates.
RESULTS
An increased risk of stomach cancer was noted among those with low economic status, fast eating rate, high eating out, hot-temperature soup preference, salt preference, cucumber Kimchi intake, use of pickled fish in Kimchi. Intake of garlic, green onion, tofu, mung bean pancake, acorn-starch paste, starch vermicelli with mixed vegetables, total fruits, citrus fruits, cabbage, green peppers, spinach, mushrooms and total meat appeared to be protective. Stomach cancer risk was not associated with intake of rice, dairy product, fishes, condiments, coffee, tea, and the cooking methods. These data suggested that the high intake of salt and smoked or pickled food may be associated with a hig risk of stomach cancer, and this association could be due to a intragastric formation of nitrosamines. The negative association with fruits and some vegetable consumption may be due to the inhibition of nitrosation process.
CONCLUSION
Our findings indicated that dietary factors contributed to stomach cancer occurrence in Korea, and this may offer clues for further ethnical and prevention research.; Summary

Methodologic Considerations on the Cohort Study of Risk Factors of Stomach Cancer: On the Incompleteness of Case Ascertainment.: Moo Song Lee, Wee Chang Kang, Dong Hyun Kim, Jong Myun Bae, Myung Hee Shin, Young Jo Lee, Yoon Ok Ahn; Korean J Epidemiol. 1997;19(2):152-160.

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Abstract PDF: Abstract
BACKGROUND
AND PURPOSE: The authors conducted the study to evaluate the incompleteness of follow-up as well as the validity of the diagnostic code in the medical insurance databases in a cohort study. They also suggested several useful regression models for the analysis of such incomplete data.
METHODS
The subjects of Seoul Cohort(n=14,533) were followed up for three and a half years. Based on the chart reviews of the subjects who had the diagnostic code of gastric cancer in the medical insurance databases, forty-four cases of gastric cancer were idenfified, using cancer registry databases and death certificates as the secondary source. Regression coefficients and the associated p-values were estimated using the following six methods and the results were compared with each other. Method 1: The subjects with the diagnostic code in the medical insurance databases were considered as the cases of gastric cancer.
Method
2: The confirmed cases were considered as the cases of gastric cancer. Method 3: The cases were the subjects with the diagnositc code whose diagnosis was confirmed by medical chart reriew. Method 4: Ordinal logistic regression.
Method
5: Weighted logistic regression. Method 6: Polytomous logistic regression RESULTS: A total of 12,541 subjects were followed up excluding censored cases. One hundred and nine subjects were diagnosed with gastric cancer in the medical utilization databases: forty-three were probable cases whose dianosis was not confrimed by chart review, twenty-six were ruled out and 26 were confirmed cases. Another 14 cases were confirmed using the cancer registry and death certificates. Using the secondary sources, four another cases were confirmed and 44 cases were confirmed during follow-up. In method 1, past history of gastritis and gastric ulcer was significant risk factor whereas intake frequency of fresh vegetable, ice cream and coffee was associated with significantly decreased risk. In the second and the sixth method, green tea was a significant protective factor, whereas in methods 3-5, no significant variables were found.
CONCLUSIONS
Polytomous logistic regression was the preferred method in the cohort study using secondary sources of information for the follow-up, and it provided additional information for the risk factor identification, especially for the specificity of the risk factors.; Summary

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