CagA+ Helicobacter pylori infection and gastric cancer risk in the EPIC-EURGAST study

Research output: Contribution to journalArticle


Helicobacter pylori (H. pylori), atrophic gastritis, dietary and lifestyle factors have been associated with gastric cancer (GC). These factors have been evaluated in a large case-control study nested in the European Prospective Investigation into Cancer and Nutrition carried out in 9 countries, including the Mediterranean area. Participants, enrolled in 1992-1998, provided life-style and dietary information and a blood sample (360,000; mean follow-up: 6.1 years). For 233 GC cases diagnosed after enrolment and their 910 controls individually-matched by center, gender, age and blood donation date H. pylori antibodies (antilysate and antiCagA) and plasma Pepsinogen A (PGA) were measured by ELISA methods. Severe chronic atrophic gastritis (SCAG) was defined as PGA circulating levels < 22 mu g/l. Overall, in a conditional logistic regression analysis adjusted for education, smoke, weight and consumption of total vegetables, fruit, red and preserved meat, H. pylori seropositivity was associated with GC risk. Subjects showing only antibodies anti-H. pylori lysate, however, were not at increased risk, while those with antiCagA antibodies had a 3.4-fold increased risk. Overall, the odds ratio associated with SCAG was 3.3 (95% CI 2.2-5.2). According to site, the risk of noncardia GC associated with CagA seropositivity showed a further increase (OR 6.5; 95% CI 3.3-12.6); on the other hand, a ten-fold increased risk of cardia GC was associated with SCAG (OR 11.0; 95% C1 3.0-40.9). These results support the causal relationship between H. pylori CagA+ strains infection, and GC in these European populations even after taking into account dietary habits. This association was limited to distal GC, while serologically defined SCAG was strongly associated with cardia GC, thus suggesting a divergent risk pattern for these 2 sites. (c) 2006 Wiley-Liss, Inc.


  • Domenico Palli
  • Giovanna Masala
  • Giuseppe Del Giudice
  • Mario Plebani
  • Daniela Basso
  • Duccio Berti
  • Mattijs E. Numans
  • Marco Ceroti
  • Petra H. M. Peeters
  • H. Bas Bueno de Mesquita
  • Frederike L. Buchner
  • Francoise Clavel-Chapelon
  • Marie-Christine Boutron-Ruault
  • Vittorio Krogh
  • Calogero Saieva
  • Paolo Vineis
  • Salvatore Panico
  • Rosario Tumino
  • Olof Nyren
  • Henrik Simán
  • And 30 others
  • Göran Berglund
  • Goran Hallmans
  • Maria-Jose Sanchez
  • Nerea Larranaga
  • Aurelio Barricarte
  • Carmen Navarro
  • Jose R. Quiros
  • Tim Key
  • Naomi Allen
  • Sheila Bingham
  • Kay Tee Khaw
  • Heiner Boeing
  • Cornelia Weikert
  • Jakob Linseisen
  • Gabriele Nagel
  • Kim Overvad
  • Reimar W. Thomsen
  • Anne Tjonneland
  • Anja Olsen
  • Antonia Trichoupoulou
  • Dimitrios Trichopoulos
  • Athina Arvaniti
  • Guillem Pera
  • Rudolf Kaaks
  • Mazda Jenab
  • Pietro Ferrari
  • Gabriella Nesi
  • Fatima Carneiro
  • Elio Riboli
  • Carlos A. Gonzalez
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cancer and Oncology


  • chronic, pepsinogen, epidemiology, Helicobacter pylori, stomach cancer, atrophic gastritis
Original languageEnglish
Pages (from-to)859-867
JournalInternational Journal of Cancer
Issue number4
Publication statusPublished - 2007
Publication categoryResearch