@article{3094565,
    title = "CagA+ Helicobacter pylori infection and gastric cancer risk in the EPIC-EURGAST study",
    author = "Palli, D. and Masala, G. and Del Giudice, G. and Plebani, M. and Basso, D. and Berti, D. and Numans, M.E. and Ceroti, M. and Peeters, P.H.M. and Bas Bueno De Mesquita, H. and Buchner, F.L. and Clavel-Chapelon, F. and Boutron-Ruault, M.-C. and Krogh, V. and Saieva, C. and Vineis, P. and Panico, S. and Tumino, R. and Nyrén, O. and Simán, H. and Berglund, G. and Hallmans, G. and Sanchez, M.-J. and Larrãnaga, N. and Barricarte, A. and Navarro, C. and Quiros, J.R. and Key, T. and Allen, N. and Bingham, S. and Khaw, K.T. and Boeing, H. and Weikert, C. and Linseisen, J. and Nagel, G. and Overvad, K. and Thomsen, R.W. and Tjonneland, A. and Olsen, A. and Trichoupoulou, A. and Trichopoulos, D. and Arvaniti, A. and Pera, G. and Kaaks, R. and Jenab, M. and Ferrari, P. and Nesi, G. and Carneiro, F. and Riboli, E. and Gonzalez, C.A.",
    journal = "International Journal  of Cancer",
    year = "2007",
    volume = "120",
    number = "4",
    pages = "859-867",
    issn = "0020-7136",
    doi = "10.1002/ijc.22435",
    keywords = "bacterium antibody;  CagA protein;  pepsinogen, adult;  article;  atrophic gastritis;  bacterial strain;  blood donor;  body weight;  cancer epidemiology;  cancer risk;  case control study;  chronic gastritis;  diet;  disease association;  education;  enzyme linked immunosorbent assay;  female;  follow up;  food preservation;  fruit;  Helicobacter infection;  Helicobacter pylori;  human;  infection risk;  lifestyle;  major clinical study;  male;  meat;  priority journal;  smoking;  Southern Europe;  stomach cancer;  stomach carcinogenesis;  vegetable, Adenocarcinoma;  Antibodies, Bacterial;  Antigens, Bacterial;  Bacterial Proteins;  Cardia;  Case-Control Studies;  Cohort Studies;  Helicobacter Infections;  Helicobacter pylori;  Humans;  International Agencies;  Male;  Middle Aged;  Prevalence;  Prospective Studies;  Risk Assessment;  Risk Factors;  Seroepidemiologic Studies;  Stomach Neoplasms;  Time Factors",
    abstract = "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 μg/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% CI 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. © 2006 Wiley-Liss, Inc."
}