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Epidemiology

The future burden of oesophageal and stomach cancers attributable to modifiable behaviours in Australia: a pooled cohort study

British Journal of Cancer volume 128, pages 1052–1069 (2023)Cite this article

Subjects

Abstract

Background

We quantified the individual and joint contribution of contemporaneous causal behavioural exposures on the future burden of oesophageal and stomach cancers and their subtypes and assessed whether these burdens differ between population groups in Australia, as such estimates are currently lacking.

Methods

We combined hazard ratios from seven pooled Australian cohorts (N = 367,058) linked to national cancer and death registries with exposure prevalence from the 2017–2018 National Health Survey to estimate Population Attributable Fractions (PAFs) with 95% confidence intervals (CIs), accounting for competing risk of death.

Results

Current and past smoking explain 35.2% (95% CI = 11.7–52.4%), current alcohol consumption exceeding three drinks/day 15.7% (95% CI = 0.9–28.4%), and these exposures jointly 41.4% (95% CI = 19.8–57.3%) of oesophageal squamous cell carcinomas in Australia. Current and past smoking contribute 38.2% (95% CI = 9.4–57.9%), obesity 27.0% (95% CI = 0.6–46.4%), and these exposures jointly 54.4% (95% CI = 25.3–72.1%) of oesophageal adenocarcinomas. Overweight and obesity explain 36.1% (95% CI = 9.1–55.1%), current and past smoking 24.2% (95% CI = 4.2–40.0%), and these exposures jointly 51.2% (95% CI = 26.3–67.8%) of stomach cardia cancers. Several population groups had a significantly higher smoking-attributable oesophageal cancer burden, including men and those consuming excessive alcohol.

Conclusions

Smoking is the leading preventable behavioural cause of oesophageal cancers and overweight/obesity of stomach cancers.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

We thank the participating cohort studies and surveys and their participants for the data for this cohort consortium. The 45 and Up Study is managed by the Sax Institute in collaboration with major partner Cancer Council NSW; and partners: the Heart Foundation; NSW Ministry of Health; NSW Department of Communities and Justice; and Australian Red Cross Lifeblood. Specific details of funding and data sources for the Australian Longitudinal Study on Women’s Health are available at: www.alswh.org.au. Cohort recruitment for the Melbourne Collaborative Cohort Study (MCCS) was funded by Cancer Council Victoria (http://www.cancervic.org.au/) and VicHealth (https://www.vichealth.vic.gov.au/). The MCCS was further supported by Australian National Health and Medical Research Council grants 209057 and 396414 and by infrastructure provided by Cancer Council Victoria. The MCCS was made possible by the contribution of many people, including the original investigators, the teams that recruited the participants and continue working on follow-up, and the many thousands of Melbourne residents who continue to participate in the study. The CHAMP study is funded by the NHMRC (ID301916) and the Ageing and Alzheimer’s Institute. We acknowledge the assistance of the AIHW Data Linkage Unit for undertaking the data linkage to the Australian Cancer Database and the National Death Index, and the AIHW Cancer Data and Monitoring Unit for providing the cancer incidence projections. The linked data were managed and accessed through the Sax Institute’s Secure Unified Research Environment (SURE). We also thank the Australian Bureau of Statistics (ABS) for providing access to the National Health Survey data via the ABS DataLab and the ABS staff for their assistance with the analysis.

Funding

This work was supported by the National Health and Medical Research Council of Australia (ID1060991). The National Health and Medical Research Council of Australia also supported MAL (ID1053642), KC (ID1082989), EB (ID1136128), JES (ID1079438) and DJM (ID1118161). MAL was additionally supported by the Cancer Institute New South Wales (ID13/ECF/1-07, 2019/CDF1022).

Author information

Authors and Affiliations

  1. School of Mathematics and Statistics, University of New South Wales, Sydney, NSW, Australia

    Maarit A. Laaksonen & Siqi Li

  2. Daffodil Centre, The University of Sydney, a joint venture with Cancer Council New South Wales, Sydney, NSW, Australia

    Karen Canfell

  3. Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, VIC, Australia

    Robert J. MacInnis & Graham G. Giles

  4. Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia

    Robert J. MacInnis & Graham G. Giles

  5. National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT, Australia

    Emily Banks

  6. Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, NSW, Australia

    Julie E. Byles

  7. Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia

    Dianna J. Magliano

  8. Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia

    Jonathan E. Shaw

  9. Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia

    Tiffany K. Gill & Anne W. Taylor

  10. School of Life and Environmental Sciences, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia

    Vasant Hirani

  11. School of Public Health, The University of Sydney, Sydney, NSW, Australia

    Robert G. Cumming

  12. ANZAC Research Institute, The University of Sydney and Concord Hospital, Sydney, NSW, Australia

    Robert G. Cumming

  13. Centre for Vision Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia

    Paul Mitchell

  14. Cancer Voices NSW, Sydney, NSW, Australia

    Michelle Bonello

  15. Kirby Institute, University of New South Wales, Sydney, NSW, Australia

    Claire M. Vajdic

  16. Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia

    Barbara-Ann Adelstein

  17. School of Nursing and Midwifery, University of South Australia, Adelaide, SA, Australia

    Kay Price

Authors
  1. Maarit A. Laaksonen
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  15. Claire M. Vajdic
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Consortia

the Australian cancer-PAF cohort consortium

  • Maarit A. Laaksonen
  • , Karen Canfell
  • , Robert J. MacInnis
  • , Graham G. Giles
  • , Emily Banks
  • , Julie E. Byles
  • , Dianna J. Magliano
  • , Jonathan E. Shaw
  • , Tiffany K. Gill
  • , Vasant Hirani
  • , Robert G. Cumming
  • , Paul Mitchell
  • , Claire M. Vajdic
  • , Barbara-Ann Adelstein
  • , Anne W. Taylor
  •  & Kay Price

Contributions

MAL, SL, and CMV designed the study, conducted the literature review, interpreted the results, and drafted and revised the manuscript. MAL harmonised and analysed the data. KC, RJM, GGG, EB, JEB, DJM, JES, TKG, VH, RGC, PM, and MB contributed substantially to interpreting the results, drafting the manuscript or revising it critically for important intellectual content. All authors approved the final version and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to Maarit A. Laaksonen.

Ethics declarations

Competing interests

KC is co-PI of an investigator-initiated trial of cervical screening, Compass, run by the Australian Centre for Prevention of Cervical Cancer (ACPCC), which is a government-funded not-for-profit charity; the ACPCC has received equipment and funding contribution from Roche Molecular Diagnostics. She is also co-PI on a major investigator-initiated implementation programme Elimination of Cervical Cancer in the Western Pacific (ECCWP) which will receive support from the Minderoo Foundation, the Frazer Family Foundation and equipment donations from Cepheid Inc. Neither KC nor her institution on her behalf receives direct funding from industry for any project. The other authors have no competing interests to declare.

Ethics approval and consent to participate

The Australian Institute of Health and Welfare (AIHW) Ethics Committee approved the study (EC2013/4/62). This study is a data linkage study where data linkage was carried out by external authorities and all data was de-identified. All the participating cohort studies have relevant ethics approvals from human research ethics committees and have obtained informed consent for participation, collection and use of data for health research from each individual. The study was performed in accordance with the Declaration of Helsinki.

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Laaksonen, M.A., Li, S., Canfell, K. et al. The future burden of oesophageal and stomach cancers attributable to modifiable behaviours in Australia: a pooled cohort study. Br J Cancer 128, 1052–1069 (2023). https://doi.org/10.1038/s41416-022-02104-x

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