BACKGROUND: The magnitude of the association
between Helicobacter pylori and
incidence of gastric cancer is unclear. H
pylori infection and the circulating antibody
response can be lost with development
of cancer; thus retrospective studies
are subject to bias resulting from classifi-
cation of cases as H pylori negative when
they were infected in the past.
AIMS: To combine data from all case control
studies nested within prospective
cohorts to assess more reliably the relative
risk of gastric cancer associated with H
pylori infection.To investigate variation in
relative risk by age, sex, cancer type and
subsite, and interval between blood sampling
and cancer diagnosis.
METHODS: Studies were eligible if blood
samples for H pylori serology were collected
before diagnosis of gastric cancer in
cases. Identified published studies and two
unpublished studies were included. Individual
subject data were obtained for
each. Matched odds ratios (ORs) and 95%
confidence intervals (95% CI) were calculated
for the association between H pylori
and gastric cancer.
RESULTS: Twelve studies with 1228 gastric
cancer cases were considered. The association
with H pylori was restricted to noncardia
cancers (OR 3.0; 95% CI 2.3–3.8)
and was stronger when blood samples for
H pylori serology were collected 10+ years
before cancer diagnosis (5.9; 3.4–10.3). H
pylori infection was not associated with an
altered overall risk of cardia cancer (1.0;
0.7–1.4).
CONCLUSIONS: These results suggest that
5.9 is the best estimate of the relative risk
of non-cardia cancer associated with H
pylori infection and that H pylori does not
increase the risk of cardia cancer. They
also support the idea that when H pylori
status is assessed close to cancer diagnosis,
the magnitude of the non-cardia
association may be underestimated
