Use Of Belts And Tight Clothing And Gastric Cancer: Is Mechanical Carcinogenesis Confirmed?

Gemma CASTANO-VINYALS, Centre for Reserach in Environmental Epidemiology (CREAL), Spain
LA VECCHIA C. 13 , MARTÍN V. 5,4 , PÉREZ-GÓMEZ B. 6,4 , ARDANAZ E. 7,4 , LLORCA J. 8,4 , DIAZ-SANTOS M. 9 , PEIRO R. 10,4 , TARDÓN A. 11,4 , JIMÉNEZ-MOLEÓN J. 12,4 , ARAGONÉS N. 6,4 , POLLÁN M. 6,4 , KOGEVINAS M. 1,2,3,4

1 ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
2 IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
3 Universitat Pompeu Fabra (UPF), Barcelona, Spain
4 CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
5 Universidad de León, León, Spain
6 Environmental and Cancer Epidemiology Unit, National Center of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
7 Instituto de Salud Pública de Navarra, Pamplona, Navarra
8 Universidad de Cantabria - IDIVAL, Santander, Spain
9 Centro de Investigación en Salud y Medio Ambiente (CYSMA), Universidad de Huelva, Huelva, Spain
10 Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana FISABIO – Salud Pública, Valencia, Spain
11 Instituto Universitario de Oncología, Universidad de Oviedo, Oviedo, Asturias, Spain
12 Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
13 Dept. of Clinical Sciences and Community Health Università degli Studi di Milano, Milan, Italy

Purpose. The hypothesis that mechanical carcinogenesis due to the abdominal pressure, for example from the use of belts, has been examined in two epidemiological studies with conflicting evidence. We examined the relationship between use of belts, tight clothes or girdles (a belt or sash worn around the waist) and gastric cancer in a population-based case- control study in Spain (MCC-Spain study) conducted between 2008-2013.
Methods. 459 histologically confirmed gastric cancer cases and 3438 population controls were included from different regions of Spain. Exposure was assessed by face-to-face interview administered by trained personnel. Odds ratio (OR) and 95% confidence intervals (CI) were calculated, adjusting for potential confounding factors for all gastric cancer cases and by anatomical sub-site.
Results. We observed an increase in gastric cancer risk for the average lifetime regular users of girdles (OR= 3.3; 95% CI 2.0-5.2) and an increase in cardia gastric cancer risk for the average lifetime regular users of tight pants or skirts (OR=2.2; 95% CI 1.1-4.4). Obese regular users of girdles had an 8-fold risk of gastric cancer. Users of girdles had a higher BMI, were less educated, and smoked and drank less alcohol than non-users.  We did not find any association with use of belts.
Conclusion. This study confirms the hypothesis that mechanical abdominal pressure is related to gastric cancer risk, particularly in obese subjects.  A proposed mechanism for this association is that the use of tight clothing may increase the gastro-esophageal reflux, although in our study the increased risk was observed in both cardia and non-cardia tumours. 
Funding source. The study was partially funded by the by the Instituto de Salud Carlos III-FEDER (PI08/1770).