The document discusses risk factors for gastric cancer. It finds that while some studies show a small increased risk associated with a Billroth II surgery, the risk is much lower than that posed by meat and H. pylori infections. Processed meat intake is associated with increased gastric cancer rates, with risk rising over 5 times for every 100g consumed daily. H. pylori infections, specifically strains that are CagA-positive, increase the risk of gastric cancer by over 6.5 times. The key message is that people should be more fearful of contracting H. pylori infections and consuming processed meats than of having a Billroth II surgery.

1. Fear of Cancer?
Fear the "Hot Dog"
Not the
Billroth II

2. Risk of Gastric Cancer after
Billroth II
• Many studies show
• NO INCREASED RISK
• Some studies do show increased risk
• But these are in ulcer patients with
probable HPylori infections
• In the worst studie the increased risk is
• 1.5 X Much less than Meat or H.Pylori

3. Meat is Bad
Increased Gastric Cancer Rates in 6 years
• Gastric cancer risk inversely associated
(i.e. they are GOOD)
• High vitamin C, Carotenoids, Retinol and
α-tocopherol, high intake of cereal Fibre
and high adherence to Mediterranean diet
• Red and processed meat were associated
with increased risk Gastric cancer

4. Meat - Nitroso compounds (NOCs)
• Risk of gastric cancer (GC) associated
with dietary intake of nitrosodimethylamine
(NDMA) and endogenous formation of
nitroso compounds (NOCs)
• NOC was significantly associated with
non-cardia cancer risk 1.42 x times
• Carcinogenesis. 2006 Jul;27(7):1497-501. Epub 2006 Mar 29 Endogenous versus exogenous
exposure to N-nitroso compounds and gastric cancer risk in the European Prospective
Investigation into Cancer and Nutrition (EPIC-EURGAST) study.

5. Meat intake and risk of stomach
cancer
• Association risk of gastric cancer and
• total meat intake was
• especially large in H. pylori-infected subjects
• odds ratio per 100-g/day increase = X 5.32
• J Natl Cancer Inst. 2006 Mar 1;98(5):345-54. Meat intake and risk of stomach and esophageal
adenocarcinoma within the European Prospective Investigation Into Cancer and Nutrition (EPIC).

6. Fear Gastric Cancer?
Fear the Hot Dog
Not the Billroth II
• 100-g/day increase = X 5.32
• 1 Hot Dog 50-100 g processed meat
• 6 years => 5+ increased risk gastric
cancer

7. Fear of Cancer?
Fear the "Hot Dog"
Not the
Billroth II

8. Fear of Cancer?
Fear the "H.Pylori"
Not the
Billroth II

9. H.Pylori increase
Gastric Cancer 6.5 X Times
• Risk of GC associated with HPylori CagA
increase 6.5 X Times
• Causal relationship between H. pylori
CagA+ strains infection, and GC in these
European populations even after taking
into account dietary habits.
•
• Int J Cancer. 2007 Feb 15;120(4):859-67. CagA+ Helicobacter pylori infection and gastric cancer
risk in the EPIC-EURGAST study.

10. Fear of Cancer?
Fear the "H.Pylori"
Not the
Billroth II