Impact of Smoking and Alcohol Consumption on Early-Onset Gastric Cancer Development in Young Koreans: A Population-Based Study

Purpose: Although smoking and alcohol consumption are known risk factors for gastric cancer (GC), studies assessing their effects on early -onset GC are limited. In this nationwide, population -based, prospective cohort study, we assessed the effects of smoking and alcohol consumption on early -onset GC in patients aged <50 years. Materials and Methods: We analyzed data of patients aged 20-39 years who underwent cancer and general health screening in the Korean National Health Screening Program between 2009 and 2012. We calculated the adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for GC incidence until December 2020. Results: We enrolled 6,793,699 individuals (men:women=4,077,292:2,716,407) in this cohort. The mean duration of follow-up was 9.4 years. During follow-up, 9,893 cases of GC (men:women=6,304:3,589) were reported. Compared with the aHRs (95% CI) of neversmokers, those of former and current -smokers were 1.121 (1.044-1.205) and 1.282 (1.212-1.355), respectively. Compared with the aHRs (95% CI) of non -consumers, those of low -moderate- and high -risk alcohol consumers were 1.095 (1.046-1.146) and 1.212 (1.113-1.321), respectively. GC risk was the highest in current -smokers and high -risk alcohol consumers (1.447 [1.297-1.615]). Interestingly, alcohol consumption and smoking additively increased the GC risk in men but not in women (P-interaction=0.002). Conclusion: Smoking and alcohol consumption are significant risk factors for early -onset GC in young Koreans. Further studies are needed to investigate sex -based impact of alcohol consumption and smoking on GC incidence in young individuals.