Gastric Cancer

, Volume 21, Issue 4, pp 598–605 | Cite as

Telomere length and risk of developing gastric adenocarcinoma: The Singapore Chinese Health Study

  • Zhensheng Wang
  • Woon-Puay Koh
  • Aizhen Jin
  • Renwei Wang
  • Jian-Min Yuan
Original Article



Extreme telomere length has been previously reported to be associated with increased risk of gastric cancer. However, evidence from prospective studies on a relative large sample size with long-term follow-up to further corroborate previous study findings is meager.


The association between peripheral blood leukocyte telomere length and risk of gastric adenocarcinoma was prospectively examined in a cohort of 26,540 middle-aged or older Chinese nested in the Singapore Chinese Health Study. Telomere length was determined using a validated qPCR-based method. The Cox proportional regression method was used to estimate hazard ratio (HR) and its 95% confidence interval (CI) of gastric adenocarcinoma associated with telomere length after adjustment for potential confounders. Restricted cubic spline analysis was applied to assess the nonlinear relationship between telomere length and gastric cancer risk.


A U-shaped association was found between telomere length and risk of gastric adenocarcinoma (P nonlinearity = 0.020). Compared with the second quintile of telomere length, a statistically significant higher risk of gastric adenocarcinoma was associated with either the lowest quintile (HR = 1.63, 95% CI, 1.07–2.47) or the highest quintile (HR = 1.55, 95% CI, 0.97–2.47) of telomere length. This U-shaped relationship was more apparent in men and younger individuals.


This is the first prospective study demonstrating a higher risk of gastric cancer to be associated with either extremely short or extremely long telomere length. Short and long telomere length may function differently in the early and late stages of gastric carcinogenesis.


Gastric adenocarcinoma Telomere length Prospective cohort study 



We thank Siew-Hong Low of the National University of Singapore for supervising the fieldwork of the Singapore Chinese Health Study and the Singapore Cancer Registry for assistance with the identification of cancer outcomes. This study was funded by National Institute of Health (NIH)/National Cancer Institute (NCI) Grant number: R01 CA144034 and UM1 CA182876 (to J.-M. Yuan). W-PK is supported by the National Medical Research Council, Singapore (NMRC/CSA/0055/2013).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent was obtained from all participants.

Ethical approval

The Singapore Chinese Health Study was approved by the Institutional Review Boards at the National University of Singapore and the University of Pittsburgh (Pittsburgh, PA, USA).


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Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2017

Authors and Affiliations

  1. 1.Department of Epidemiology, Graduate School of Public HealthUniversity of PittsburghPittsburghUSA
  2. 2.Duke-NUS Medical SchoolSingaporeSingapore
  3. 3.Saw Swee Hock School of Public HealthNational University of SingaporeSingaporeSingapore
  4. 4.National Registry of Diseases OfficeHealth Promotion BoardSingaporeSingapore
  5. 5.Division of Cancer Control and Population SciencesUPMC Hillman Cancer CenterPittsburghUSA

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