Epidemiology of gastric cancer
- Annie On On Chan, MD
Annie On On Chan, MD
- Department of Medicine
- University of Hong Kong
- Benjamin Wong, DSc, MD, PhD
Benjamin Wong, DSc, MD, PhD
- Honorary Clinical Professor
- Department of Medicine
- University of Hong Kong
Gastric cancer has been described as early as 3000 BC in hieroglyphic inscriptions and papyri manuscripts from ancient Egypt. The first major statistical analysis of cancer incidence and mortality (using data gathered in Verona, Italy from 1760 to 1839) showed that gastric cancer was the most common and lethal cancer. It has remained one of the most important malignant diseases with significant geographical, ethnic, and socioeconomic differences in distribution.
This topic review will focus on the epidemiology of gastric cancer. Risk factors are presented separately. (See "Risk factors for gastric cancer".)
Gastric cancer is one of the most common cancers worldwide . Approximately 22,220 patients are diagnosed annually in the United States, of whom 10,990 are expected to die . Global, country-specific incidence rates are available in the World Health Organization GLOBOCAN database.
Gastric cancer used to be the leading cause of cancer deaths in the world until the 1980s when it was overtaken by lung cancer [3,4]. The worldwide incidence of gastric cancer has declined rapidly over the recent few decades [5-9]. Part of the decline may be due to the recognition of certain risk factors such as H. pylori and other dietary and environmental risks. However, the decline clearly began before the discovery of H. pylori. The decline first took place in countries with low gastric cancer incidence such as the United States (beginning in the 1930s), while the decline in countries with high incidence like Japan was slower. In the United Kingdom, there was a consistent decline in incidence of gastric cancer, with a reduction in relative risk from 1.14 in 1971 to 1975 to 0.84 in 1996 to 2000 in men, and 1.18 in 1971 to 1975 to 0.81 in 1996 to 2000 in women . In China, the decline was less dramatic than other countries; despite an overall decrease in gastric cancer incidence, an increase has been observed in the oldest and the youngest group, and a less remarkable decline has been observed among women than in men . Of note is that the age of onset of developing gastric cancer in Chinese population is younger than that in the West. In the United States, risk factors for noncardia gastric cancer include male gender, nonwhite race, and older age . Between 1977 and 2006, the incidence rate for noncardia gastric cancer in the United States declined among all race and age groups except for whites aged 25 to 39 years for whom it increased . The rise in incidence of noncardia gastric cancer among those at 25 to 39 years is noteworthy, since this may signal the introduction of new environmental factors.
An interesting hypothesis is that the popularization of refrigerators marks a pivotal point for the decline [14,15]. Refrigerators improved the storage of food, thereby reducing salt-based preservation of food and preventing bacterial and fungal contamination. Refrigeration also allowed for fresh food and vegetables to be more readily available, which may be a valuable source of antioxidants important for cancer prevention.
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