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Gastric Cancer Epidemiology

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Title: Gastric Cancer Epidemiology


1
Gastric Cancer Epidemiology
  • Suminori Kono, MD, PhDProfessor of Preventive
    MedicineKyushu Univ School of MedicineFukuoka
    812-8582, Japanskono_at_phealth.med.kyushu-u.ac.jp

2
Learning Objectives
  • Understand descriptive features
  • Learn protective and risk factors
  • Learn ways of interpreting epidemiological
    observation

3
Reading Materials
  • Kono S, Hirohata T. Nutrition and stomach cancer.
    Cancer Causes Control 1996 7 41-55.
  • World Cancer Research. Food, nutrition and the
    prevention of cancer a global perspective.
    Washington, DC American Institute for Cancer
    Research, 1997.

4
Descriptive Features of Gastric Cancer
  • 1) Second most common cancer
  • 2) Dramatic decline worldwide
  • 3) Wide variation in incidence
  • 4) Altered risk among migrants
  • 5) Male-to-female ratio 1.5 to 2.0

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8
Histological Types
  • Intestinal typemore frequent in males and at
    older ages
  • Diffuse typelittle difference between sexes and
    more frequent at younger ages
  • Intestinal typeenvironmental cancer (?)

9
5-year Relative Survival Rates
  • Japan (1987-89) 48 US (1986-91)
    19
  • Denmark (1983-85) 19
  • Source Hanai A. Jpn J Cancer Clin 1998 44 49-59

10
Screening for Gastric Cancer
  • Nationwide screening in Japan
  • Barium X-ray method
  • No randomized controlled trial
  • Benefit in case-control studies

11
Smoking and Gastric Cancer
  • Japanese physicians study
  • Cigarettes/day RR (95 CI)
  • Never/past 1.0
  • 1-19 1.7 (1.1-2.6)
  • 20 1.8 (1.1- 3.0)
  • Adjusted for age and alcohol use

12
Alcohol Use and Gastric Cancer
  • Generally, no association between alcohol use and
    gastric cancer.
  • Exceptionally, increased risk in relation to a
    heavy use of red wine and vodka drinking

13
Helicobacter pylori and Gastric Cancer
prospective studies
  • Study (year) Population RR (95
    CI)Parsonnet, et al. HMO subscribers 3.6
    (1.8-7.3)(1991) in USA Nomura, et
    al. Japanese men 6.0 (2.1-17.3)(1991) in
    HawaiiForman, et al. British men 2.8
    (1.0-8.0)(1991)

14
Helicobacter pylori and Gastric Cancer current
interpretation
  • A definite cause of gastric cancer
  • African enigma
  • No sex difference in H. pylori

15
Dietary Factors and Gastric Cancer
  • Protective Factor
  • Convincing Vegetables and fruits,
    refrigerators
  • Probable Vitamin C
  • Possible Carotenoids, allium compounds, whole
    grain cereals, green tea
  • Risk Factor
  • Convincing None
  • Probable Salt/salting
  • Possible Starch, grilled meat and fish

16
Vegetables and Fruits
  • Many case-control studiesdecreased risk
    associated with high consumption
  • Few prospective studies less consistent
    association
  • Antioxidant micronutrients postulated
    constituents

17
Vitamin Supplements Randomized Controlled Trial
  • Country Supplements Relative risk
  • China beta-carotene 0.84 vitamin E
  • Finland beta-carotene 1.25 vitamin E 1.25

18
Salt and Salted Foods
  • Many case-control studies increased risk with
    salt intake, use of table salt, or salty foods.
  • 1 of 2 prospective studies increased risk with
    salted fish.
  • High salt intake promoted chemically-induced
    gastric carcinoma in rats. (Jpn J Cancer Res
    1983 74 28-34)

19
Green Tea and Gastric Cancer
  • Area Comparison RR (95 CI)
  • Nagoya (Jpn) 4 cups vs. less 0.6 (n.s.)Saga
    (Jpn) 10 cups vs. less 0.3 (0.1-0.7)Shanghai U
    se of strong tea 0.3 (0.1-0.7)Shanghai
    M 3kg/yr vs 0 0.8 (0.6-1.3)
    F 1.2kg/yr vs 0 0.8 (0.5-1.4)Shanghai 4
    batches vs 0 0.5 (0.3-0.9)Hawaii 2 cups
    vs. 0 1.5 (0.9-2.3)
  • Per day. Prospective study of Japanese men.

20
Nitrate, Nitrite, and N-nitroso Compounds in
Gastric Carcinogenesis
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