Stomach cancer was the most
common form of cancer in the world in the 1970s and early 1980s, and is probably
now only surpassed by lung cancer. Stomach cancer incidence rates show substantial
variation internationally. Rates are highest in Japan and eastern Asia, but
other areas of the world have high stomach cancer incidence rates including
eastern Europe and parts of Latin America. Incidence rates are generally lower
in western Europe and the United States. Stomach cancer incidence and mortality
rates have been declining for several decades in most areas of the world. For
one subsite of the stomach, the cardia, incidence rates appear to be increasing,
particularly among white men.
Stomach cancer incidence
rates for the racial/ethnic populations in the SEER regions can be grouped broadly
into three levels. Those with high age-adjusted incidence rates are Koreans,
Vietnamese, Japanese, Alaska Natives and Hawaiians. Those with intermediate
incidence rates are white Hispanic, Chinese, and black populations. Filipinos
and non-Hispanic whites have substantially lower incidence rates than the other
groups. These patterns hold for both men and women when rates are available
for both sexes.
The incidence rate for
Korean men is 1.6 times the rate in Japanese men, the group with the second
highest rate, and is 2.4 times the rate in Hawaiians. The range in incidence
rates is narrower among the groups in the intermediate level. The incidence
rate for Korean men is nearly 5.8 times greater than the rate in Filipino men,
the group with the lowest incidence rate. Among women, the highest incidence
rate is in the Vietnamese population and is nearly 6.6 times greater than the
rate in non-Hispanic whites. The male-to-female ratio of age-adjusted incidence
rates is highest for Koreans (2.6) and followed closely by non-Hispanic whites
and blacks (2.5 and 2.4, respectively). The ratio is less than two for other
racial-ethnic groups. Notably, the incidence rates for Vietnamese men and women
are the same.
The racial/ethnic patterns
of stomach cancer mortality in the United States are similar to those for incidence.
These patterns remain when incidence and mortality rates are calculated for
the three age groups. There are some differences in the ratios of incidence
rates to mortality rates. Filipinos show relatively high ratios of incidence
to mortality (greater than 2); Japanese, Alaska Natives, white Hispanics, Chinese,
and non-Hispanic whites show intermediate ratios (1.5-1.9); blacks and Hawaiians
show low ratios of incidence to mortality rates (1.0-1.4).
Better techniques for food
preservation and storage are often cited as reasons for the decline in stomach
cancer incidence worldwide. Refrigeration has resulted in lower intake of salted,
smoked and pickled foods and greater availability of fresh fruits and vegetables.
Evidence is strong that salt intake is a major determinant of stomach cancer
risk. Cigarette smoking may also play a role. Infection with Helicobacter pylori,
the major cause of chronic active gastritis, also appears to be important in
the development of stomach cancer.
Source: Miller BA,
Kolonel LN, Bernstein L, Young, Jr. JL, Swanson GM, West D, Key CR, Liff JM,
Glover CS, Alexander GA, et al. (eds). Racial/Ethnic Patterns of Cancer in the
United States 1988-1992, National Cancer Institute. NIH Pub. No. 96-4104. Bethesda,
MD, 1996.
Graphs showing incidence and mortality for specific racial and ethnic
groups including information that may not be discussed in the text above,
is available at the NCI's Surveillance, Epidemiology, and End Results
(SEER) Web site at: http://seer.cancer.gov/.
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