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Gastric Cancer Epidemiology Suminori Kono, MD, PhD Professor of Preventive Medicine Kyushu Univ School of Medicine Fukuoka 812-8582, Japan

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Presentation on theme: "Gastric Cancer Epidemiology Suminori Kono, MD, PhD Professor of Preventive Medicine Kyushu Univ School of Medicine Fukuoka 812-8582, Japan"— Presentation transcript:

1 Gastric Cancer Epidemiology Suminori Kono, MD, PhD Professor of Preventive Medicine Kyushu Univ School of Medicine Fukuoka 812-8582, Japan skono@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 type: more frequent in males and at older ages Diffuse type: little difference between sexes and more frequent at younger ages Intestinal type: environmental 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 physician’s study Cigarettes/dayRR (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)PopulationRR (95% CI)* Parsonnet, et al.HMO subscribers 3.6 (1.8-7.3) (1991)in USA Nomura, et al.Japanese men6.0 (2.1-17.3) (1991)in Hawaii Forman, 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, wholegrain cereals, green tea Risk Factor Convincing:None Probable:Salt/salting Possible:Starch, grilled meat and fish

16 Vegetables and Fruits Many case-control studies: decreased 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-carotene0.84 + vitamin E Finland beta-carotene1.25 vitamin E1.25

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 AreaComparisonRR (95% CI) Nagoya (Jpn)4+ cups* vs. less0.6 (n.s.) Saga (Jpn)10+ cups vs. less0.3 (0.1-0.7) ShanghaiUse of strong tea0.3 (0.1-0.7) Shanghai M3+kg/yr vs 00.8 (0.6-1.3) F1.2+kg/yr vs 00.8 (0.5-1.4) Shanghai4+ batches vs 00.5 (0.3-0.9) Hawaii † 2+ cups vs. 01.5 (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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