Changing trends in gastric cancer incidence and mortality: the role of upper endoscopy in low-risk countries.

Abstract

Gastric cancer, which is diagnosed in approximately one million new patients annually, is a significant contributor to global cancer burden and cancer-related mortality [1]. East Asia, eastern Europe, and Latin America have the highest incidences, while North America and most of western Europe have relatively low incidences [2]. This geographical variation is thought to be associated with several different predisposing and etiologic factors among the countries, such as tumor biology, Helicobacter pylori (H. pylori) infection rate, cigarette smoking, and a high sodium diet with salt-preserved foods. Global age-standardized gastric cancer incidence has steadily declined over the past century, particularly in high-risk countries such as Korea and Japan. This trend has been linked to a decline in noncardia cancer because of the eradication of H. pylori [2]. Contrarily, in countries with low gastric cancer incidence, such as those in western Europe and the USA, the decline in gastric cancer has reduced, especially in the middle-aged population [1] [2]. This phenomenon may also be related to changes in H. pylori infection patterns or the increased proportion of cardia cancer related to epidemic obesity and gastroesophageal reflux disease [1]. As with incidence, global gastric cancer mortality has also decreased [2]. Improvements in surgical techniques and the development of chemotherapy regimens have led to better survival outcomes. Above all, early detection of cancer is a crucial factor contributing to the decline in mortality.