Gastric Cancer in Asian American Populations: a Neglected Health Disparity

Victoria M Taylor,John M Inadomi,Mo-Kyung Sin,Joo Ha Hwang,Linda K Ko

doi:10.7314/apjcp.2014.15.24.10565

Abstract

Gastric cancer incidence rates vary dramatically by world region with East Asia having the highest rate. The Asian population of the United States (US) is growing rapidly and over 17 million Americans are of Asian descent. A majority of Chinese, Korean and Vietnamese Americans are immigrants. Americans of East and Southeast Asian descent experience marked gastric cancer disparities and the incidence rate among Korean men in the US is over five times higher than the incidence rate among non-Hispanic white men. Randomized controlled trials have provided evidence for the effectiveness of helicobacter pylori identification and eradication in preventing gastric cancer. Additionally, Japan and South Korea have both experienced improvements in gastric cancer mortality following the implementation of programs to detect early stage gastric cancers. There are currently no clear US guidelines regarding the primary and secondary prevention of gastric cancer in high-risk immigrant populations. However, it is likely that a proportion of US physicians are already recommending gastric cancer screening for Asian patients and some Asian immigrants to the US may be completing screening for gastric cancer in their native countries. Surveys of US primary care physicians and Asian American communities should be conducted to assess current provider practices and patient uptake with respect to gastric cancer prevention and control. In the absence of clinical guidelines, US health care providers who serve high-risk Asian groups could consider a shared decision-making approach to helicobacter pylori identification and eradication, as well as gastric endoscopy.

Highlights

Worldwide, gastric cancer is the fifth most commonly occurring cancer and third leading cause of cancer death (Ferlay et al, 2013)
Asian Americans for this review, many of the issues that we address are relevant to United States (US) immigrant populations from other regions of the world with high gastric cancer incidence rates as well as Asian immigrants to other Western countries (e.g. Australia and Canada) (Ferlay et al, 2013)
While much attention has been paid to hepatic cancer control in Asian American communities over the last decade, relatively little attention has been paid to gastric cancer control (Chao et al, 2009; Nguyen et al, 2012)

Summary

Introduction

Gastric cancer is the fifth most commonly occurring cancer and third leading cause of cancer death (Ferlay et al, 2013). Gastric cancer incidence rates vary dramatically by world region with East Asia having the highest rate (Ferlay et al, 2013; Fock, 2014). Three East Asian countries (China, Japan and Korea) account for 60% of all gastric cancer cases (Fock, 2014). Gastric cancer incidence rates increase progressively with age (Crew and Neugot, 2006; Brenner et al, 2009). Gender is strongly associated with gastric cancer risk and men have markedly higher incidence rates than women (Crew and Neugot, 2006; Brenner et al, 2009; Ferlay et al, 2013)

Objectives

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Discussion

Conclusion