Abstract
Despite all recent treatment advances and the worldwide decline in the incidence rate, gastric cancer (GC) remains an ongoing global health challenge and one of the major leading causes of cancer-specific deaths, particularly in high-incidence regions including Iran. Since GC is often diagnosed in advanced stages, the best action may be to enable early diagnosis of the disease or even prevent it in the first place through identification and control of the underlying risk factors. Endoscopy, as the gold standard method, is both expensive and invasive, making it an unfavorable device in this regard. Therefore, it is crucial to implement a reliable region-specific screening and surveillance program to identify high-risk individuals with more efficient screening modalities. Here, in addition to a review of current GC knowledge, we presented the data of newly-established Population-based Cancer Registries (PBCRs) in Iran. Our assessment confirmed earlier reports of a very high GC incidence rate in the northwestern and northern provinces of Iran, most notably Ardabil. Along with the important role of conventional risk factors such as Helicobacter pylori (HP) infection and high dietary intake of salt, of more interest, we highlighted new region-specific risk factors, namely hookah, and opium. In conclusion, it seems the best results in reducing GC incidence and mortality rates on larger scales arise from modifying behavioral and environmental risk factors and advancing genetic and molecular biomarkers in order to supersede endoscopy. Regular endoscopic screening and antibiotic chemoprophylaxis against HP are still more appropriate in high-risk groups with specified criteria.
Highlights
Gastric cancer (GC) is the fifth most frequently diagnosed cancer and the third leading cause of cancer-specific mortality worldwide.[1]
There exists a remarkable diversity in the geographical distribution of GC incidence and mortality rates across populations (Figure 1).[2]
Numerous studies have shown that more than 80% of Iranian GC patients have been diagnosed in advanced stages of disease and their 5-year survival rates remain no better than 29.7%,12-14 even those treated with surgery.[15,16]
Summary
Gastric cancer (GC) is the fifth most frequently diagnosed cancer and the third leading cause of cancer-specific mortality worldwide.[1]. In a population-based case-control study in Ardabil, Pourfarzi et al reported that GC development was attributed to an increase in the frequency of dairy products intake (OR = 2.28).[57] Besides, different types of dairy products were discussed in detail in a study by Somi et al, which indicated that high-fat milk, yogurt and special types of cheeses (khiki and koze) increased the risk of GC.[71] the cause is unknown; the association may be confounded by other environmental risk factors, in rural areas where dairy consumption is higher than the urban population Another potent contributor to GC is suspected to be the habit of drinking strong and hot tea in northwestern and northern parts of Iran, similar to esophageal cancer (OR = ~2.5).[57] Food groups containing fat and sugar and mixed nuts have displayed a clear association with non-cardia GC.[64]. There is no consensus on an inclusive definition; individuals with the following characteristics might be cautiously considered at a higher risk for developing GC138: (a) Demographic features: male gender, age of 50 or more, positive family history of GC, low socioeconomic status, residence in a high-risk region. (b) Life Style: heavy smoking, chronic use of hookah, opium abuse, chronic heavy alcohol consumption, diets containing excessive salt intake, preserved food (smoked or salted), high amounts of meat, low amounts of antioxidants, fruits and vegetables. (c) Genetic factors: hereditary diffuse GC, familial adenomatous polyposis, hereditary non-polyposis colon cancer, blood group A, Li-Fraumeni syndrome. (d) Pathological features: positive HP infection, gastric precancerous lesions, and pernicious anemia
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