Abstract
In northern Canada where there is a high prevalence of Helicobacter pylori infection, there is a paucity of information on gastric cancer by the topographical subsites cardia (CGC) and non-cardia (NCGC). Here we describe the incidence of CGC and NCGC, separately, among northern Canadian populations. We used data from the Cancer Incidence in Five Continents Volumes X (CI5X) and XI (CI5XI) to obtain CGC and NCGC incidence for Canada and for Yukon (YT), a northern Canadian territory. Using these data with those provided by the Government of the Northwest Territories (NT), we estimated standardized incidence ratios comparing northern populations to Canada as a whole. We also estimated age-standardized incidence rates to permit comparisons across populations globally. NT and YT populations were disproportionately impacted by gastric cancer, particularly NCGC. This was especially true for Indigenous populations: NCGC incidence rates among NT Indigenous men were 2.7 times the rates among all men in Canada, while rates among NT Indigenous women were 3.1 times the rates among all women in Canada. Similarly, age-standardized rates of NCGC among Indigenous NT residents were comparable to global regions where there is a high burden of NCGC. This study has, for the first time, quantified the incidence of CGC and NCGC for the NT and YT, providing new insights into the burden of these cancers among northern Canadian populations.
Highlights
Gastric cancer is a major contributor to the global burden of cancer: in 2018, there were an estimated 1,033,701 new cases and 782,685 deaths due to gastric cancer, making it the 6th most commonly diagnosed and 3rd most fatal cancer worldwide [1]
During 2003 through 2012, there was an annual average of 2638 cases of gastric cancer in Canada; in each of the two northern territories included here, YT during 2003–2012 and Northwest Territories (NT) during 1997–2015, there was an annual average of 3 cases (Table 1)
Consistent with other work describing gastric cancer among northern and Indigenous populations, we found that NT and YT populations were disproportionately impacted by gastric cancer, of the non-cardia gastric region
Summary
Gastric cancer is a major contributor to the global burden of cancer: in 2018, there were an estimated 1,033,701 new cases and 782,685 deaths due to gastric cancer, making it the 6th most commonly diagnosed and 3rd most fatal cancer worldwide [1]. Often reported as a single entity, gastric cancers can be subdivided into two topographical categories: cardia gastric cancer (CGC) arising in the proximal area of the stomach, and non-cardia. As with all gastric cancers combined, there is considerable geographic variation in incidence across these subsites [2]. This may result, in part, from differences in risk factors by subsite that vary by geography. Environmental factors play a role: NCGC risk is increased by Helicobacter pylori infection [5,6,7] and cancers of this subsite are more common in less-resourced countries [8,9]. CGC is positively associated with obesity and gastroesophageal reflux but not with H. pylori infection, evidence that suggests a distinct etiology from H. pylori-associated
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