Incidence Of Non-cardia Gastric Cancer Research Articles

Ethnic Disparities in Early-Onset Gastric Cancer Persist across Rural-Urban Geographies.

The incidence of noncardia gastric cancer is increasing in adults ages less than 50 years old. Early-onset gastric cancer (EOGC) is characterized by ethnic disparities occurring more in Hispanic persons than non-Hispanic persons. It is unknown whether rural-urban disparities exist in EOGC and if this intersects with ethnic disparities. We utilized the Surveillance Epidemiology and End Results 17 Census Tract-level Socioeconomic Status and Rurality Database from 2006 to 2018 to calculate incidence rates and incidence rate ratios of EOGC among Hispanic and non-Hispanic persons by census tract rural-urban location, age, gender, persistent poverty, and stage of disease. We used the Tiwari Method to estimate incidence rate ratios with 95% confidence intervals (CI). Hispanic persons had higher incidence rates of EOGC compared with non-Hispanic persons in both rural [incident rate ratios (IRR), 2.12; 95% confidence interval (CI), 1.64-2.73] and urban census tracts (IRR, 2.03; 95% CI, 1.91-2.16). Similar findings were seen when comparing Hispanic to non-Hispanic persons in rural and urban census tracts by age, stage of disease, and persistent poverty. Higher incidence rates of EOGC among Hispanic persons persist across rural-urban locations. Further research is needed to understand the etiology of this elevated risk in young Hispanics and interventions that may help to modify their outcome. While other cancers have ethnic disparities which may differ by rural-urban location, the ethnic disparity in EOGC among Hispanic and non-Hispanic persons does not differ by rural-urban residence.

Rising Incidence of Non-Cardia Gastric Cancer among Young Women in the United States, 2000-2018: A Time-Trend Analysis Using the USCS Database.

Although the global incidence of non-cardia gastric cancer (NCGC) is decreasing, there are limited data on sex-specific incidence in the United States. This study aimed to investigate time trends of NCGC from the SEER database to externally validate findings in a SEER-independent national database, and to further assess trends among subpopulations. Age-adjusted incidence rates of NCGC were obtained from the SEER database from 2000 to 2018. We used joinpoint models to calculate average annual percentage change (AAPC) to determine sex-specific trends among older (≥55 years) and younger adults (15-54 years). Using the same methodology, findings were then externally validated using SEER-independent data from the National Program of Cancer Registries (NPCR). Stratified analyses by race, histopathology, and staging at diagnosis were also conducted in younger adults. Overall, there were 169,828 diagnoses of NCGC from both independent databases during the period 2000-2018. In SEER, among those <55 years, incidence increased at a higher rate in women (AAPC = 3.22%, p < 0.01) than men (AAPC = 1.51%, p = 0.03), with non-parallel trends (p = 0.02), while a decreasing trend was seen in both men (AAPC = -2.16%, p < 0.01) and women (AAPC = -1.37%, p < 0.01) of the ≥55 years group. Validation analysis of the SEER-independent NPCR database from 2001 to 2018 showed similar findings. Further stratified analyses showed that incidence is disproportionately increasing in young non-Hispanic White women [AAPC = 2.28%, p < 0.01] while remaining stable in their counterpart men [AAPC = 0.58%, p = 0.24] with non-parallel trends (p = 0.04). This pattern was not observed in other race groups. NCGC incidence has been increasing at a greater rate in younger women compared to counterpart men. This disproportionate increase was mainly seen in young non-Hispanic White women. Future studies should investigate the etiologies of these trends.

S1602 The Disproportionate Rise of Non-Cardia Primary Gastric Cancer Incidence Rates in Younger Women Is Driven by Black and White Race but Not Asian Race: A Population-Based Time-Trend Analysis Using the USCS Database

S1602 The Disproportionate Rise of Non-Cardia Primary Gastric Cancer Incidence Rates in Younger Women Is Driven by Black and White Race but Not Asian Race: A Population-Based Time-Trend Analysis Using the USCS Database

S1386 Diverging Patterns of Cardia and Non-Cardia Gastric Adenocarcinoma Incidence by Race and Age in the United States From 2000-2018

Introduction: Gastric adenocarcinoma is the fifth-leading cause of cancer incidence and fourth-leading cause of cancer mortality worldwide. In the United States (US), racial groups differ in their incidence of cardia (CGA) and non-cardia (NCGA) gastric adenocarcinomas. There have been few studies published observing secular trends in incidence of both CGA and NCGA stratified by race in the US. Methods: Age-adjusted incidence rates and trends of CGA and NCGA in adults aged ≥ 25 years were calculated using data form 18 registries reporting to the Surveillance, Epidemiology, and End Results (SEER) Program from years 2000-2018. Race/ethnicity was classified as non-Hispanic White, non-Hispanic Black, American Indian/Alaskan Native, Asians/Pacific Islanders, and Hispanic. Analysis was also stratified by age (25-49 and ≥50). We used joinpoint regression to assess annual percent change (APC), average annual percent change (AAPC), and corresponding 95% confidence intervals (CIs). Results: The incidence of NCGA decreased in all racial groups, regardless of age, across the study period. The incidence of CGA also decreased in all racial groups among individuals ≥50 (Table 1). However, among individuals 25-49, the incidence of CGA is increasing among non-Hispanic Whites (AAPC = 1.0, 95% CI; 0.3, 1.7), Asian/Pacific Islanders (AAPC = 2.5, 95% CI; -0.3, 5.4), and Hispanics (AAPC = 2.3, 95% CI; 0.9, 3.8) (Figure 1). Conclusion: NCGA incidence is decreasing in all racial and age groups. By contrast, CGA incidence in increasing in the young among certain racial/ethnic groups. Clinicians and policy makers must be cognizant of these recent and worrisome trends. Moreover, appropriate cancer prevention programs are needed to target these at-risk populations.Table 1.: Average annual percent change in cardia and non-cardia gastric cancer incidence rates by race and age: SEER 2000-2018 SEER, Surveillance, Epidemiology and End Results; AAPC, average annual percent change. † Lack of data to analyze AAPC.Figure 1.: Age- and race-specific cardia gastric cancer incidence trends in the SEER data, 2000-2018 A. Non-Hispanic Whites aged 25-49 B. Non-Hispanic Asian/Pacific Islanders aged 25-49 C. Hispanics aged 25-49 D. Non-Hispanic Whites aged ≥50 E. Non-Hispanic Asian/Pacific Islanders aged ≥50 F. Hispanics aged ≥50

Autoimmunity as an Etiological Factor of Cancer: The Transformative Potential of Chronic Type 2 Inflammation.

Recent epidemiological studies have found an alarming trend of increased cancer incidence in adults younger than 50 years of age and projected a substantial rise in cancer incidence over the next 10 years in this age group. This trend was exemplified in the incidence of non-cardia gastric cancer and its disproportionate impact on non-Hispanic white females under the age of 50. The trend is concurrent with the increasing incidence of autoimmune diseases in industrialized countries, suggesting a causal link between the two. While autoimmunity has been suspected to be a risk factor for some cancers, the exact mechanisms underlying the connection between autoimmunity and cancer remain unclear and are often controversial. The link has been attributed to several mediators such as immune suppression, infection, diet, environment, or, perhaps most plausibly, chronic inflammation because of its well-recognized role in tumorigenesis. In that regard, autoimmune conditions are common causes of chronic inflammation and may trigger repetitive cycles of antigen-specific cell damage, tissue regeneration, and wound healing. Illustrating the connection between autoimmune diseases and cancer are patients who have an increased risk of cancer development associated with genetically predisposed insufficiency of cytotoxic T lymphocyte-associated protein 4 (CTLA4), a prototypical immune checkpoint against autoimmunity and one of the main targets of cancer immune therapy. The tumorigenic process triggered by CTLA4 insufficiency has been shown in a mouse model to be dependent on the type 2 cytokines interleukin-4 (IL4) and interleukin-13 (IL13). In this type 2 inflammatory milieu, crosstalk with type 2 immune cells may initiate epigenetic reprogramming of epithelial cells, leading to a metaplastic differentiation and eventually malignant transformation even in the absence of classical oncogenic mutations. Those findings complement a large body of evidence for type 1, type 3, or other inflammatory mediators in inflammatory tumorigenesis. This review addresses the potential of autoimmunity as a causal factor for tumorigenesis, the underlying inflammatory mechanisms that may vary depending on host-environment variations, and implications to cancer prevention and immunotherapy.

496 THE INFLAMMATORY-METAPLASIA-DYSPLASIA-OESOPHAGEAL ADENOCARCINOMA SEQUENCE: THE ROLE OF THE MICROBIOME

Abstract The human microbiota, the collection of microbes that inhabit the human body, is increasingly recognized as playing a role in human health. A seminal example of this relationship is Helicobacter pylori and gastric cancer oncogenesis. The decline in H.pylori prevalence and non-cardia gastric cancer incidence have coincided with the rise in oesophageal adenocarcinoma (OAC) incidence. We sought to explore the relationship between the gastric and oesophageal microbiome and OAC oncogenesis. Methods This study aimed to explore changes in the microbiome associated with oesophageal adenocarcinoma and its precancerous and inflammatory states by performing 16S rRNA gene amplicon sequencing on DNA extracted from oesophago-gastric biopsies from patients with normal oesophageal mucosa, reflux oesophagitis, Barrett’s oesophagus with and without dysplasia, locally advanced but resectable oesophageal adenocarcinoma, and incurable metatstatic oesophageal adenocarcinoma (See Table 1). We dissected ecological differences between sample site and clinical classification using a variety of approaches including examining differentially abundant taxa and inferred metabolic pathways, alpha diversity and beta-diversity. Results There was no statistically significant difference in beta diversity with respect to biopsy location. Alpha diversity was reduced in gastric biopsies compare to oesophageal biopsies. A small but significant shift was noted in beta diversity (Bray–Curtis Dissimilarity) with respect to clinical classification in biopsies derived from the gastroesophageal junction (GEJ) and stomach. Fusobacterium nucleatum was found to overrepresented in oesophageal biopsies derived from diseased groups relative to the healthy controls. Several taxa assigned to the genus Prevotella were depleted in biopsies of individuals with metastatic OAC compared to all other groups. Conclusion Community structure was shifted in samples derived from the GEJ, the epicentre of OAC oncogenesis. Fusobacterium plays a role in cancer development and progression through a number of mechanisms including increasing cell proliferation, immune cell infiltration and chemoresistance. Fusobacterium can cause upregulation of MicroRNA-21, a microRNA upregulated in OAC.

A Summary of the 2020 Gastric Cancer Summit at Stanford University

There exists no coherent national strategy for the early detection or prevention of gastric cancer in the United States (US), even among identified high-risk groups such as Asian Americans, African Americans, Hispanic Americans, and Alaska Native/American Indian peoples. As a result, patients with gastric cancer in the US are diagnosed at later stages and demonstrate worse overall survival compared to nations of East Asia with established screening programs (Table 1). The under-recognition of gastric cancer risk within minority communities is a significant unaddressed healthcare disparity.

Increasing Incidence of Advanced Non-cardia Gastric Cancers Among Younger Hispanics in the USA.

Recent findings indicate a shift in the epidemiology of non-cardia gastric cancer in the USA. In particular, an uprising trend in incidence rates among non-Hispanic whites aged < 50years. To examine secular trends in the incidence of non-cardia gastric cancer among adults aged < 50years in the USA by race/ethnicity and stage at diagnosis. Age-adjusted incidence rates and trends in adults aged < 50years and ≥ 50years were calculated using data from all 50 states in the National Program of Cancer Registries and the SEER program. We used joinpoint regression to compute average annual percent change (AAPC) in cancer incidence rates. Overall, we found an increasing trend of non-cardia gastric cancer among non-Hispanic whites aged < 50years between 2001 and 2014 (AAPC = 1.24, 95% CI 0.49, 1.99). However, among non-Hispanic whites aged < 50years, the rates of localized disease increased (AAPC = 5.28, 95% CI 3.94, 6.64), whereas the rates of distant stage non-cardia gastric cancer remained unchanged (AAPC = 0.68, 95% CI - 0.63, 2.00). Conversely, we found a significant increase in rates of distant stage non-cardia gastric cancer among Hispanics aged < 50years (AAPC = 1.78, 95% CI 0.66, 2.91). Non-cardia gastric cancer incidence rates decreased over the study period among non-Hispanic whites and Hispanics aged ≥ 50years. Given the rapid growth of the young Hispanic population in the USA, preventative strategies for non-cardia gastric cancer cannot neglect this population.

Racial/Ethnic Patterns of Young-Onset Noncardia Gastric Cancer.

Increasing noncardia gastric cancer incidence rates among individuals age younger than 50 years have gained much attention, particularly as causes remain unknown. Using population-based NIH/NCI's Surveillance, Epidemiology, and End Results (SEER) program data from 2007 to 2015, multivariable logistic regression was used to quantify associations between race/ethnicity and clinicodemographic features among young-onset noncardia gastric cancer patients. A total of 2,872 individuals ages 20 to 49 years were diagnosed with primary noncardia gastric cancer. Age at diagnosis, insurance status, anatomic subsite, American Joint Committee on Cancer (AJCC) clinical stage, histologic type, tumor grade, surgery, and county-level smoking prevalence differed by race/ethnicity (all P ≤ 0.003). Compared with non-Hispanic whites, Hispanics were more likely to be diagnosed at younger ages [odds ratio (OR) = 0.97; 95% confidence intervals (CI), 0.95-0.99], on Medicaid/uninsured (OR = 3.83; 95% CI, 2.89-5.08), diagnosed with higher grade tumors (OR = 1.93; 95% CI, 1.32-2.84), and less likely to undergo surgery (OR = 0.62; 95% CI, 0.44-0.88) or to reside in counties with higher smoking prevalence (OR = 0.15; 95% CI, 0.11-0.21) after adjustment for sex, subsite, and histologic type. Asian/Pacific Islanders were more likely to be female (OR = 1.40; 95% CI, 1.04-1.88), and less likely to be diagnosed with metastatic disease (OR = 0.59; 95% CI, 0.37-0.95) or to reside in counties with higher smoking prevalence (OR = 0.13; 95% CI, 0.08-0.19). Approximately two in every five patients with young-onset noncardia gastric cancer are Hispanic. Further investigation into the molecular heterogeneity of young-onset noncardia gastric cancers by race/ethnicity to understand etiologies underlying this rising disease epidemic is warranted. This population-based cohort study sheds light that biological and environmental factors may partly underlie race/ethnicity-related differences in young-onset noncardia gastric cancer susceptibility and outcomes.

1231 Racial and Ethnic Differences in Mortality in Gastric Cancer and Esophageal Adenocarcinoma in the United States

INTRODUCTION: Studies have shown that the incidence of non-cardia gastric cancer (GC) has been declining in recent years, while the rate of cardia GC has been increasing, paralleling the trends of esophageal adenocarcinoma (EAC). Mortality trends in these malignancies have not been well studied, particularly for non-cardia GC. The aim of our study was to examine differences in incidence-based mortality in cardia and non-cardia GC, as well as EAC for comparison, in a representative cohort of the US population. METHODS: A total of 19,025 individuals with non-cardia GC, 14,268 with cardia GC, and 18,015 with EAC were identified in the Surveillance, Epidemiology, and End Results database. Age-adjusted incidence-based mortality rates and corresponding annual percent change (APC) were calculated between 2004-2016 to assess trends. Mortality analyses were stratified by race/ethnicity, age, and stage of disease at diagnosis. RESULTS: The age-adjusted incidence-based mortality rate (per 100,000 population) for non-cardia GC was 2.50, for cardia GC was 1.85, and for EAC was 2.31. Mortality in non-cardia GC was higher in blacks, Hispanics, and Asians/Pacific Islanders than non-Hispanic whites (P-value &lt; 0.01 for each group). These differences remained statistically significant across all age groups and stages of disease (P-value &lt; 0.01). From 2004-2016, mortality rates have not changed significantly over time for any racial/ethnic group. Interestingly, incidence-based mortality in EAC and cardia GC was higher in non-Hispanic whites than blacks, Hispanics, and Asians/Pacific Islanders (P-value &lt; 0.01 for each group). These differences remained statistically significant across all age groups and stages of disease (P-value &lt; 0.05). From 2004-2016 mortality has been rising in whites for EAC (APC = 3.86, P-value &lt; 0.05) and cardia GC (APC = 3.90, P-value &lt; 0.05), and in Hispanics for cardia GC (APC = 2.23, P-value &lt; 0.05). CONCLUSION: Incidence-based mortality is higher in blacks, Hispanics, and Asians/Pacific Islanders in non-cardia GC, and higher in non-Hispanic whites in EAC and cardia GC. These differences persist when adjusting for age and stage of disease at diagnosis. Further research is needed to better understand the underlying causes of these differences in order to improve outcomes.

Helicobacter pylori infection, chronic atrophic gastritis and risk of stomach and esophagus cancer: Results from the prospective population-based ESTHER cohort study.

Helicobacter pylori (H. pylori) infection is considered as principal cause of gastric cancer. It is further associated with a reduced risk of esophageal adenocarcinomas. In a large prospective population-based cohort study including 9,949 subjects with average observation time of 13.8 years, we assessed the risk of invasive gastric and esophageal cancer according to H. pylori infection and presence of chronic atrophic gastritis (CAG). Incidence rates and hazard ratios (HR) derived by Cox proportional hazards models and adjusted for relevant confounders were derived by seroprevalence of H. pylori and cytotoxin-associated gene A (CagA) antibodies and presence of CAG based on serological markers at baseline, respectively. During follow-up, 30 cases of noncardia gastric cancer and 33 cases of esophageal cancer were observed. Infection by H. pylori without and with expression of CagA was associated with a 5.2-fold (95% confidence interval 1.00-27.1) and an 18.2-fold (4.3-77.4) increase of noncardia gastric cancer incidence. A 0.65-fold decreased risk of esophageal adenocarcinomas (HR 0.35, 0.12-0.97) was observed among H. pylori-infected individuals. In participants infected with CagA expressed H. pylori, the presence of mild/moderate and severe CAG was associated with a 6.4-fold (1.3-31.0) and an 11.8-fold (3.1-45.4) increase of gastric cancer incidence, respectively. The results of this prospective population-based cohort study may contribute relevant evidence to the ongoing research of H. pylori-related cancers. The results may furthermore enhance the empirical basis for risk stratification among H. pylori-infected people and for recommendations regarding H. pylori screening and treatment among older adults in a Western population.

Abstract 1190: Incidence of gastric cancer in the United States during 1999 to 2013: A 50-state analysis

Abstract Background: The incidence of gastric cancer while declining in many places worldwide is characterized by considerable geographic variability in incidence rates and temporal trends. The United States has large racial, ethnic, and regional variation; we collected data from all 50 states to better characterize recent changes in gastric cancer incidence in the entire United States. Methods: We extracted data on the annual gastric cancer (ICD-O-3: C16.0-C16.9) incidence rates for the period 1999-2013 from the United Stated Cancer Statistics (USCS) registry, which covers 97% of the population. Both age-adjusted incidence rates and temporal trends of gastric cancer incidence were examined overall, as well as stratified by sociodemographic factors and at the state level. We used Joinpoint regression analysis to compute annual percent change (APC) and average annual percent change (AAPC) and corresponding 95% CIs. Heat maps were created to highlight the temporal trend in age-adjusted incidence rates in each state over three 5-year periods: 1999-2003, 2004-2008, and 2009-2013. As a secondary analysis, we also extracted data from the SEER 13 registries to examine the incidence rates and trends separately for cardia and non-cardia gastric cancers. Results: Overall gastric cancer incidence decreased from 7.64 per 100,000 in 1999 to 6.55 per 100,000 in 2013, decreasing by 1.02% (AAPC=-1.02; 95% CI, -1.28 to -0.76) annually between 1999 and 2013. However, while overall gastric cancer incidence rates decreased (1999-2008 APC=-1.75, 95% CI, -2.02 to -1.47) and then plateaued (2008-2013 APC=-0.24, 95% CI: -0.89, 0.42) among persons aged ≥50 years, the rates increased among persons aged&amp;lt;50 years (AAPC=0.89, 95% CI: 0.61 to 1.16). Most notable increases were observed among non-Hispanic white females (AAPC=1.46, 95% CI: 0.87 to 2.06) and Hispanic females (AAPC=0.47, 95% CI: 0.10 to 0.84). Based on the analysis of SEER 13 registries, the decreasing trend among persons aged ≥50 years is mainly due to decreasing incidence of non-cardia gastric cancer (AAPC=-2.20, 95% CI, -2.51 to -1.90). Increasing rate of non-cardia cancer helped explain the uprising trend of gastric cancer among aged &amp;lt;50 years (AAPC=0.69, 95% CI: -0.06 to 1.44). States with rapid increase of high risk population groups such as Hispanic females including California and Texas are among the top 5 states with both overall high incidence rate of gastric cancer (1999-2013) and high AAPC (California: 1.77, 95% CI, 0.52 to 2.34; Texas: 1.70, 95% CI, 0.25 to 3.17) within last 5 years (2009-2013) among females aged &amp;lt;50 years. Conclusions: While gastric cancer, particularly non-cardia, rates have decreased rapidly among persons aged ≥50 years in the United States, the incidence rates among persons aged &amp;lt;50 years have increased. Future studies on explanatory factors for this trend are warranted. Citation Format: Zhensheng Wang, Anam Khan, Maya Balakrishnan, Hashem B. El-Serag, Aaron P. Thrift. Incidence of gastric cancer in the United States during 1999 to 2013: A 50-state analysis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1190.

A Comprehensive Assessment of the Racial and Ethnic Disparities in the Incidence of Gastric Cancer in the United States, 1992-2014.

PurposeThis study aimed to evaluate the racial and ethnic disparities in the incidence of gastric cancer and their temporal trends in the United States.Materials and MethodsUsing data from 13 cancer registries in the Surveillance, Epidemiology, and End Results database, we assessed such disparities during 1992-2014 in the United States using a variety of disparity metrics.ResultsThe age-standardized incidence rate of non-cardia gastric cancer was highest in Asian and Pacific Islanders, while the incidence of cardia gastric was highest in non-Hispanic whites in men and was similarly low in all groups in women. The incidence of non-cardia gastric cancer decreased in all groups over time, particularly in Asian and Pacific Islanders (on average by 3% per year). The incidence of cardia gastric remained relatively stable in virtually all racial/ethnic groups. The racial and ethnic disparities in gastric cancer incidence steadily decreased over time as measured on the absolute scale, which was mainly driven by the reduced disparities in non-cardia gastric cancer. The range difference in the incidence of gastric cancer decreased on average by 4.1% per year in men and by 2.6% per year in women from 1992 to 2014. The between group variance decreased by 5.6% per year in men and by 3.4% per year in women. The relative-scale disparity measures generally remained stable over time.ConclusionThis study demonstrates decreased racial and ethnic disparities in the incidence of gastric cancer over time in the United States, particularly as measured on the absolute scale.

Incidence of gastric cancer in the USA during 1999 to 2013: a 50-state analysis.

The incidence of gastric cancer, while declining in many places worldwide, is characterized by considerable geographical variability. The USA has large racial, ethnic and regional variation; we collected data from all 50 states to better characterize recent changes in gastric cancer incidence nationwide. Annual gastric cancer incidence rates from 1999 to 2013 were extracted from the United States Cancer Statistics (USCS) registry. Secular trends of gastric cancer incidence were examined overall and by sociodemographic factors and states. We used Joinpoint regression to compute annual percent change (APC) and average annual percent change (AAPC) and corresponding 95% confidence intervals (CIs). SEER 13 registries data were extracted to examine the secular trends by cardia and non-cardia gastric cancers. Overall gastric cancer incidence decreased until 2007 (APC = -1.55, 95% CI: -1.88, -1.21), and remained stable thereafter (APC = -0.32, 95% CI: -0.84, 0.20). However, rates increased among persons <50 years of age (AAPC = 0.89, 95% CI: 0.61, 1.16), especially among non-Hispanic white females and Hispanic females. Incidence of non-cardia gastric cancer increased among persons <50 years of age (AAPC = 0.69, 95% CI: -0.06, 1.44), whereas rates of gastric cardia cancer remained unchanged. States with rapid increases in high-risk population groups (e.g. Hispanic females aged <50), including California and Texas, had highest annual increases in gastric cancer incidence. Divergent trends for gastric cancer incidence were observed in the USA. Incidence rates, particularly for non-cardia gastric cancer, were stable or increasing among persons aged <50 years.

The Changing Face of Noncardia Gastric Cancer Incidence Among US Non-Hispanic Whites.

The initial step for noncardia gastric carcinogenesis is atrophic gastritis, driven by either Helicobacter pylori infection or autoimmunity. In recent decades, the prevalence rates of these two major causes declined and increased, respectively, with changes in Western lifestyles. We therefore assessed gastric cancer incidence trends for US race/ethnic groups, 1995-2013. Age-standardized rates (ASRs) from 45 North American Association of Central Cancer Tumor Registries were summarized by estimated annual percentage change (EAPC) and 95% confidence intervals (CIs). Age period cohort models supplemented standard descriptive techniques and projected future trends. There were 137 447 noncardia cancers in 4.4 billion person-years of observation. Among non-Hispanic whites, the ASR was 2.2 per 100 000 person-years, with an EAPC of -2.3% (95% CI = -2.0% to -2.6%). Notwithstanding this overall decline, EAPCs rose 1.3% (95% CI = 0.6% to 2.1%) for persons younger than age 50 years and fell -2.6% (95% CI = -2.4% to -2.9%) for older individuals. These converging trends manifested a birth cohort effect more pronounced among women than men, with incidence among women born in 1983 twofold (95% CI = 1.1-fold to 3.6-fold) greater than those born in 1951. Age interaction was also statistically significant among Hispanic whites, with slightly increasing vs decreasing EAPCs for younger and older individuals, respectively. Incidence declined regardless of age for other races. Current trends foreshadow expected reversals in both falling incidence and male predominance among non-Hispanic whites. Dysbiosis of the gastric microbiome associated with modern living conditions may be increasing risk of autoimmune gastritis and consequent noncardia cancer. The changing face by age and sex of gastric cancer warrants analytical studies to identify potential causal mechanisms.

Advanced non-cardia gastric cancer and Helicobacter pylori infection in Vietnam

BackgroundThe incidence of gastric cancer in the Northern city, Hanoi is higher than in the Southern city, Ho Chi Minh, Vietnam. We previously reported that Helicobacter pylori vacA m1 genotype might be responsible for the difference between the two cities, however, the study only included non-cancer patients. The aim of this study is to investigate the non-cardia gastric cancer characteristics and the role of H. pylori virulence on different non-cardia gastric cancer incidence between two cities in Vietnam.Methods and ResultsWe recruited 282 non-cardia gastric cancer patients that had undergone gastroscopy in two cities, Ho Chi Minh and Hanoi, Vietnam. Characteristics of non-cardia gastric cancer were late age of onset (mean age, 62.5 years), predominance in males (ratio of males/females; 3.9:1), diffuse type (55.3%), and high prevalence of H. pylori infection (79.4%). H. pylori infection and the vacA m1 genotype conferred an increased risk for GC (OR, 2.02; 95% CI 1.4–3.0; P = 0.0003 and OR, 2.7; 95% CI 1.5–4.7; P = 0.001, respectively). Interestingly, the presence of vacA m1 genotype in the gastric cancer group was significantly higher than that in the non-cancer group (68.8% vs 44.9%, P = 0.001) and the significant tendency still observed in Ho Chi Minh (67.6% vs 31.9%, P < 0.0001).ConclusionWe first describe the characteristics of non-cardia gastric cancer in Vietnam. Helicobacter pylori infection was associated with the development of non-cardia GC. vacA m1 genotype might contribute to incidence differences between the two cities.

Abstract 265: Global transition in cardia and non-cardia gastric cancer incidence, 1998-2007

Abstract Gastric cardia and non-cardia cancer differs in their descriptive patterns and risk factors. The objective of this study was to determine the global trends in incidence of cardiac and non-cardiac gastric cancer. Ninety two high quality registries with the proportion of Not Otherwise Specified (NOS) gastric cancer (ICD-10 code C16.8-9) below 50% and the total number of gastric cancer cases above 300 were selected from 225 registries in Cancer Incidence of Five Continent (CI5) volume 9 and 262 registries from CI5 volume 10. The NOS cases were re-distributed to cardia and non-cardia according to the registry-specific proportion. Age-standardized incidence rates (ASRs) per 100,000 population and incidence rate ratios (IRR) from 1998-2002 to 2003-2007 were calculated. Non-cardia cancer incidence was significantly decreased in 5 out of 10 Asian registries, 17 out of 18 European registries, 27 out of 56 North American registries, and all 5 Oceanian registries in men. Only two registries in Asia showed a significant increase in non-cardia cancer incidence. In contrast, cardia cancer significantly increased in one Asian registry, two European registries, and two North American registries. Significant decrease in cardia cancer was observed in 3 Asian registries, 6 European registries, 11 North American registries, and 3 Oceanian registries in men. In women, six registries (1 Asian, 2 European, and 3 North American) showed significant increase in non-cardia cancer, whereas registries 25 (3 Asian, 13 European, 8 North American, and 1 Oceanian) showed significant decrease in non-cardia cancer incidence. Cardia cancer in women increased in 16 registries (2 Asian and 14 North American) and decreased in 9 registries (1 Asian, 5 European, and 3 North American). In conclusion, non-cardia cancer incidence decreased in most registries, whereas decrease in cardia cancer is more prominent in men but not in women. Citation Format: Aesun Shin, Dalis Seungeun Kim, Hyungtaek Woo. Global transition in cardia and non-cardia gastric cancer incidence, 1998-2007 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 265. doi:10.1158/1538-7445.AM2017-265

Abstract 1735: Fruit and vegetable consumption and risk of gastric cancer: a prospective nested case-control study in China, Japan and Korea

Abstract Introduction: Epidemiological findings on the association between fruit and vegetable consumption and gastric cancer risk remain inconsistent, resulting in the designation of fruits and vegetables as “probable” and “possible” respectively, but not “convincing”, protective factors. However, intervention studies provide support for the effect of micronutrient supplementation in the prevention of gastric cancer and its precursor lesions, though the effects remain less substantial than for Helicobacter pylori (H. pylori) eradication. Objective: To ascertain the association between fruit and vegetable intake and non-cardia gastric cancer incidence with adjustment for H. pylori within East Asian cohort studies. Methods: The present analysis includes 1970 participants (810 prospectively ascertained non-cardia gastric cancer cases with 1160 matched controls) from 5 cohort studies in the Helicobacter pylori Biomarker Cohort Consortium. These cohorts collected blood samples as well as demographic, lifestyle, and dietary data at baseline. Pre-diagnostic antibody levels to 15 H. pylori proteins were assessed using multiplex serology. Conditional logistic regression, adjusting for total energy intake, smoking, and H. pylori status, was applied to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for gastric cancer risk across cohort- and sex-specific quartiles of fruit and vegetable intake. Results: Increasing fruit intake was significantly associated with decreasing risk of non-cardia gastric cancer, so that individuals in the highest quartile of fruit consumption had a 29% reduced odds of gastric cancer, compared to individuals in the lowest quartile (OR = 0.71, 95% CI, 0.52-0.95, P for trend = 0.02). Compared to CagA-positive H. pylori low fruit consumers, the strongest inverse association of gastric cancer risk was amongst those high fruit consumers without evidence of H. pylori antibodies (OR = 0.12, 95% CI: 0.06-0.25), whereby the inverse association by increasing fruit consumption was attenuated among individuals infected with CagA-positive H. pylori (OR = 0.82, 95% CI: 0.66-1.03). We observed a weaker, non-dose-response suggestion of an inverse association of vegetable intake with non-cardia gastric cancer risk. Conclusions: To our knowledge, this is the largest prospective study in the high-risk region of East Asia to examine the association of fruit and vegetable consumption with non-cardia gastric cancer risk adjusted for H. pylori. We have found that high fruit intake may play a role in decreasing risk of non-cardia gastric cancer, even after adjustment for H. pylori subtype-specific infection. Funding: R01 CA174853 Citation Format: Tianyi Wang, Hui Cai, Shizuka Sasazuki, Shoichiro Tsugane, Wei Zheng, Eo Rin Cho, Sun Ha Jee, Angelika Michel, Michael Pawlita, Yong-Bing Xiang, Yu-Tang Gao, Xiao-Ou Shu, Weicheng You, Meira Epplein. Fruit and vegetable consumption and risk of gastric cancer: a prospective nested case-control study in China, Japan and Korea. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1735.

Trends in incidence of oesophageal and gastric cancer according to morphology and anatomical location, in Switzerland 1982-2011.

This study aimed to evaluate trends in the incidence of oesophageal and gastric cancer by anatomical location and histology using nationally representative Swiss data. We included all oesophageal and gastric cancers recorded in 10 Swiss population-based cancer registries 1982-2011. We calculated age-standardised incidence rates (ASIRs) per 100 000 person-years (PY) (European standard) for both cancer sites stratified by sex, language region (German, French-Italian), morphology and anatomical location. To assess time trends, we estimated annual percentage changes (APCs) with 95% confidence intervals (95% CIs). ASIR of oesophageal adenocarcinoma increased in both sexes and language regions (p <0.001). The steepest increase occurred in males of the German-speaking region (APC 6.8%, 95% CI 5.8-7.8) with ASIRs of 0.8 per 100,000 PY in 1982-1987 and 3.9 per 100.000 PY in 2007-2011. Incidence of oesophageal squamous cell carcinoma decreased significantly in males of both language regions by around -1.5% per year. In contrast, a slight but significant increase (APC 1.4%, 95% CI 0.3-2.4]) of oesophageal squamous cell carcinoma was observed in females of the German-speaking region. We observed stable rates for cancer of the gastric cardia. The incidence of noncardia gastric cancer decreased substantially in both sexes and language regions (p <0.001). In Switzerland, the incidence of oesophageal adenocarcinoma has risen whereas incidence of noncardia gastric cancer has decreased substantially as observed in other developed countries.

Global patterns of cardia and non-cardia gastric cancer incidence in 2012

ObjectiveGlobally, gastric cancer incidence shows remarkable international variation and demonstrates distinct characteristics by the two major topographical subsites, cardia (CGC) and non-cardia (NCGC). Because global incidence estimates by subsite are...