Through 2030, the incidence rates of gastric cancer (GC) are expected to remain stable or decrease in most countries, with the exception of Ecuador and Lithuania. These findings are based on the results of a study published in Gastroenterology.

Research has shown that Helicobacter pylori (H pylori) chronic infection is significantly associated with the cause of GC. Other risk factors for GC include smoking, heavy alcohol consumption, and obesity.

Less than a century ago, GC was the most common cancer in the world. Although the incidence and mortality rates of GC have declined since the 1950s, it still represents a major cancer burden worldwide. However, few studies to date have focused on the long-term trends in GC rates from a global perspective. To address this gap, a team of investigators sought to explore the past temporal trends (1988-2012) in GC incidence rates in 43 countries and to predict future trends (2012-2030).


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The C15plus database was used to describe the trends in GC from a global perspective. From 1988 to 2012, age-standard incidence rates (ASRs) per 100,000 persons were computed. The Bayesian age-period-cohort (BAPC) model was used to predict the number of new cases and incidence rates of GC to 2030.

According to the study authors, the majority of the included countries had decreasing trends in GC incidence rates from 1988 to 2012. In addition, the age-standardized incidence rates of GC in men were determined to be 2-fold higher compared with the incidence rates in women in most countries.

The two countries with the highest GC incidence rates (above 40) were Japan and Korea. However, Japan and Korea’s GC incidence rates decreased between 1998 and 2012. In Japan, the incidence rates of GC declined from 57.5 in 1988 to 41.4 in 2012. In Korea, the incidence rate of GC declined from 54.3 in 1993 to 43.4 in 2012.

From 1998 to 2012, the worldwide incidence rate of GC showed a persistent decline, with an overall average annual percent change (AAPC) of -2.1% (95% CI, -2.5 to 1.7). The AAPC varied greatly in different countries. The AAPC ranged from -4.0% (95% CI, -6.3 to -1.6) for Bahrain-Bahraini to 3.7% (95% CI, 1.8 to 5.6) for Turkey.

The ASR of GC in high-income countries (from14.67 per 100,000 in 1988 to 6.55 per 100,000 in 2012; percentage of change in ASR, -55.34%) had a relatively larger reduction compared to middle- and low-income countries (from 20.08 per 100,000 in 1988 to 11.7 per 100,000 in 2012; percentage of change in ASR, -41.72%).

Compared to younger adults, the incidence rates of GC were higher in older adults in all selected countries, though, the ratio of ASR in terms of elderly adults vs younger adults varied among the different countries and over time.

The researchers assert that the GC incidence rate trends will remain stable or continue to decrease until 2030 in most of the selected countries, with the exclusion of Lithuania and Ecuador.

They predict that Lithuania’s GC incidence rates will rapidly increase from approximately 20 per 100,000 in 2012 to approximately 55 per 100,000 in 2030. Similarly, in Ecuador, the GC incidence rates will likely increase substantially from approximately 20 per 100,000 in 2012 to above 80 per 100,000 in 2030.

This study had several limitations. The underreporting and misdiagnosis issues may have caused bias in estimating the incidence rates, particularly in economically developing countries. Also, the C15plus does not contain reliable histological or anatomical data for GC. Further studies are therefore warranted regarding the specific pattern according to various histological or anatomical subtypes.

Additionally, registry coverage with high-quality data remains significantly below 10% in Africa, Asia, and Latin America, and the results from these countries may not be generalizable to other countries. Finally, future research is warranted to assess any potential changes in GC incident rates due to advances in prevention and diagnosis.  

Despite these limitations, the study authors concluded that the incidence rates of GC will likely remain stable or decrease through 2030 in most countries. These findings suggest that improved diet, reduction in smoking and H pylori prevalence likely contributed to the decrease. However, the incidence rates of GC in Ecuador and Lithuania are predicted to significantly increase. Therefore, countries with predicted increasing incidence rates of GC should prioritize lifestyle interventions for diet and smoking, as well as additional H pylori screening and treatment.

Disclosure: This study was funded by multiple sources. Please refer to the original article for a full list of disclosures.

Reference

Lin Y, Zheng Y, Wang H-I, Wu J. Global patterns and trends in gastric cancer incidence rates (1988-2012) and predictions to 2030. Gastroenterol. Published online March 17, 2021. doi: 10.1053/j.gastro.2021.03.023