An increasing incidence of gastric cancer among younger individuals was observed in several countries, according to a study published in JAMA Network Open.

Researchers performed a population-based cohort study using data from national and global cancer registries, including at least 15 calendar years of incidence and mortality data from 1980 to 2018. The 10-year incidence trend of gastric cancer was determined by both age and sex; global incidence and mortality of gastric cancer in 2018 was also determined.

In 2018 there were 1,033,701 new cases of gastric cancer and 782,685 cancer-related deaths. The region with the highest cumulative risk for gastric cancer was Eastern Asia (2.64%) and lowest risk was in southern Africa (0.42%). Cumulative risk was also highest in countries with a high Human Development Index (HDI) and lowest in countries with a low HDI.


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Overall, incidence and mortality decreased in 29 and 41 countries, respectively. The age-standardized incidence of gastric cancer decreased from a range of 2.6 to 59.1 per 100,000 persons in 1980 to 2.5 to 56.8 per 100,000 persons in 2018. The overall age-standardized mortality rate per 100,000 persons also decreased from a range of 1.3 to 25.8 in 1980 to 1.5 to 18.5 in 2018.

In Thailand, mortality increased, as measured by the average annual percent change (AAPC) of the incidence and mortality trends. For women and men respectively, AAPC was 5.30 (95% CI, 4.38-6.23; P <.001) and 3.92 (95% CI, 2.14-5.74; P <.001).

In 30 of 48 countries analyzed, the incidence of gastric cancer decreased among individuals aged 40 years or older and increased in those aged less than 40 years. Notable increases in younger populations occurred in Sweden (men: AAPC, 13.92; 95% CI, 7.16-21.11; P =.001), Ecuador (women: AAPC, 6.05; 95% CI, 1.40-10.92; P =.02), and the United Kingdom (men: AAPC, 4.27; 95% CI, 0.15-8.55; P =.04; women: AAPC, 3.60; 95% CI, 3.59-3.61; P <.001).

Decreasing trends in mortality occurred in 41 of 48 countries, with the largest mortality decreases occurring in Norway (AAPC, −5.86; 95% CI, −7.56 to −4.13; P <.001), Estonia (AAPC, −4.01; 95% CI, −7.77 to −0.10; P =.05), Ecuador (AAPC, −3.86; 95% CI, −4.58 to −3.13; P <.001), and Finland (AAPC, −3.78; 95% CI, −5.99 to −1.51; P =.005).

The study was limited by probable underreporting of gastric cancer rates in developing countries, overestimates of incidence in high HDI countries, variance in cancer registry systems across countries, and changes in these systems over time.  Incidence and mortality data based on age and subgroup of gastric cancer were not available and detailed information on staging of gastric cancer was also not included. Finally, some countries had missing data and thus the results of trends analysis may not be available.

Researchers concluded that gastric cancer prevention, especially among younger populations, should be a priority in clinical guidelines and policy agendas. They concluded that for younger populations, “preventive measures that involve increased physical activity, which confers a benefit beyond that of reducing caloric expenditure; promotion of healthy dietary habits; and raising awareness among the general public are warranted.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Wong MCS, Huang J, Chan PSF, et al. Global incidence and mortality of gastric cancer, 1980-2018. JAMA Netw Open. 2021;4(7):e2118457. doi: 10.1001/jamanetworkopen.2021.18457