Epidemiological Trends, Risk Factors, Screening, and Prevention of Gastric Cancer: A Global Perspective – Nature Reviews Clinical Oncology

Gastric cancer remains a global health concern, with over 1 million new cases diagnosed each year. The epidemiological trends of this disease show significant geographic and demographic variations, with a higher burden in low- and middle-income countries. Known risk factors include Helicobacter pylori infection, smoking, and dietary factors. Screening and prevention strategies have been developed to decrease the incidence and mortality associated with this cancer. In this article, we discuss the global burden of gastric cancer, its epidemiological trends, risk factors, and screening and prevention options, providing insights into the current state of knowledge in this important area of clinical oncology.

Gastric cancer, also known as stomach cancer, is a significant global health issue. According to the Global Cancer Statistics 2020, there were an estimated 4.7 million new cases and 3.1 million deaths from gastric cancer worldwide in 2020, making it the fifth most common cancer and the fourth leading cause of cancer death. The incidence and mortality rates vary widely by region, with the highest rates found in Eastern Asia, followed by Eastern Europe and South America. However, recent studies suggest that the incidence of gastric cancer is declining globally, possibly due to improvements in prevention and early detection.

Gastric cancer has two main histological types: diffuse and intestinal. The diffuse type tends to affect younger individuals, and the intestinal type is more common in older adults. A hereditary form of gastric cancer, known as hereditary diffuse gastric cancer (HDGC) syndrome, is associated with mutations in the CDH1 gene.

The development of gastric cancer is believed to be a multi-step process, beginning with chronic inflammation of the gastric mucosa. The most common cause of chronic inflammation is infection with Helicobacter pylori (H. pylori), a bacterium that colonizes the gastric mucosa of approximately half of the world’s population. The prevalence of H. pylori infection is highest in developing countries and decreasing in developed countries. However, the burden of gastric cancer remains high in regions with high H. pylori prevalence, such as China, and among certain populations, including Hispanics in the USA.

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The diagnosis of H. pylori infection can be challenging due to the wide range of available testing methods, each with its own strengths and limitations. Serologic tests are the most commonly used non-invasive tests, but they may have low sensitivity and specificity, particularly in populations with a high prevalence of H. pylori infection. Invasive tests, such as endoscopic biopsy and urease tests, are more accurate but carry a higher risk of complications.

There is strong evidence that H. pylori infection is a major risk factor for gastric cancer, particularly the intestinal type. Other risk factors include older age, male sex, tobacco use, and a diet high in salt and low in fruits and vegetables. Prevention measures include vaccination against H. pylori, screening and early detection, and lifestyle modifications such as smoking cessation and a healthy diet.

Overall, gastric cancer remains a significant public health challenge due to its high incidence and mortality rates, particularly in regions with high H. pylori prevalence. However, recent advances in prevention and early detection strategies, including the development of effective vaccines against H. pylori, offer hope for reducing the burden of this disease globally.

In conclusion, the global burden of gastric cancer remains a significant public health issue, with high incidence and mortality rates in many regions of the world. However, with advances in our understanding of the epidemiological trends, risk factors, and mechanisms of this disease, there is hope for better prevention and management strategies. Greater awareness, screening programs, and effective vaccines hold promise for reducing the incidence of gastric cancer in the future. Through continued research and collaboration, we can work towards a world where fewer people are affected by this devastating disease.

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