Gastric Cancer Declining in Western Countries

A decline in premalignant lesions suggests a decrease in the incidence of gastric cancer in Western countries in the coming decade, claims a new study.

Researchers at the Erasmus University Medical Center (Rotterdam, The Netherlands) reviewed 97,732 patients newly diagnosed with premalignant gastric lesions in the Netherlands between 1991 and 2005. Of these, 23,278 patients had atrophic gastritis (AG), 65,937 had intestinal metaplasia (IM), and 8,517 had dysplasia (DYS), all considered principal risk factors for gastric cancer. The researchers studied the number of new diagnoses per year relative to the total number of patients with a first gastric biopsy; they then evaluated time trends with age, period, and cohort models using logistic regression analysis.

The researchers found that the incidence of AG declined similarly in men and women - 8.2% per year. This was also the case for dysplasia, with a decline of 8.1% per year. The proportional number of new IM cases declined 2.9% per year in men and 2.4% in women. The researchers also observed a period phenomenon, with a larger decline in the number of diagnoses after 1996 for AG and IM. The study was published in the December 4, 2007, issue of Gut.

"The incidence of pre-malignant gastric lesions is declining. Period and cohort phenomena were demonstrated for diagnoses of AG and IM,” said lead author A.C. de Vries, M.D., from the department of gastroenterology and hepatology. "These findings imply that a further decrease of at least 24% in the incidence of gastric cancer in the coming decade may be anticipated in Western countries without specific intervention.”

The researchers believe that the finding, in particular with respect to AG, can in part be related to changing histological definitions introduced around 1996. However, such an effect is less likely for IM as it has a relatively straightforward diagnosis not affected by changing histological definitions, other effects, such as the widespread introduction of Helicobacter pylori diagnosis and treatment starting in the early 1990s, could explain the reduction observed.


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