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Screening and surveillance for stomach cancer in non-East Asian countries : Is it needed ?
Authorities committed to lengthy and expensive battle to find patients and cure infections
Gastric cancer , which occurs when malignant cells form in the lining of the stomach , is one of the world ’ s leading causes of morbidity and mortality from malignant disease . An estimated one million cases of gastric cancer occurred globally in 2012 , making it the fifth most common malignancy in the world , after lung , breast , colorectal , and prostate cancers . More than 70 percent of gastric cancer cases occur in the developing world , with approximately 50 percent found in East Asia . Gastric cancer is less common in the United States , with the incidence among males and females there at 12.3 and 6.0 per 100,000 / year , respectively ; however , there is a disproportionally higher incidence in Asians .
While we have guidelines for oesophageal cancer screening and surveillance of Barrett ’ s oesophagus , those for gastric cancer screening and surveillance of gastric intestinal metaplasia ( IM ), or pre-cancerous gastric lesions , are lacking . Since the 1970s , there have been notable improvements in the five-year relative survival rates for gastric cancer in the United States , from 15 percent in 1975 to 29 percent in 2009 .
However , these are low survival rates and suggest that most cases ( over 65 percent ) are still diagnosed at an advanced stage . The overall five-year relative survival rate is about 20 percent in most parts of the world , but in �apan and �orea we have seen fiveyear survival rates above 70 percent for stage I and II gastric cancer .
A study of 2,191 patients with gastric cancer undergoing surgical resection ( removal ) showed that early gastric cancer ( EGC ) comprised approximately 20 percent of all surgically resected cancers in North America compared with 50 percent of resected cancers in �apan . Although these differences can be explained by multiple factors , one of most plausible reasons is the implementation of a screening programme for detection of EGC in Japan and �orea . Identification of risk factors involved in carcinogenesis and interventions to address these risk factors may reduce the incidence of gastric cancer . Reducing gastric cancer mortality also requires early identification of patients who are at high risk as well as management strategies to slow or prevent its progression . It ’ s likely to be more cost-effective to detect and treat early-stage gastric cancer with endoscopic resection rather than surgical resection . Detection of early cancer also means that one does not need chemotherapy and radiotherapy as adjunct treatments , thereby reducing significant morbidity and cost .
Gastric cancer is a multifactorial disease involving
GlobalHealthAndTravel . com AUGUST 2021
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