Demographics of Gastric Cancer Risk Underscore the Need for Screening

Demographics of Gastric Cancer Risk Underscore the Need for Screening
New findings point to the severest impacts by race and ethnicity, anatomic site.

Non-white Americans, especially Asian Americans, are at disproportionately higher risk of developing noncardia gastric cancer (the most common type of gastric cancer globally) compared to non-Hispanic white Americans. A new study published in Gastroenterology breaks down risk according to specific ethnicities and anatomic sites (cardia versus noncardia).

“We are hopeful that the findings of this study will break the inertia surrounding gastric cancer screening,” said Shailja Shah, M.D., lead author of the study and an assistant professor of medicine at Vanderbilt University Medical Center.

“We are hopeful that the findings of this study will break the inertia surrounding gastric cancer screening.”

Shah’s research is set on developing a strong foundation of evidence to establish screening guidelines for gastric cancer in the U.S., where the number of people at risk for the cancer is increasing as the nation’s population becomes more diverse.

Race and Ethnic Disparities

The study analyzed contemporary data from the California Cancer Registry and found that non-white race and ethnic groups had a significantly higher risk of developing noncardia gastric adenocarcinoma compared to the non-Hispanic white population. This risk was most striking among Korean American women and men age 50 and older, who had a 12- and 14.5-fold higher risk compared to non-Hispanic white women and men, respectively.

“We specifically chose to analyze individuals age 50 years and older since this is the age group for whom average-risk colorectal cancer screening and high-risk esophageal cancer screening is already recommended,” Shah said.

“Even though certain ethnic groups have rates of gastric cancer that exceed colorectal cancer, and even though gastric cancer is more common than esophageal cancer, screening for gastric cancer does not yet occur in the U.S. among high-risk groups,” Shah said.

In contrast, for cardia gastric adenocarcinoma, all non-white men age 50 years and older (with the exception of Japanese and Korean American men) had a significantly lower risk than non-Hispanic whites. “Cardia gastric cancer is much rarer in the U.S. and has a different risk factor profile compared to noncardia gastric cancer,” Shah explained.

“Even though certain ethnic groups have rates of gastric cancer that exceed colorectal cancer, and even though gastric cancer is more common than esophageal cancer, screening for gastric cancer does not yet occur in the U.S. among high-risk groups.”

The Case for Gastric Cancer Screening

The research sets the stage for developing targeted early detection and prevention programs for gastric cancer in the U.S.

Shah and colleagues have previously demonstrated that endoscopy for gastric cancer screening starting at age 50 in non-white race and ethnic groups is cost effective. Shah was also one of the lead members of the American Gastroenterology Association’s Technical Review team on gastric intestinal metaplasia surveillance for early gastric cancer detection, which recently announced new guidelines for management of gastric precancer.

“The immediate need for gastric cancer prevention and early detection efforts in the U.S. is amplified when considering that the pool of at-risk individuals is only expected to grow, with non-Hispanic whites now considered the minority population in 35 of the 50 largest cities and projections that non-Hispanic whites will no longer be the overall majority population by 2065,” Shah said.