The Changing Face of Noncardia Gastric Cancer Incidence Among US Non-Hispanic Whites

Abstract

Background: The initial step for noncardia gastric carcinogenesis is atrophic gastritis, driven by either Helicobacter pylori infection or autoimmunity. In recent decades, the prevalence rates of these two major causes declined and increased, respectively, with changes in Western lifestyles. We therefore assessed gastric cancer incidence trends for US race/ethnic groups, 1995-2013.

Methods: Age-standardized rates (ASRs) from 45 North American Association of Central Cancer Tumor Registries were summarized by estimated annual percentage change (EAPC) and 95% confidence intervals (CIs). Age period cohort models supplemented standard descriptive techniques and projected future trends.

Results: There were 137 447 noncardia cancers in 4.4 billion person-years of observation. Among non-Hispanic whites, the ASR was 2.2 per 100 000 person-years, with an EAPC of -2.3% (95% CI = -2.0% to -2.6%). Notwithstanding this overall decline, EAPCs rose 1.3% (95% CI = 0.6% to 2.1%) for persons younger than age 50 years and fell -2.6% (95% CI = -2.4% to -2.9%) for older individuals. These converging trends manifested a birth cohort effect more pronounced among women than men, with incidence among women born in 1983 twofold (95% CI = 1.1-fold to 3.6-fold) greater than those born in 1951. Age interaction was also statistically significant among Hispanic whites, with slightly increasing vs decreasing EAPCs for younger and older individuals, respectively. Incidence declined regardless of age for other races. Current trends foreshadow expected reversals in both falling incidence and male predominance among non-Hispanic whites.

Conclusions: Dysbiosis of the gastric microbiome associated with modern living conditions may be increasing risk of autoimmune gastritis and consequent noncardia cancer. The changing face by age and sex of gastric cancer warrants analytical studies to identify potential causal mechanisms.

Figure 1.

Age-specific incidence trends of noncardia gastric cancer among non-Hispanic white men (A) and women (B).Symbols represent the observed incidence rates in 15 four-year age groups over 4 four-year time periods, with the shaded areas denoting 95% confidence intervals from the age period cohort models. The modeled 95% confidence intervals provide a good fit to the observed data for every age group except women age 25 to 28 years.

Figure 2.

Age-standardized incidence trends of noncardia gastric cancer among non-Hispanic whites by age group (A) and overall (B).Symbols represent current (1995–2013) and expected (2014–2030) incidence rates by age group (<50 vs 50+ years) and overall for men (shown as squares) and women (shown as circles).