High Incidence of Gastric Cancer in El Salvador: A National Multisectorial Study during 2000 to 2014

Abstract

Background: Gastric adenocarcinoma is the fourth leading cause of global cancer mortality and leading infection-associated cancer. Gastric cancer has significant geographic variability, with a high incidence in East Asia and mountainous regions of Latin America. In the United States, gastric cancer represents a marked disparity with incidence rates that are two to three times higher in Hispanics compared to non-Hispanic Whites.

Methods: We conducted a national retrospective study of incident gastric cancer in El Salvador from to 2000 to 2014 to estimate the age-standardized incidence rate (ASIR) by using a combination of pathology and endoscopy databases. A unique multisectorial coalition was formed between the Ministry of Health (MINSAL) and ES Gastroenterology Society (AGEDES), representing public hospitals (n = 5), governmental employee hospitals (ISSS, n = 5), and private facilities (n = 6), accounting for >95% of national endoscopy capacity. HER2 and EBV tumor status was ascertained in a representative sample during 2014 to 2016.

Results: A total of 10,039 unique cases of gastric cancer were identified, 45.5% female, and mean age of 65. 21% and 9.4% were <55 and <45 years old, respectively. ASIRs (M, F) were 18.9 (95% CI, 14.4-20.7) and 12.2 per 100,000 persons (95% CI, 10.9-13.5), respectively, in the period 2010 to 2014 with all centers operational. Intestinal gastric cancer was 2.8 times more common than diffuse gastric cancer; 23.2% had partial or complete pyloric obstruction. The HER2 2+/3+ status was 16.7% and EBV-encoded RNA positivity was 10.2%.

Conclusions: A high incidence of gastric cancer was confirmed in El Salvador and nearly half of the patients were female.

Impact: The findings have implications for cancer control in the Central America LMICs and for US Latino populations. See related commentary by Riquelme and Abnet, p. 1550.

Figure 1.. Gastric cancer age-standardized incidence rates (ASIR) in El Salvador 2000–2014.

This figure presents a line graph comparing the Age-Standardized Rates (ASR) for males and females over a 14-year period. The dashed lines represent the central ASR estimates for males (blue) and females (red), with the shaded areas indicating the 95% confidence intervals (CI) for each gender.

Figure 2.. Trend in Age-Standardized Gastric Cancer Incidence Rates per 100,000 people.

2a. Male 2b. Female This figure is divided into two panels, each displaying the trend in age-standardized incidence rates of gastric cancer from 2000 to 2014, stratified by gender. Figure 2a presents the observed Age-Standardized Rates (ASR) for males, marked by blue dots, with a solid blue line indicating the Annual Percent Change (APC) over the 15-year period. Figure 2b shows the observed ASR for females, marked by pink dots, with a solid pink line representing the APC. *Indicates that the Annual Percent Change (APC) is significantly different form zero at the alpha = 0.005 level.