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. 2000 Jul 3;83(3):391–396. doi: 10.1054/bjoc.2000.1205

Decreasing incidence of both major histologic subtypes of gastric adenocarcinoma – a population-based study in Sweden

A M Ekström 1, L-E Hansson 1,2, L B Signorello 1,3, A Lindgren 4, R Bergström 1,5, O Nyrén 1
PMCID: PMC2374560  PMID: 10917557

Abstract

While the overall incidence of gastric cancer has fallen, presumably to a large extent in parallel with Helicobacter pylori infection, the occurrence of the diffuse histologic type is thought to have remained more stable, questioning the aetiologic role of H. pylori. We have analysed the incidence of the intestinal and diffuse types separately, while considering subsite (cardia/non-cardia). With an extensive prospective effort we identified all incident cases of gastric adenocarcinoma (n = 1337) in a well-defined Swedish population (1.3 million) 1989–1994. Tumours were uniformly classified histologically and topographically. Subgroup-specific incidence rates were computed and modelled using multivariate logistic regression. Site-specific trends were clearly discrepant. The overall incidence of adenocarcinoma distal to the gastric cardia declined by 9% (95% confidence interval 6–12%) per year, while cardia cancer remained stable. Thus, the feared rise in cardia cancer could not be confirmed despite clear site-specific trend discrepancies. The intestinal type predominated, especially in high-risk areas, while diffuse tumours prevailed among young patients and women. Both main histologic types of gastric adenocarcinoma declined markedly, at similar rapidity, and with no significant trend differences between the intestinal and diffuse types, even after multivariate adjustments. Our results are consistent with an aetiologic role of environmental factors including H. pylori also for diffuse-type gastric cancers. © 2000 Cancer Research Campaign

Keywords: stomach neoplasms, incidence, histologic type, cardia, Helicobacter pylori

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Selected References

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  1. Amorosi A., Bianchi S., Buiatti E., Cipriani F., Palli D., Zampi G. Gastric cancer in a high-risk area in Italy. Histopathologic patterns according to Lauren's classification. Cancer. 1988 Nov 15;62(10):2191–2196. doi: 10.1002/1097-0142(19881115)62:10<2191::aid-cncr2820621020>3.0.co;2-5. [DOI] [PubMed] [Google Scholar]
  2. Antonioli D. A., Goldman H. Changes in the location and type of gastric adenocarcinoma. Cancer. 1982 Aug 15;50(4):775–781. doi: 10.1002/1097-0142(19820815)50:4<775::aid-cncr2820500425>3.0.co;2-w. [DOI] [PubMed] [Google Scholar]
  3. Beteta O., Lozano R., Monge E., Yoza M., Cavero J. Change in the histologic type of gastric carcinoma. Am J Gastroenterol. 1993 May;88(5):787–788. [PubMed] [Google Scholar]
  4. Coleman M. P., Estève J., Damiecki P., Arslan A., Renard H. Trends in cancer incidence and mortality. IARC Sci Publ. 1993;(121):1–806. doi: 10.3109/9780415874984-2. [DOI] [PubMed] [Google Scholar]
  5. Correa P., Chen V. W. Gastric cancer. Cancer Surv. 1994;19-20:55–76. [PubMed] [Google Scholar]
  6. Correa P., Shiao Y. H. Phenotypic and genotypic events in gastric carcinogenesis. Cancer Res. 1994 Apr 1;54(7 Suppl):1941s–1943s. [PubMed] [Google Scholar]
  7. Ekström A. M., Signorello L. B., Hansson L. E., Bergström R., Lindgren A., Nyrén O. Evaluating gastric cancer misclassification: a potential explanation for the rise in cardia cancer incidence. J Natl Cancer Inst. 1999 May 5;91(9):786–790. doi: 10.1093/jnci/91.9.786. [DOI] [PubMed] [Google Scholar]
  8. Hanai A., Fujimoto I. Cancer incidence in Japan in 1975 and changes of epidemiological features for cancer in Osaka. Natl Cancer Inst Monogr. 1982;62:3–7. [PubMed] [Google Scholar]
  9. Hansson L. E., Lindgren A., Nyrén O. Can endoscopic biopsy specimens be used for reliable Laurén classification of gastric cancer? Scand J Gastroenterol. 1996 Jul;31(7):711–715. doi: 10.3109/00365529609009155. [DOI] [PubMed] [Google Scholar]
  10. Hansson L. E., Sparén P., Nyrén O. Increasing incidence of carcinoma of the gastric cardia in Sweden from 1970 to 1985. Br J Surg. 1993 Mar;80(3):374–377. doi: 10.1002/bjs.1800800338. [DOI] [PubMed] [Google Scholar]
  11. Hansson L. R., Engstrand L., Nyrén O., Lindgren A. Prevalence of Helicobacter pylori infection in subtypes of gastric cancer. Gastroenterology. 1995 Sep;109(3):885–888. doi: 10.1016/0016-5085(95)90398-4. [DOI] [PubMed] [Google Scholar]
  12. Haruma K., Okamoto S., Kawaguchi H., Gotoh T., Kamada T., Yoshihara M., Sumii K., Kajiyama G. Reduced incidence of Helicobacter pylori infection in young Japanese persons between the 1970s and the 1990s. J Clin Gastroenterol. 1997 Dec;25(4):583–586. doi: 10.1097/00004836-199712000-00006. [DOI] [PubMed] [Google Scholar]
  13. Howson C. P., Hiyama T., Wynder E. L. The decline in gastric cancer: epidemiology of an unplanned triumph. Epidemiol Rev. 1986;8:1–27. doi: 10.1093/oxfordjournals.epirev.a036288. [DOI] [PubMed] [Google Scholar]
  14. LAUREN P. THE TWO HISTOLOGICAL MAIN TYPES OF GASTRIC CARCINOMA: DIFFUSE AND SO-CALLED INTESTINAL-TYPE CARCINOMA. AN ATTEMPT AT A HISTO-CLINICAL CLASSIFICATION. Acta Pathol Microbiol Scand. 1965;64:31–49. doi: 10.1111/apm.1965.64.1.31. [DOI] [PubMed] [Google Scholar]
  15. Laurén P. A., Nevalainen T. J. Epidemiology of intestinal and diffuse types of gastric carcinoma. A time-trend study in Finland with comparison between studies from high- and low-risk areas. Cancer. 1993 May 15;71(10):2926–2933. doi: 10.1002/1097-0142(19930515)71:10<2926::aid-cncr2820711007>3.0.co;2-x. [DOI] [PubMed] [Google Scholar]
  16. Lehtola J. Family behaviour of gastric carcinoma. Ann Clin Res. 1981 Jun;13(3):144–148. [PubMed] [Google Scholar]
  17. Lunde A. S., Lundeborg S., Lettenstrom G. S., Thygesen L., Huebner J. The person-number systems of Sweden, Norway, Denmark, and Israel. Vital Health Stat 2. 1980;(84):1–59. [PubMed] [Google Scholar]
  18. Lundegårdh G., Lindgren A., Rohul A., Nyrén O., Hansson L. E., Bergström R., Adami H. O. Intestinal and diffuse types of gastric cancer: secular trends in Sweden since 1951. Br J Cancer. 1991 Dec;64(6):1182–1186. doi: 10.1038/bjc.1991.487. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Mennicken C., Bohrer M. H., Jung M., Manegold B. C. Neue Aspekte beim Magenfrühkarzinom. Dtsch Med Wochenschr. 1986 Feb 14;111(7):255–258. doi: 10.1055/s-2008-1068436. [DOI] [PubMed] [Google Scholar]
  20. Misumi A., Murakami A., Harada K., Baba K., Akagi M. Definition of carcinoma of the gastric cardia. Langenbecks Arch Chir. 1989;374(4):221–226. doi: 10.1007/BF01359557. [DOI] [PubMed] [Google Scholar]
  21. Muñoz N., Asvall J. Time trends of intestinal and diffuse types of gastric cancer in Norway. Int J Cancer. 1971 Jul 15;8(1):144–157. doi: 10.1002/ijc.2910080118. [DOI] [PubMed] [Google Scholar]
  22. Muñoz N., Connelly R. Time trends of intestinal and diffuse types of gastric cancer in the United States. Int J Cancer. 1971 Jul 15;8(1):158–164. doi: 10.1002/ijc.2910080119. [DOI] [PubMed] [Google Scholar]
  23. Muñoz N., Franceschi S. Epidemiology of gastric cancer and perspectives for prevention. Salud Publica Mex. 1997 Jul-Aug;39(4):318–330. doi: 10.1590/s0036-36341997000400010. [DOI] [PubMed] [Google Scholar]
  24. Nikulásson S., Hallgrímsson J., Tulinius H., Sigvaldason H., Olafsdóttir G. Tumours in Iceland. 16. Malignant tumours of the stomach. Histological classification and description of epidemiological changes in a high-risk population during 30 years. APMIS. 1992 Oct;100(10):930–941. [PubMed] [Google Scholar]
  25. Parkin D. M., Muir C. S. Cancer Incidence in Five Continents. Comparability and quality of data. IARC Sci Publ. 1992;(120):45–173. [PubMed] [Google Scholar]
  26. Parkin D. M., Pisani P., Ferlay J. Estimates of the worldwide incidence of eighteen major cancers in 1985. Int J Cancer. 1993 Jun 19;54(4):594–606. doi: 10.1002/ijc.2910540413. [DOI] [PubMed] [Google Scholar]
  27. Parsonnet J., Blaser M. J., Perez-Perez G. I., Hargrett-Bean N., Tauxe R. V. Symptoms and risk factors of Helicobacter pylori infection in a cohort of epidemiologists. Gastroenterology. 1992 Jan;102(1):41–46. doi: 10.1016/0016-5085(92)91782-y. [DOI] [PubMed] [Google Scholar]
  28. Parsonnet J., Samloff I. M., Nelson L. M., Orentreich N., Vogelman J. H., Friedman G. D. Helicobacter pylori, pepsinogen, and risk for gastric adenocarcinoma. Cancer Epidemiol Biomarkers Prev. 1993 Sep-Oct;2(5):461–466. [PubMed] [Google Scholar]
  29. Powell J., McConkey C. C. The rising trend in oesophageal adenocarcinoma and gastric cardia. Eur J Cancer Prev. 1992 Apr;1(3):265–269. doi: 10.1097/00008469-199204000-00008. [DOI] [PubMed] [Google Scholar]
  30. Roosendaal R., Kuipers E. J., Buitenwerf J., van Uffelen C., Meuwissen S. G., van Kamp G. J., Vandenbroucke-Grauls C. M. Helicobacter pylori and the birth cohort effect: evidence of a continuous decrease of infection rates in childhood. Am J Gastroenterol. 1997 Sep;92(9):1480–1482. [PubMed] [Google Scholar]
  31. Sipponen P., Järvi O., Kekki M., Siurala M. Decreased incidences of intestinal and diffuse types of gastric carcinoma in Finland during a 20-year period. Scand J Gastroenterol. 1987 Sep;22(7):865–871. doi: 10.3109/00365528708991927. [DOI] [PubMed] [Google Scholar]
  32. Talley N. J., Zinsmeister A. R., Weaver A., DiMagno E. P., Carpenter H. A., Perez-Perez G. I., Blaser M. J. Gastric adenocarcinoma and Helicobacter pylori infection. J Natl Cancer Inst. 1991 Dec 4;83(23):1734–1739. doi: 10.1093/jnci/83.23.1734. [DOI] [PubMed] [Google Scholar]
  33. Xia H. H., Talley N. J. Natural acquisition and spontaneous elimination of Helicobacter pylori infection: clinical implications. Am J Gastroenterol. 1997 Oct;92(10):1780–1787. [PubMed] [Google Scholar]
  34. Yang P. C., Davis S. Epidemiological characteristics of adenocarcinoma of the gastric cardia and distal stomach in the United States, 1973-1982. Int J Epidemiol. 1988 Jun;17(2):293–297. doi: 10.1093/ije/17.2.293. [DOI] [PubMed] [Google Scholar]

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