Combating Gastric Cancer in Alaska Native People: An Expert and Community Symposium

Abstract

A laska Native (AN) people experience higher incidence of, and mortality from, gastric cancer compared to other US populations. 1,2 Compared to the general U.S. population, gastric cancer in AN people occurs at a younger age, is diagnosed at later stages, is more evenly distributed between the sexes, and more frequently shows signet-ring or diffuse histology. 3 It is known that the prevalence of Helicobacter pylori infection, a risk factor for gastric cancer, is high in AN people 4 ; however, high antimicrobial resistance combined with high reinfection rates in Alaska make treatment at the population level complex. 5 In addition, health issues in AN people are uniquely challenging because of the extremely remote locations of many residents. A multiagency workgroup hosted a symposium in Anchorage, Alaska, that brought internationally recognized experts and local leaders together to evaluate issues around gastric cancer in the AN population. The overall goal of this symposium was to identify the best strategies to combat gastric cancer in the AN population through prevention and early diagnosis. Symposium Framework To identify goals and actions that were scientifically sound, logistically realistic, and culturally acceptable, a symposium was hosted in Anchorage, Alaska, in July 2019. This symposium brought together voices from many viewpoints, included gastric cancer and H pylori experts, Alaskan health providers, AN community and tribal leaders, public health officials, and representatives from other North American indigenous populations. Overall, 57 people attended and contributed to this symposium. The symposium aimed to identify concrete actions and was designed to maximize discussion. Scientific presentations were kept to a minimum. Presenters were encouraged to present well-established conclusions and information that could be used to address gastric cancer in AN people. After the scientific presentations, the symposium was divided into small groups, and participants were asked to identify the main questions or challenges related to gastric cancer in AN people. On the second day, the group was divided into 2 sections; 1 focused on scientific data and investigations, and 1 focused on community priorities and cultural acceptability. The symposium ended with the 2 groups coming together to summarize findings. The overall goal of this symposium was not to create guidance but to evaluate existing data, identify knowledge gaps, and summarize actions that could improve gastric cancer diagnosis and survival.

Screening and eradication ofHelicobacter pylorifor gastric cancer prevention: the Taipei global consensus

“…87 88 A recent systematic review and meta-analysis showed that the global annual recurrence rates after H. pylori eradication in clinical settings without mass eradication was 4.3%. 87 High reinfection/recrudescence has been reported in some areas such as Alaska, Vietnam and Bangladesh which may require modifications, such as treatment of the entire community at one time [89][90][91] The annual recurrence rate in the gastric cancer prevention study in Shandong (not mass screening and eradication) was nearly 7% per person-year. 29 However, the annual reinfection/recrudescence rate was only 1% in mass in the Matsu Islands, where the participation rates for screening and eradication therapy were 82% among the total population.…”

Molecular Classification of Gastric Cancer among Alaska Native People

“…The Alaska Native (AN) population has the highest incidence and mortality rates of gastric cancer among all ethnicities in the United States [14][15][16][17]. Gastric cancer etiology differs between the AN populations and other U.S. and Alaska populations [14].…”

Molecular Mechanisms Contributing Bacterial Infections to the Incidence of Various Types of Cancer

“…Nolen et al reported an earlier onset of gastric carcinoma and a higher mortality rate in Alaska Native people as compared to the US population. This was attributed to the higher prevalence of H. pylori infection, antimicrobial resistance, and reinfection in people in Alaska Natives as compared to the US population [36]. A study in Japan on 213 gastric cancer patients showed 88.2% of patients having higher levels of H. pylori antibodies.…”