Gastric Cancer in Alaska Native and American Indian People Living in Alaska, 1990–2017

Abstract

INTRODUCTION: Alaska Native (AN) people experience a high burden of gastric cancer compared with other US Native and non-Native populations. Previous reports have suggested that gastric cancer in AN people occurs at a younger age and is a more aggressive pathologic type. We evaluated all cases of gastric cancer in AN people from 1990 to 2017 and compared the epidemiologic and pathologic characteristics with the gastric cancers that occurred in the same time in the US white (USW) population. METHODS: Cancer data were collected by the Alaska Native Tumor Registry and National Cancer Institute's Surveillance, Epidemiology, and End Results Program. Comparisons were performed looking at the age and sex distribution of the affected AN and USW people, as well as the cancer characteristics, including the location, stage, and pathology. RESULTS: The age distribution was significantly different between AN and USW patients (P < 0.001), with a greater proportion of AN people diagnosed younger than 40 years (11% vs 3%, P < 0.0001) and 40–59 years (37% vs 20%, P < 0.0001). In addition, a greater proportion of AN people were diagnosed with distant stage cancer (AN: 48% and USW: 35%, P < 0.0001). The age-adjusted rate of gastric cancer in the AN population was significantly higher than the USW population (20.8 vs 6.7 per 100,000 persons, P < 0.0001). Although there has been a significant decrease in the gastric cancer incidence rate in the USW population, no significant change in incidence was seen in the AN population. DISCUSSION: This study highlights the disproportionate burden of gastric cancer in the AN population. Further work is needed to address and understand this disparity.

Cancer statistics forAmericanIndian andAlaskaNative individuals, 2022: Including increasing disparities in early onset colorectal cancer

“…In contrast, H. pylori infection is the principal risk factor for noncardia tumors 131 . H. pylori is most common in persons with lower SES and is especially prevalent in Alaska Native individuals 132,133 …”

Native and Indigenous Populations and Gastric Cancer: A Worldwide Review

“…Exact prognosis based on non-cardia versus cardia is inconclusive, but a recent study (2021) indicated that cardia variants may lead to worse outcomes [43]. A cause of concern among Alaska Native individuals is the high rate of antimicrobial resistance, which may affect the treatment efficacy of therapies targeted against H. pylori [7,44]. Reinfection has also been found to occur among Alaska Natives after treatment [7,44].…”

“…A cause of concern among Alaska Native individuals is the high rate of antimicrobial resistance, which may affect the treatment efficacy of therapies targeted against H. pylori [7,44]. Reinfection has also been found to occur among Alaska Natives after treatment [7,44]. Smoking has also been found to decrease antibiotic treatment efficacy of H. pylori among the Indigenous population of Taiwan [4].…”

“…As location is a factor in access to food and environmental issues as discussed earlier, it also matters when it comes to accessing health care for Indigenous populations. In Alaska, single jet engine airplanes have been found to be the only form of transportation to healthcare facilities for cancer care treatment for patients from some Alaska Native communities [7,44].…”

“…Figure 2.Issues Indigenous patients face in regards to access to cancer prevention and control for all types of cancer (yellow), gastric cancer alone (purple) and both (grey)[7,13,[15][16][17]21,23,[26][27][28]37,[44][45][46][47][48][49].…”