Gastric cancer in Alaska Native people: A cancer health disparity

Abstract

AIMTo evaluate recent trends in gastric cancer incidence, response to treatment, and overall survival among Alaska Native (AN) people.METHODSA retrospective analysis of the Alaska Native Medical Center patient database was performed. Patient history, clinical, pathological, response to treatment and patient outcomes were collected from one-hundred and thirty-two AN gastric cancer patients. The Surveillance, Epidemiology and End Result database 18 was used to collect comparison United States non-Hispanic White (NHW) and AN gastric cancer patient data between 2006-2014.RESULTSAN gastric cancer patients have a higher incidence rate, a poorer overall survival, and are diagnosed at a significantly younger age compared to NHW patients. AN patients differ from NHW patients in greater prevalence of non-cardia, diffuse subtype, and signet ring cell carcinomas. AN females were more likely to be diagnosed with later stage cancer, stage IV, compared to AN males. Diminished overall survival was observed among AN patients with increasing stage, O+ blood type, < 15 lymph nodes examined at resection, and no treatment. This study is the first report detailing the clinicopathologic features of gastric cancer in AN people with outcome data.CONCLUSIONOur findings confirm the importance of early detection, treatment, and surgical resection for optimizing AN patient outcomes. Further research on early detection markers are warranted.

Molecular Classification of Gastric Cancer among Alaska Native People

“…Of the nine MMR-deficient patients, seven of the patients had tumors in the distal (body, pyloric, and antrum) stomach location. Place of residence was also associated with MMR deficiency with 6/8 patients located in northern Alaska, which has a higher percentage of intestinal type cancers, 64.7%, compared to other regions in Alaska that range from 20-40% [14]. Patients with MMR deficiency had slightly shorter survival rates (16.5 months) but not significant compared to MMR-stable patients (24.6 months).…”

“…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]. AN gastric cancer patients are diagnosed at a younger age and have a higher prevalence of non-cardia tumors, diffuse subtype, and signet ring cell carcinomas [14].…”

“…Gastric cancer etiology differs between the AN populations and other U.S. and Alaska populations [14]. AN gastric cancer patients are diagnosed at a younger age and have a higher prevalence of non-cardia tumors, diffuse subtype, and signet ring cell carcinomas [14]. The higher incidence of non-cardia gastric cancers among AN people has been associated with the high seropositivity rates of H. pylori among the general population [18][19][20][21].…”

Oesophageal and proximal gastric adenocarcinomas are rare after detection of Helicobacter pylori infection

“…Those of Black, Asian, and Native Hawaiian/Pacific Islander were less likely to develop future oesophageal and proximal gastric cancers, as were those of Hispanic or Latino ethnicity, though this was not statistically significant. Asian Americans, Hispanics and African Americans, as well as immigrants and native populations, are known to have a disproportionate burden of gastric cancer in the US, particularly distal cancers . Non‐Hispanic whites, on the contrary, are more affected by oesophageal and proximal gastric cancers .…”

“…Asian Americans, Hispanics and African Americans, as well as immigrants and native populations, are known to have a disproportionate burden of gastric cancer in the US, particularly distal cancers. [36][37][38][39] Non-Hispanic whites, on the contrary, are more affected by oesophageal and proximal gastric cancers. [40][41][42][43] While these findings are not novel, they validate prior studies, and demonstrate how our cohort has risks consistent with other patient populations, and reinforce the external validity of our results.…”