Gastric Cancer in Asian American Populations: a Neglected Health Disparity

Abstract

Gastric cancer incidence rates vary dramatically by world region with East Asia having the highest rate. The Asian population of the United States (US) is growing rapidly and over 17 million Americans are of Asian descent. A majority of Chinese, Korean and Vietnamese Americans are immigrants. Americans of East and Southeast Asian descent experience marked gastric cancer disparities and the incidence rate among Korean men in the US is over five times higher than the incidence rate among non-Hispanic white men. Randomized controlled trials have provided evidence for the effectiveness of helicobacter pylori identification and eradication in preventing gastric cancer. Additionally, Japan and South Korea have both experienced improvements in gastric cancer mortality following the implementation of programs to detect early stage gastric cancers. There are currently no clear US guidelines regarding the primary and secondary prevention of gastric cancer in high-risk immigrant populations. However, it is likely that a proportion of US physicians are already recommending gastric cancer screening for Asian patients and some Asian immigrants to the US may be completing screening for gastric cancer in their native countries. Surveys of US primary care physicians and Asian American communities should be conducted to assess current provider practices and patient uptake with respect to gastric cancer prevention and control. In the absence of clinical guidelines, US health care providers who serve high-risk Asian groups could consider a shared decision-making approach to helicobacter pylori identification and eradication, as well as gastric endoscopy.

Cancer statistics for Asian Americans, Native Hawaiians, and Pacific Islanders, 2016: Converging incidence in males and females

“…AANHPIs are more likely than NHWs to be diagnosed with stomach cancer at a localized or regional stage (Fig. ), possibly because of awareness of the higher risk of stomach cancer among Asian Americans and/or screening recommendations by some medical societies . The American Society for Gastrointestinal Endoscopy states that endoscopic screening may be considered for first‐generation immigrants aged 40 years or older from high‐risk Asian countries such as Japan or China, especially if there is a history of gastric cancer in a first‐degree relative .…”

“…4), possibly because of awareness of the higher risk of stomach cancer among Asian Americans and/or screening recommendations by some medical societies. 68 The American Society for Gastrointestinal Endoscopy states that endoscopic screening may be considered for firstgeneration immigrants aged 40 years or older from high-risk Asian countries such as Japan or China, especially if there is a history of gastric cancer in a first-degree relative. 69 Likely because of the earlier stage at diagnosis, AANHPIs have higher 5-year survival than NHWs, 40% versus 28% in males and 38% versus 34% in females, respectively ( Fig.…”

Green Tea and Its Extracts in Cancer Prevention and Treatment

“…The incidence is especially high in Japan as compared to other countries [241]. Therefore, risk factors for gastric cancer and its association with GT or GTE have been investigated in six cohort studies from Japan [242][243][244][245][246][247], but no similar cohort study was published from other countries ( Table 9).…”

“…With one exception [254] published 11 years earlier, all case control studies were performed in China (Table 9); some Chinese areas also have a high gastric cancer incidence, but still lower than in Japan [241]. The results from these studies are ambiguous at best: the Japanese study found a decrease with high GT intake (set at >10 cups GT/day) [254]; two Chinese studies [230,237,238] found a similar protection with "high GT intake", which here was set at >250 g tea/month.…”

Screening and Early Detection of Gastric Cancer

“…In particular, even in low prevalence countries, health care providers should consider screening with primary prevention, including endoscopy for high-risk populations such as Asian immigrants. 56 To overcome these limitations, several state-of-the art technologies are now under development. Multitarget stool DNA testing could be considered as a noninvasive alternative in gastric cancer screening, as recently reported for colorectal cancer.…”