Helicobacter pylori infection appears essential for stomach carcinogenesis: Observations in Semarang, Indonesia

Abstract

The gastric cancer incidence in Semarang, Indonesia, is exceedingly low: only approximately 1/100th of the level in Japan. To elucidate the reason, we carried out an ecological study recruiting 69 male and 102 female participants from the general populace in January 2005. Positive urea breath tests were 0% for both men and women, and Helicobacter pylori (H. pylori) IgG antibodies were found in 2% (0-5, 95% confidence interval) of men and 2% (0 -4) of women, significantly lower than the 62% (58-65) and 57% (53-60), respectively, in Japan. Furthermore, there were no positive findings with the pepsinogen tests in Semarang, again significant in comparison with the 23% (22-25) and 22% (20-23) in Japan. Variation in smoking levels and consumption of NaCl, vegetables and fruit were found, but not to an extent that would allow explanation of the major differences in gastric cancer incidence. We may conclude that the very low prevalence of H. pylori infection and thus chronic atrophic gastritis account for the rarity of stomach cancer in Semarang, Indonesia. (Cancer Sci 2005; 96: 873-875) S ince 2002, we have been conducting a collaborative epidemiologic appraisal of host and environmental factors for stomach and colorectal cancer in several South-east Asian countries. Ecological and case-control studies are now being carried out in Hanoi and Ho Chi Minh City, Vietnam; Khon Kaen, Thailand; and Yogyakarta and Semarang, Indonesia, in order to take advantage of the major variation in cancer incidence among these geographical areas and also with data for Japan. Stomach cancer incidence rates in Hanoi, Ho Chi Minh City, Khon Kaen, Yogyakarta and Semarang are approximately 1/2, 1/4, 1/10, 1/50 and 1/100 those prevailing in Japan, respectively: the annual age-adjusted incidence rates for Semarang were 0.6/10 5 for men and 0.3/10 5 for women during 1990-1999, and the respective figures for Japan in 1995 were 67/10 5 and 27/10 5 .(1,2)Gastric cancer may be caused by environmental or lifestyle risks, host genetic polymorphisms, as well as aging.(3) Many laboratory studies have pointed to roles for carcinogenic substances, including amine pyrolysate products and nitrosamines; however, grilled or barbecued meat and fish are categorized as possible risk factors in humans.(3) A probable risk factor for stomach cancer is salt or salty foods, which act synergistically with Helicobacter pylori (H. Pylori) infection in the development of stomach cancer in experimental animals (4) and humans. (5) Convincing preventive factors are vegetables and fruit and refrigeration, and a probable preventive factor is vitamin C. The International Agency for Research on Cancer (IARC) has concluded that gastric cancer is a smokerelated malignancy.(6) H. pylori is a definite carcinogen, (7)(8)(9) and is accepted to be a major factor for chronic atrophic gastritis (CAG), (5) a precursor lesion for stomach cancer.We here report the results of an ecological study of stomach cancer with reference to H. pylori infection and pepsinogen tests as a marker of CAG, ...

Current situation of <em>Helicobacter pylori</em> infection in Indonesia

“…8 Moreover, most of these studies investigated only the largest ethnic group, the Javanese. 6,7,9,10 In a previous study, Miftahussurur et al confirmed that the prevalence of H. pylori infection in Surabaya (Java island) was low, only 11.5%, diagnosed using five different methods. 8 It is still to be expected that our geneticpolymorphism evaluation of the possibility that some ethnic groups, such as the Javanese and most of the ethnic groups in Sumatra (Acehnese, Minang, and Palembang), might have immunity against H. pylori infection.…”

“…4 There were significant differences in the prevalence of H. pylori infection in terms of ethnic groups (p<0.001). 6,7 This could be attributable to the different study populations and different tests used for H. pylori diagnosis. 8 Moreover, most of these studies investigated only the largest ethnic group, the Javanese.…”

Cancer Control Programs in East Asia: Evidence From the International Literature

“…The very low incidence of gastric cancer in Indonesia has been attributed primarily to very low rates of infection with helicobacter[57]. Alcohol does not appear to be a major influence.…”

Population-attributable fractions in gastric cancer risk factors: the necessity to focus on Helicobacter pylori infection

“…Observational studies, including our own experience with cross-country comparisons, have indicated that Helicobacter pylori (H. pylori) infection is essentially related to stomach cancer, at least to cancers in the noncardia zone [3][4][5][6][7][8]. In fact, similar to the PAF% for cancer of the cervix uteri, the PAF% for noncardia gastric adenocarcinoma is …”