27 years of stomach cancer: painting a global picture
Menée dans 195 pays, cette étude analyse, sur la période 1990-2017, les disparités géographiques dans l'évolution de l'incidence du cancer de l'estomac, des années de vies perdues ajustées sur l'incapacité et de la mortalité associées
Stomach cancer is common and lethal: in 2017, more than 1·2 million patients worldwide were diagnosed with stomach cancer and nearly 865 000 patients died from this disease. Although statistics from the International Agency for Research on Cancer suggest that stomach cancer incidence has fallen, data for epidemiological trends at a regional level, on the association between risk factors and stomach cancer incidence, and the effect of stomach cancer on disability-adjusted life-years are scarce. These findings are described in The Lancet Gastroenterology & Hepatology.The GBD 2017 Stomach Cancer Collaborators found that, paradoxically, although the age-standardised incidence rate of stomach cancer has decreased, the absolute number of cases diagnosed annually is increasing. The age-standardised incidence rate decreased by 28% between 1990 and 2017, but incident cases increased from about 864 000 (95% uncertainty interval [UI] 847 000–890 000) to 1·22 million (1·19–1·25) over the same period. These counterintuitive results can be explained by a larger, ageing population, especially in high-risk regions such as China. Encouragingly, stomach cancer death rates have fallen more rapidly than stomach cancer incidence (43·2% [95% UI −45·1 to −41·4] global decline over the same period. Globally and regionally, there is a strong correlation between improvements in Socio-demographic Index (SDI) and improvement in the death rate from stomach cancer. SDI is not a health-care metric, but is composed of variables relating to fertility, education, and income; thus, stomach cancer mortality might be improved by indirect measures, as much as by gastric cancer-specific measures. That said, the substantial contribution of smoking and high salt diet to gastric cancer incidence, especially in men and in east Asia, would appear to be low-hanging fruit for targeted primary prevention.