February 25, 2024

Assessing Risk for Stomach Cancer Development: The Role of Country of Birth

Stomach cancer, also known as gastric cancer, is a relatively rare but deadly condition, particularly among certain racial and ethnic groups in the United States. A recent study conducted by researchers at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine sheds light on the importance of considering an individual’s country of birth, rather than just their geographic region, as a key risk factor for gastric intestinal metaplasia (GIM), a precursor lesion of stomach cancer.

The research team, which serves a diverse population with many immigrants and visitors from Latin America and the Caribbean, discovered significant variability among countries in terms of GIM risk, even among those with geographical proximity. Dr. Shria Kumar, a clinical epidemiologist and gastroenterologist at the Miller School, emphasizes the need to precisely identify risk based on country of birth to develop tailored screening and surveillance programs.

The study, published in The Lancet Regional Health—Americas, analyzed the medical records of 21,108 individuals from 130 countries who underwent upper endoscopic procedures and gastric biopsies between 2011 and 2021. Out of this sample, 1,699 cases of GIM were identified. Statistical analyses were conducted on 15 countries with at least 100 people, comprising 1,208 cases of GIM. The researchers found that individuals born in Ecuador, Honduras, and Peru had the highest risk of GIM.

It is important to note that not all countries traditionally considered as being in high-risk regions are associated with higher rates of GIM. Therefore, future screening and surveillance efforts should take into account an individual’s country of birth, along with other risk factors, to provide more effective and efficient guidelines.

Experts highlight the challenge of universal screening for gastric cancer due to its relatively low prevalence in the general population. Targeted screening among higher-risk groups, however, may be cost-effective. To identify those who would benefit the most from screening, more precise information is needed. The researchers at Sylvester Comprehensive Cancer Center investigated risk factors and developed a timing strategy for screening that considers the progression of the disease.

The development of gastric cancer often begins with an infection of the stomach by the bacterium Helicobacter pylori (HP). When left untreated, the infection can progress to chronic inflammation and thinning of the stomach lining, leading to atrophic gastritis, a condition that may eventually result in GIM. Given that GIM is considered a critical precursor to gastric cancer and is more prevalent among Asian Americans and Hispanics compared to non-Hispanic white individuals, screening during this stage is crucial for identifying patients and evaluating their cancer risk.

The study findings reaffirm that country of birth is a significant risk factor for GIM, along with other factors such as HP infection, race and ethnicity, age, and smoking. Dr. Shria Kumar emphasizes the need to study this under-investigated risk factor in addition to racial and ethnic classification to gain a more comprehensive understanding of risk.

Dr. Shida Haghighat, the first author of the study, suggests that comprehensive risk-prediction models should be developed to identify high-risk individuals more accurately. While having one risk factor for GIM may not be enough to warrant screening, those with multiple risk factors could be considered for screening and surveillance.

In conclusion, the study highlights the importance of considering an individual’s country of birth when assessing the risk of developing GIM, a precursor lesion of stomach cancer. By identifying the countries with the highest rates of GIM, researchers can develop targeted screening and surveillance programs to mitigate the risk of gastric cancer among vulnerable populations. Further research is needed to develop comprehensive risk-prediction models that take into account multiple factors to identify those at the highest risk and provide effective screening and surveillance strategies.

Note:
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it