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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/pdqcis/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" alt="Cover of PDQ Cancer Information Summaries" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>PDQ Cancer Information Summaries [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK65822_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK65822_dtls__"><div>Bethesda (MD): <a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>; 2002-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/pdqcis/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK65822_"><span class="title" itemprop="name">Stomach (Gastric) Cancer Prevention (PDQ®)</span></h1><div class="subtitle whole_rhythm">Health Professional Version</div><p class="contrib-group"><span itemprop="author">PDQ Screening and Prevention Editorial Board</span>.</p><p class="small">Published online: February 5, 2016.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000062830__167">This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about stomach (gastric) cancer prevention. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.</p><p id="CDR0000062830__168">This summary is reviewed regularly and updated as necessary by the PDQ Screening and Prevention Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).</p></div><div id="CDR0000062830__1"><h2 id="_CDR0000062830__1_">Overview</h2><p id="CDR0000062830__2">Note: Separate PDQ summaries on <a href="/books/n/pdqcis/CDR0000062757/">Stomach (Gastric) Cancer Screening</a>, <a href="/books/n/pdqcis/CDR0000062911/">Gastric Cancer
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Treatment</a>, and <a href="/books/n/pdqcis/CDR0000304747/">Levels of Evidence for Cancer Screening and Prevention Studies</a> are also available.
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</p><div id="CDR0000062830__113"><h3>Who Is at Risk?</h3><p id="CDR0000062830__114">People at elevated risk for gastric cancer include elderly patients with atrophic gastritis or pernicious anemia, patients with sporadic gastric adenomas,[<a class="bk_pop" href="#CDR0000062830_rl_1_1">1</a>] familial adenomatous polyposis,[<a class="bk_pop" href="#CDR0000062830_rl_1_2">2</a>] or hereditary nonpolyposis colon cancer,[<a class="bk_pop" href="#CDR0000062830_rl_1_3">3</a>] and immigrant ethnic populations from countries with high rates of gastric carcinoma.[<a class="bk_pop" href="#CDR0000062830_rl_1_4">4</a>,<a class="bk_pop" href="#CDR0000062830_rl_1_5">5</a>] Workers in the rubber and coal industries are also at increased risk.[<a class="bk_pop" href="#CDR0000062830_rl_1_6">6</a>]</p><p id="CDR0000062830__115">Risk factors for gastric cancer include the presence of precursor conditions such as chronic atrophic gastritis and intestinal metaplasia, pernicious anemia, and gastric adenomatous polyps. Genetic factors include a family history of gastric cancer, Li Fraumeni syndrome, and Type A blood type.[<a class="bk_pop" href="#CDR0000062830_rl_1_6">6</a>] Environmental factors include low consumption of fruits and vegetables; consumption of salted, smoked, or poorly preserved foods; cigarette smoking; and radiation exposure.[<a class="bk_pop" href="#CDR0000062830_rl_1_6">6</a>-<a class="bk_pop" href="#CDR0000062830_rl_1_8">8</a>]</p><p id="CDR0000062830__116">There is consistent evidence that <i>Helicobacter pylori</i> infection, also known as<i> H. pylori</i> infection, of the stomach is strongly associated with both the initiation and promotion of carcinoma of the gastric body and antrum and of gastric lymphoma.[<a class="bk_pop" href="#CDR0000062830_rl_1_9">9</a>-<a class="bk_pop" href="#CDR0000062830_rl_1_11">11</a>] The International Agency for Research on Cancer classifies <i>H. pylori</i> infection as a cause of noncardia gastric carcinoma and gastric low-grade B-cell mucosa-associated lymphoid tissue or MALT lymphoma (i.e., a Group 1 human carcinogen).[<a class="bk_pop" href="#CDR0000062830_rl_1_12">12</a>,<a class="bk_pop" href="#CDR0000062830_rl_1_13">13</a>]</p><p id="CDR0000062830__117">Compared with the general population, people with duodenal ulcer disease may have a lower risk of gastric cancer.[<a class="bk_pop" href="#CDR0000062830_rl_1_14">14</a>]</p></div><div id="CDR0000062830__124"><h3>Interventions for Reduction of Stomach (Gastric) Cancer Risk</h3><div id="CDR0000062830__125"><h4>Smoking cessation</h4><p id="CDR0000062830__126">Based on solid evidence, smoking is associated with an increased risk of stomach cancer.[<a class="bk_pop" href="#CDR0000062830_rl_1_15">15</a>-<a class="bk_pop" href="#CDR0000062830_rl_1_17">17</a>] The 2004 Surgeon General’s report identifies cigarette smoking as a cause of stomach cancer, with an average relative risk (RR) in former smokers of 1.2 and in current smokers of 1.6.[<a class="bk_pop" href="#CDR0000062830_rl_1_18">18</a>] Compared with persistent smokers, the risk of stomach cancer decreases among former smokers with time since cessation. This pattern of observations makes it reasonable to infer that cigarette smoking prevention or cessation would result in a decreased risk of gastric cancer.</p><p id="CDR0000062830__127"><b>Magnitude of Effect: A systematic review and meta-analysis showed a 60% increase in gastric cancer in male smokers and a 20% increase in gastric cancer in female smokers compared with nonsmokers.[<a class="bk_pop" href="#CDR0000062830_rl_1_15">15</a>]</b></p><ul id="CDR0000062830__128" class="simple-list"><li class="half_rhythm"><div>Study Design: Evidence obtained from case-control and cohort studies.</div></li><li class="half_rhythm"><div>Internal Validity: Good.</div></li><li class="half_rhythm"><div>Consistency: Good.</div></li><li class="half_rhythm"><div>External Validity: Good.</div></li></ul></div><div id="CDR0000062830__129"><h4><i>H. Pylori</i> infection eradication</h4><p id="CDR0000062830__130">Based on solid evidence, <i>H. pylori</i> infection is associated with an increased risk of gastric cancer. A meta-analysis of seven randomized studies, all conducted in areas of high-risk gastric cancer and all but one conducted in Asia, suggests that treatment of <i>H. pylori</i> may reduce gastric cancer risk (from 1.7% to 1.1%; RR = 0.65; 95% confidence interval, 0.43–0.98).[<a class="bk_pop" href="#CDR0000062830_rl_1_19">19</a>] Only two studies assessed gastric cancer incidence as the primary study outcome, and two different studies were double blinded. It is unclear how generalizable the results may be to the North American population.</p><p id="CDR0000062830__159">In the initial report from a clinical trial, 3,365 randomized subjects were followed in an intention-to-treat analysis; it was shown that short-term treatment with amoxicillin and omeprazole reduced the incidence of gastric cancer by 39% during a period of 15 years following randomization, with similar but not statistically significant reductions for gastric cancer mortality.[<a class="bk_pop" href="#CDR0000062830_rl_1_20">20</a>]</p><p id="CDR0000062830__131"><b>Magnitude of Effect: Risk of cancer may be reduced; effect on cancer mortality is not known.</b></p><ul id="CDR0000062830__132" class="simple-list"><li class="half_rhythm"><div>Study Design: Randomized controlled trials of <i>H. pylori</i> eradication. </div></li><li class="half_rhythm"><div>Internal Validity: Good.</div></li><li class="half_rhythm"><div>Consistency: Good.</div></li><li class="half_rhythm"><div>External Validity: Good.</div></li></ul></div></div><div id="CDR0000062830__133"><h3>Interventions With Inadequate Evidence as to Whether They Reduce the Risk of Stomach (Gastric) Cancer</h3><div id="CDR0000062830__134"><h4>Diet</h4><p id="CDR0000062830__135">Based on fair evidence, excessive salt intake and deficient dietary consumption of fresh fruits and vegetables are associated with an increased risk of gastric cancer. Dietary intake of vitamin C contained in vegetables, fruits, and other foods of plant origin is associated with a reduced risk of gastric cancer. Diets high
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in whole-grain cereals, carotenoids, allium compounds, and green tea are also
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associated with a reduced risk of this cancer. However, it is uncertain if changing one's diet to include more vegetables, fruits, and whole grains would reduce the risk of gastric cancer.</p><p id="CDR0000062830__136"><b>Magnitude of Effect: Small, difficult to determine.</b></p><ul id="CDR0000062830__137" class="simple-list"><li class="half_rhythm"><div>Study Design: Cohort or case-control studies.</div></li><li class="half_rhythm"><div>Internal Validity: Good.</div></li><li class="half_rhythm"><div>Consistency: Small number of studies.</div></li><li class="half_rhythm"><div>External Validity: Fair (populations vary greatly in their underlying nutritional status).</div></li></ul></div></div><div id="CDR0000062830_rl_1"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062830_rl_1_1">MING SC, GOLDMAN H: Gastric polyps: a histogenetic classification and its relation to carcinoma. Cancer 18: 721-6, 1965. [<a href="https://pubmed.ncbi.nlm.nih.gov/14297468" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14297468</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_1_2">Utsunomiya J, Maki T, Iwama T, et al.: Gastric lesion of familial polyposis coli. Cancer 34 (3): 745-54, 1974. [<a href="https://pubmed.ncbi.nlm.nih.gov/4852134" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 4852134</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_1_3">Aarnio M, Salovaara R, Aaltonen LA, et al.: Features of gastric cancer in hereditary non-polyposis colorectal cancer syndrome. Int J Cancer 74 (5): 551-5, 1997. [<a href="https://pubmed.ncbi.nlm.nih.gov/9355980" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9355980</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_1_4">Kurtz RC, Sherlock P: The diagnosis of gastric cancer. Semin Oncol 12 (1): 11-8, 1985. [<a href="https://pubmed.ncbi.nlm.nih.gov/3975641" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3975641</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_1_5">Boeing H: Epidemiological research in stomach cancer: progress over the last ten years. J Cancer Res Clin Oncol 117 (2): 133-43, 1991. [<a href="https://pubmed.ncbi.nlm.nih.gov/2036128" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2036128</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_1_6">Pisters PWT, Kelsen DP, Tepper JE: Cancer of the stomach. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. Vols. 1 & 2. 8th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2008, pp 1043-1079.</div></li><li><div class="bk_ref" id="CDR0000062830_rl_1_7">Crew KD, Neugut AI: Epidemiology of gastric cancer. World J Gastroenterol 12 (3): 354-62, 2006. [<a href="/pmc/articles/PMC4066052/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4066052</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/16489633" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16489633</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_1_8">Leung WK, Wu MS, Kakugawa Y, et al.: Screening for gastric cancer in Asia: current evidence and practice. Lancet Oncol 9 (3): 279-87, 2008. [<a href="https://pubmed.ncbi.nlm.nih.gov/18308253" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18308253</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_1_9">Parsonnet J, Hansen S, Rodriguez L, et al.: Helicobacter pylori infection and gastric lymphoma. N Engl J Med 330 (18): 1267-71, 1994. [<a href="https://pubmed.ncbi.nlm.nih.gov/8145781" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8145781</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_1_10">Ando T, Goto Y, Maeda O, et al.: Causal role of Helicobacter pylori infection in gastric cancer. World J Gastroenterol 12 (2): 181-6, 2006. [<a href="/pmc/articles/PMC4066024/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4066024</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/16482615" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16482615</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_1_11">Aromaa A, Kosunen TU, Knekt P, et al.: Circulating anti-Helicobacter pylori immunoglobulin A antibodies and low serum pepsinogen I level are associated with increased risk of gastric cancer. Am J Epidemiol 144 (2): 142-9, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/8678045" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8678045</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_1_12">IARC Working Group on the Evaluation of Carcinogenic Risks to Humans: A review of human carcinogens--Part B: biological agents. Volume 100. Lyon, France: IARC Press, 2011.</div></li><li><div class="bk_ref" id="CDR0000062830_rl_1_13">Bouvard V, Baan R, Straif K, et al.: A review of human carcinogens--Part B: biological agents. Lancet Oncol 10 (4): 321-2, 2009. [<a href="https://pubmed.ncbi.nlm.nih.gov/19350698" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19350698</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_1_14">Hansson LE, Nyrén O, Hsing AW, et al.: The risk of stomach cancer in patients with gastric or duodenal ulcer disease. N Engl J Med 335 (4): 242-9, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/8657240" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8657240</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_1_15">Ladeiras-Lopes R, Pereira AK, Nogueira A, et al.: Smoking and gastric cancer: systematic review and meta-analysis of cohort studies. Cancer Causes Control 19 (7): 689-701, 2008. [<a href="https://pubmed.ncbi.nlm.nih.gov/18293090" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18293090</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_1_16">González CA, Pera G, Agudo A, et al.: Smoking and the risk of gastric cancer in the European Prospective Investigation Into Cancer and Nutrition (EPIC). Int J Cancer 107 (4): 629-34, 2003. [<a href="https://pubmed.ncbi.nlm.nih.gov/14520702" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14520702</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_1_17">La Torre G, Chiaradia G, Gianfagna F, et al.: Smoking status and gastric cancer risk: an updated meta-analysis of case-control studies published in the past ten years. Tumori 95 (1): 13-22, 2009 Jan-Feb. [<a href="https://pubmed.ncbi.nlm.nih.gov/19366050" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19366050</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_1_18">The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta, Ga: U.S. Department of Health and Human Services, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004. <a href="http://www.cdc.gov/tobacco/data_statistics/sgr/2004/index.htm" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Also available online</a>. Last accessed February 4, 2016.</div></li><li><div class="bk_ref" id="CDR0000062830_rl_1_19">Fuccio L, Zagari RM, Eusebi LH, et al.: Meta-analysis: can Helicobacter pylori eradication treatment reduce the risk for gastric cancer? Ann Intern Med 151 (2): 121-8, 2009. [<a href="https://pubmed.ncbi.nlm.nih.gov/19620164" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19620164</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_1_20">Ma JL, Zhang L, Brown LM, et al.: Fifteen-year effects of Helicobacter pylori, garlic, and vitamin treatments on gastric cancer incidence and mortality. J Natl Cancer Inst 104 (6): 488-92, 2012. [<a href="/pmc/articles/PMC3309129/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3309129</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/22271764" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22271764</span></a>]</div></li></ol></div></div><div id="CDR0000062830__15"><h2 id="_CDR0000062830__15_">Description of the Evidence</h2><div id="CDR0000062830__16"><h3>Background</h3><div id="CDR0000062830__118"><h4>Incidence and mortality</h4><p id="CDR0000062830__119">The age-adjusted incidence rate for gastric cancer in the United States for the years 2004 to 2008 was 7.7 persons per 100,000 population. Incidence among men is twice as high as among women.[<a class="bk_pop" href="#CDR0000062830_rl_15_1">1</a>] Mortality rates for gastric cancer have been declining worldwide in recent
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decades, most prominently in the United States.[<a class="bk_pop" href="#CDR0000062830_rl_15_2">2</a>,<a class="bk_pop" href="#CDR0000062830_rl_15_3">3</a>] Mortality rates for white
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males in the United States were approximately 40 deaths per 100,000 population in 1930, compared
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with 4.6 deaths per 100,000 population for the years 2003 to 2007. The death rate from gastric cancer for black males was 2.3 times higher than for whites for the years 2003 to 2007.[<a class="bk_pop" href="#CDR0000062830_rl_15_4">4</a>] The annual number of new cases seems to be steady in recent years; in
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2016, it is estimated that 26,370 Americans will be diagnosed with gastric cancer and
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10,730 persons will die of it.[<a class="bk_pop" href="#CDR0000062830_rl_15_5">5</a>] Gastric cancer is the fourth most common cancer in the world.[<a class="bk_pop" href="#CDR0000062830_rl_15_6">6</a>,<a class="bk_pop" href="#CDR0000062830_rl_15_7">7</a>] Worldwide, the estimated number of cases per year in 2008 was 988,000, and the estimated number of deaths was 736,000. Age-standardized annual incidence rates vary widely across the world: from 3.9 to 42.4 cases per 100,000 in men, and from 2.2 to 18.3 cases per 100,000 in women. More than 70% of cases occur in developing countries, and 50% of the cases occur in Eastern Asia.[<a class="bk_pop" href="#CDR0000062830_rl_15_7">7</a>]</p><p id="CDR0000062830__120">Most
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cancers in the United States are advanced at diagnosis, which is reflected in
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an overall 5-year survival rate of 29.9% from 2005 to 2011.[<a class="bk_pop" href="#CDR0000062830_rl_15_8">8</a>] Carcinomas
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localized to the mucosa or submucosa (“early” cancers) have a much better prognosis;
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the 5-year survival rate is more than 95% in Japan and more than 65% in the United States. In
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high-risk populations, secondary prevention measures linked to screening programs have
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been instituted.[<a class="bk_pop" href="#CDR0000062830_rl_15_9">9</a>] In Japan, endoscopic resection techniques have been
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refined and could possibly be responsible for drastic reductions in mortality rates in the
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presence of steady incidence rates. This hypothesis, however, has not been
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tested in clinical trials.
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(Refer to the PDQ summary on <a href="/books/n/pdqcis/CDR0000062757/">Stomach (Gastric) Cancer Screening</a> for more information.) </p></div><div id="CDR0000062830__121"><h4>Pathogenesis</h4><p id="CDR0000062830__123">Understanding the pathogenesis of gastric cancer has advanced over the
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years. A lengthy precancerous process has been identified in which the
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gastric mucosa is slowly transformed from normal to chronic gastritis, to
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multifocal atrophy, to intestinal metaplasia of various degrees, to dysplasia,
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and then to invasive carcinoma.[<a class="bk_pop" href="#CDR0000062830_rl_15_10">10</a>] The process is apparently driven by
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forces acting on the gastric epithelium for many years, such as excessive dietary salt and most
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prominently, infection with <i>H. pylori</i>.</p></div></div><div id="CDR0000062830__138"><h3>Interventions for Reduction of Stomach (Gastric) Cancer Risk</h3><div id="CDR0000062830__139"><h4>Smoking cessation</h4><p id="CDR0000062830__140">A systematic review and meta-analysis showed a 60% increase in gastric cancer in male smokers and a 20% increase in gastric cancer in female smokers compared with nonsmokers.[<a class="bk_pop" href="#CDR0000062830_rl_15_11">11</a>] A systematic review of studies addressing the relationship between cigarette smoking and gastric cancer to estimate the magnitude of the association for different levels of exposure to cancer provides solid evidence to classify smoking as the most important behavioral risk factor for gastric cancer.[<a class="bk_pop" href="#CDR0000062830_rl_15_11">11</a>-<a class="bk_pop" href="#CDR0000062830_rl_15_13">13</a>] Compared with persistent smokers, the risk of stomach cancer decreases among former smokers with time since cessation. The pattern that emerges from these observations makes it reasonable to infer that cigarette smoking prevention or cessation would result in a decreased risk of gastric cancer.</p></div><div id="CDR0000062830__141"><h4><i>H. pylori</i> infection eradication</h4><p id="CDR0000062830__142"><i>H. pylori</i> infection is an accepted cause of gastric adenocarcinoma.[<a class="bk_pop" href="#CDR0000062830_rl_15_14">14</a>,<a class="bk_pop" href="#CDR0000062830_rl_15_15">15</a>] Questions remain concerning the natural history of <i>H. pylori</i> infection; the mechanism of transmission and the rates of reinfection or recrudescence for different populations are unknown.[<a class="bk_pop" href="#CDR0000062830_rl_15_16">16</a>,<a class="bk_pop" href="#CDR0000062830_rl_15_17">17</a>] A small randomized trial of antibiotic eradication in 140 <i>H. pylori</i>-infected people suggests the possibility of transmission among close family members.[<a class="bk_pop" href="#CDR0000062830_rl_15_18">18</a>] In 70 participants, only the participant received eradication therapy; in the other 70 participants, all <i>H. pylori</i>-infected family members living with the primary participant also received the eradication therapy. Nine months after the therapy, the positivity rates in the index participants in each group were 38.6% and 7.1%, respectively (odds ratio = 8.61; 95% confidence interval [CI], 2.91–22.84), suggesting the possibility of transmission from untreated, infected family members. </p><p id="CDR0000062830__143">Since about half of the world population is infected with <i>H. pylori</i>, antibacterial treatment for all people who are chronically infected may be impractical and could trigger antimicrobial resistance. Vaccination against <i>H. pylori</i> has been shown effective in experimental animal models, but thus far, such efficacy has not been studied in humans.</p><p id="CDR0000062830__160">A randomized controlled trial (RCT) showed that short-term treatment with amoxicillin and omeprazole reduced the incidence of gastric cancer by 39% during a period of 15 years following randomization, with similar but not statistically significant reductions for gastric cancer mortality.[<a class="bk_pop" href="#CDR0000062830_rl_15_19">19</a>]</p><p id="CDR0000062830__144">A meta-analysis of seven randomized studies, all conducted in areas with high-risk gastric cancer populations, and all but one study conducted in Asia, suggests that treatment of <i>H. pylori</i> may reduce gastric cancer risk (from 1.7% to 1.1%; relative risk [RR] = 0.65; 95% CI, 0.43–0.98).[<a class="bk_pop" href="#CDR0000062830_rl_15_20">20</a>] Only two studies assessed gastric cancer incidence as the primary study outcome, and two different studies were double blinded. It is unclear how generalizable the results may be to the North American population. It would be useful to know which subgroups of persons with <i>H. pylori</i> are particularly likely to develop cancer in order to decide which subgroups might be appropriate to consider for targeted screening and eradication. However, studies in <i>H. pylori</i>-infected subjects have been underpowered for determining progression to invasive cancer. Even studies of associations between baseline characteristics (such as age, alcohol use, and well water used as the source of drinking water in rural China) and histologic progression of intestinal metaplasia to more severe grades of metaplasia show associations of insufficient magnitude to be useful in clinical decision making.[<a class="bk_pop" href="#CDR0000062830_rl_15_21">21</a>]</p></div></div><div id="CDR0000062830__145"><h3>Interventions With Inadequate Evidence as to Whether They Reduce the Risk of Stomach (Gastric) Cancer or Evidence of No Effect</h3><div id="CDR0000062830__146"><h4>Diet</h4><p id="CDR0000062830__147">Excessive salt intake has been identified as a possible risk factor for gastric cancer in correlation and case-control studies.[<a class="bk_pop" href="#CDR0000062830_rl_15_22">22</a>,<a class="bk_pop" href="#CDR0000062830_rl_15_23">23</a>] The daily intake of salt has decreased drastically in most western countries and in Japan, in part due to public health campaigns to reduce hypertensive diseases. This may be at least partially responsible for declines in gastric cancer rates. There is a consistent association between high salt intake and the risk of gastric cancer. </p><p id="CDR0000062830__148">Epidemiologic evidence from case-control and cohort studies suggests that increased intake of fresh fruits and vegetables is associated with decreased gastric cancer rates.[<a class="bk_pop" href="#CDR0000062830_rl_15_23">23</a>,<a class="bk_pop" href="#CDR0000062830_rl_15_24">24</a>] However, no RCTs have been done to establish a causal association.</p></div><div id="CDR0000062830__149"><h4>Dietary supplements</h4><p id="CDR0000062830__150">Because of the evidence for an inverse association between gastric cancer and dietary intake of fruits and vegetables, especially those rich in antioxidants, there has been interest in dietary supplementation with antioxidants.</p><p id="CDR0000062830__151">Dietary indices of micronutrient intake have been calculated and indicate possible protective effects of beta carotene, vitamin A, vitamin E, selenium, vitamin C or foods that contain these compounds. A chemoprevention trial in China reported a statistically significant reduction in the gastric cancer mortality rate after supplementation with beta carotene, vitamin E, and selenium.[<a class="bk_pop" href="#CDR0000062830_rl_15_25">25</a>] The population studied, however, may have been nutritionally deficient, raising questions of generalizability to other populations such as that of the United States. In addition, the experimental design did not permit assessment of the relative effects of beta carotene, vitamin E, and selenium.</p><p id="CDR0000062830__152">Likewise, there was a randomized placebo-controlled trial of 200 mg of oral allitridium (a component of garlic) every day combined with 100 mcg of oral selenium every other day for 1 month of each year over a 3-year period in Qixia County (Shandong Province, China), an area with low intake of garlic and low selenium content in their garlic compared with other areas of China.[<a class="bk_pop" href="#CDR0000062830_rl_15_26">26</a>] Although designed as a double-blinded trial, allitridium causes a distinctive odor of garlic. A total of 5,033 people, who met at least one of the following criteria: (1) medical history of stomach disorder, (2) family history of tumor, (3) history of smoking, or (4) history of alcohol consumption, were randomly assigned. The study, published in a Chinese medical journal, was not well described. After a follow-up for as many as 11 years, there were a total of 23 gastric cancer cases in the allitridium/selenium group and 30 cases in the placebo group (RR after adjustment for a number of baseline characteristics = 0.48; 95% CI, 0.21–1.06). Only 60% of the gastric cancers were diagnosed by histopathology. There was a qualitative difference in outcome by sex: RRmen = 0.36 (95% CI, 0.14–0.92); RRwomen = 1.14 (95% CI, 0.22–5.76). Given the problems with design and reporting of the study, the evidence of benefit (including men) is weak and may not be generalizable to Western countries.</p><p id="CDR0000062830__153">In a randomized, double-blind, chemoprevention trial in Venezuela among a population at increased risk for gastric cancer, a combination of antioxidant vitamins (vitamins C, E, and beta carotene) failed to modify progression or regression of precancerous gastric lesions.[<a class="bk_pop" href="#CDR0000062830_rl_15_27">27</a>] Another potential explanation for the lack of benefit of vitamin supplementation in this trial was the high prevalence of advanced premalignant lesions and the high <i>H. pylori</i> infection rate.[<a class="bk_pop" href="#CDR0000062830_rl_15_28">28</a>]</p><p id="CDR0000062830__154">A secondary analysis of the Alpha-Tocopherol Beta Carotene trial conducted on male smokers in Finland evaluated the effect of supplementation on gastric cancer incidence.[<a class="bk_pop" href="#CDR0000062830_rl_15_29">29</a>] No protective effects for these supplements against gastric cancer were observed. Six-year follow-up results of a study of 976 Colombian patients have been reported. Patients were randomly assigned to receive eight different treatments that included vitamin supplements and anti-Helicobacter therapy either alone or in combination versus placebo. Among the 79 patients who received anti-Helicobacter therapy, a borderline statistically significant regression of intestinal metaplasia when compared with a placebo (15% vs. 6%; RR = 3.1; 95% CI, 1.0–9.3) was noted. However, the combinations of antibiotics and vitamins did not confer additional benefits. More importantly, the progression rate of intestinal metaplasia was comparable irrespective of the treatments received. The progression rate was 23% in the placebo group and 17% in antibiotic recipients.[<a class="bk_pop" href="#CDR0000062830_rl_15_30">30</a>]</p><p id="CDR0000062830__155">A systematic review examined randomized trials of antioxidant dietary supplements for the prevention of gastrointestinal cancers, including gastric cancer.[<a class="bk_pop" href="#CDR0000062830_rl_15_31">31</a>] Twenty trials were identified that assessed the preventive effects of antioxidant supplements or vitamin C on gastrointestinal cancer. With regard to gastric cancer, there were 12 comparisons of one or more micronutrients with placebo: beta-carotene alone (4 trials); vitamin C alone (1 trial); vitamin E alone (1 trial); vitamin A plus beta-carotene (1 trial); beta-carotene plus vitamin C (1 trial); beta-carotene plus vitamin E (1 trial); beta-carotene plus vitamins C and E (1 trial); selenium plus vitamins C and E (1 trial); and beta-carotene, vitamins C and E, and selenium (1 trial). None of the comparisons showed a statistically significant effect on the incidence of gastric cancer. The overall summary estimate across all trials of antioxidants showed no statistically significant effect (RR of gastric cancer = 1.14; 95% CI, 0.97–1.33). Approximately 0.51% of participants in the combined antioxidant groups developed gastric cancer versus 0.38% in the placebo groups after treatment of 2.1 to 12 years and follow-up for as many as 14.1 years. In the combined analysis of all 20 trials of antioxidants for the prevention of gastrointestinal cancers, a fixed effects model showed an increase in overall mortality of antioxidants compared with a placebo (RR for mortality = 1.04; 95% CI, 1.02–1.07) but not in a random effects model (RR for mortality = 1.02; 95% CI, 0.97–1.07)</p></div></div><div id="CDR0000062830_rl_15"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062830_rl_15_1">Howlader N, Noone AM, Krapcho M, et al., eds.: SEER Cancer Statistics Review, 1975-2008. Bethesda, Md: National Cancer Institute, 2011. <a href="http://seer.cancer.gov/csr/1975_2008/index.html" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Also available online</a>. Last accessed February 4, 2016.</div></li><li><div class="bk_ref" id="CDR0000062830_rl_15_2">Qiu D, Tanaka S: International comparisons of cumulative risk of stomach cancer, from Cancer Incidence in Five Continents Vol. VIII. Jpn J Clin Oncol 36 (2): 123-4, 2006. [<a href="https://pubmed.ncbi.nlm.nih.gov/16517837" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16517837</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_15_3">Stomach. In: Ries LA, Kosary CL, Hankey BF, et al., eds.: SEER Cancer Statistics Review 1973-1995. Bethesda, Md: National Cancer Institute, 1998, Section 13.</div></li><li><div class="bk_ref" id="CDR0000062830_rl_15_4">Altekruse SF, Kosary CL, Krapcho M, et al.: SEER Cancer Statistics Review, 1975-2007. Bethesda, Md: National Cancer Institute, 2010. <a href="http://seer.cancer.gov/archive/csr/1975_2007/" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Also available online</a>. Last accessed February 2, 2016.</div></li><li><div class="bk_ref" id="CDR0000062830_rl_15_5">American Cancer Society: Cancer Facts and Figures 2016. Atlanta, Ga: American Cancer Society, 2016. <a href="http://www.cancer.org/acs/groups/content/@research/documents/document/acspc-047079.pdf" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Available online.</a> Last accessed May 19, 2016.</div></li><li><div class="bk_ref" id="CDR0000062830_rl_15_6">Parkin DM: Global cancer statistics in the year 2000. Lancet Oncol 2 (9): 533-43, 2001. [<a href="https://pubmed.ncbi.nlm.nih.gov/11905707" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11905707</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_15_7">Ferlay J, Shin HR, Bray F, et al.: GLOBOCAN 2008:
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Cancer Incidence and Mortality Worldwide in 2008. Lyon, France: IARC CancerBase No. 10. <a href="http://globocan.iarc.fr/" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Available online</a>. Last accessed February 4, 2016.</div></li><li><div class="bk_ref" id="CDR0000062830_rl_15_8">Howlader N, Noone AM, Krapcho M, et al., eds.: SEER Cancer Statistics Review, 1975-2012. Bethesda, Md: National Cancer Institute, 2015. <a href="http://seer.cancer.gov/csr/1975_2012/" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Also available online</a>. Last accessed February 8, 2016.</div></li><li><div class="bk_ref" id="CDR0000062830_rl_15_9">Tan YK, Fielding JW: Early diagnosis of early gastric cancer. Eur J Gastroenterol Hepatol 18 (8): 821-9, 2006. [<a href="https://pubmed.ncbi.nlm.nih.gov/16825897" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16825897</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_15_10">Correa P: Human gastric carcinogenesis: a multistep and multifactorial process--First American Cancer Society Award Lecture on Cancer Epidemiology and Prevention. Cancer Res 52 (24): 6735-40, 1992. [<a href="https://pubmed.ncbi.nlm.nih.gov/1458460" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1458460</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_15_11">Ladeiras-Lopes R, Pereira AK, Nogueira A, et al.: Smoking and gastric cancer: systematic review and meta-analysis of cohort studies. Cancer Causes Control 19 (7): 689-701, 2008. [<a href="https://pubmed.ncbi.nlm.nih.gov/18293090" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18293090</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_15_12">González CA, Pera G, Agudo A, et al.: Smoking and the risk of gastric cancer in the European Prospective Investigation Into Cancer and Nutrition (EPIC). Int J Cancer 107 (4): 629-34, 2003. [<a href="https://pubmed.ncbi.nlm.nih.gov/14520702" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14520702</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_15_13">La Torre G, Chiaradia G, Gianfagna F, et al.: Smoking status and gastric cancer risk: an updated meta-analysis of case-control studies published in the past ten years. Tumori 95 (1): 13-22, 2009 Jan-Feb. [<a href="https://pubmed.ncbi.nlm.nih.gov/19366050" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19366050</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_15_14">IARC Working Group on the Evaluation of Carcinogenic Risks to Humans: A review of human carcinogens--Part B: biological agents. Volume 100. Lyon, France: IARC Press, 2011.</div></li><li><div class="bk_ref" id="CDR0000062830_rl_15_15">Bouvard V, Baan R, Straif K, et al.: A review of human carcinogens--Part B: biological agents. Lancet Oncol 10 (4): 321-2, 2009. [<a href="https://pubmed.ncbi.nlm.nih.gov/19350698" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19350698</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_15_16">Cheung TK, Xia HH, Wong BC: Helicobacter pylori eradication for gastric cancer prevention. J Gastroenterol 42 (Suppl 17): 10-5, 2007. [<a href="https://pubmed.ncbi.nlm.nih.gov/17238019" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17238019</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_15_17">de Vries AC, Haringsma J, Kuipers EJ: The detection, surveillance and treatment of premalignant gastric lesions related to Helicobacter pylori infection. Helicobacter 12 (1): 1-15, 2007. [<a href="https://pubmed.ncbi.nlm.nih.gov/17241295" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17241295</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_15_18">Sari YS, Can D, Tunali V, et al.: H pylori: Treatment for the patient only or the whole family? World J Gastroenterol 14 (8): 1244-7, 2008. [<a href="/pmc/articles/PMC2690673/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2690673</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/18300351" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18300351</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_15_19">Ma JL, Zhang L, Brown LM, et al.: Fifteen-year effects of Helicobacter pylori, garlic, and vitamin treatments on gastric cancer incidence and mortality. J Natl Cancer Inst 104 (6): 488-92, 2012. [<a href="/pmc/articles/PMC3309129/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3309129</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/22271764" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22271764</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_15_20">Fuccio L, Zagari RM, Eusebi LH, et al.: Meta-analysis: can Helicobacter pylori eradication treatment reduce the risk for gastric cancer? Ann Intern Med 151 (2): 121-8, 2009. [<a href="https://pubmed.ncbi.nlm.nih.gov/19620164" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19620164</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_15_21">Leung WK, Lin SR, Ching JY, et al.: Factors predicting progression of gastric intestinal metaplasia: results of a randomised trial on Helicobacter pylori eradication. Gut 53 (9): 1244-9, 2004. [<a href="/pmc/articles/PMC1774213/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1774213</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/15306578" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15306578</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_15_22">Stomach. In: World Cancer Research Fund, American Institute for Cancer Research: Food, Nutrition and the Prevention of Cancer: A Global Perspective. Washington, DC: The Institute, 1997, pp 148-175.</div></li><li><div class="bk_ref" id="CDR0000062830_rl_15_23">Buiatti E, Palli D, Decarli A, et al.: A case-control study of gastric cancer and diet in Italy: II. Association with nutrients. Int J Cancer 45 (5): 896-901, 1990. [<a href="https://pubmed.ncbi.nlm.nih.gov/2335393" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2335393</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_15_24">Pisters PWT, Kelsen DP, Tepper JE: Cancer of the stomach. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. Vols. 1 & 2. 8th ed. Philadelphia, Pa: Lippincott Williams & Wilkins, 2008, pp 1043-1079.</div></li><li><div class="bk_ref" id="CDR0000062830_rl_15_25">Blot WJ, Li JY, Taylor PR, et al.: Nutrition intervention trials in Linxian, China: supplementation with specific vitamin/mineral combinations, cancer incidence, and disease-specific mortality in the general population. J Natl Cancer Inst 85 (18): 1483-92, 1993. [<a href="https://pubmed.ncbi.nlm.nih.gov/8360931" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8360931</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_15_26">Li H, Li HQ, Wang Y, et al.: An intervention study to prevent gastric cancer by micro-selenium and large dose of allitridum. Chin Med J (Engl) 117 (8): 1155-60, 2004. [<a href="https://pubmed.ncbi.nlm.nih.gov/15361287" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15361287</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_15_27">Plummer M, Vivas J, Lopez G, et al.: Chemoprevention of precancerous gastric lesions with antioxidant vitamin supplementation: a randomized trial in a high-risk population. J Natl Cancer Inst 99 (2): 137-46, 2007. [<a href="https://pubmed.ncbi.nlm.nih.gov/17227997" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17227997</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_15_28">Taylor PR: Prevention of gastric cancer: a miss. J Natl Cancer Inst 99 (2): 101-3, 2007. [<a href="https://pubmed.ncbi.nlm.nih.gov/17227989" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17227989</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_15_29">Malila N, Taylor PR, Virtanen MJ, et al.: Effects of alpha-tocopherol and beta-carotene supplementation on gastric cancer incidence in male smokers (ATBC Study, Finland). Cancer Causes Control 13 (7): 617-23, 2002. [<a href="https://pubmed.ncbi.nlm.nih.gov/12296509" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12296509</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_15_30">Correa P, Fontham ET, Bravo JC, et al.: Chemoprevention of gastric dysplasia: randomized trial of antioxidant supplements and anti-helicobacter pylori therapy. J Natl Cancer Inst 92 (23): 1881-8, 2000. [<a href="https://pubmed.ncbi.nlm.nih.gov/11106679" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11106679</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062830_rl_15_31">Bjelakovic G, Nikolova D, Simonetti RG, et al.: Antioxidant supplements for preventing gastrointestinal cancers. Cochrane Database Syst Rev (3): CD004183, 2008. [<a href="https://pubmed.ncbi.nlm.nih.gov/18677777" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18677777</span></a>]</div></li></ol></div></div><div id="CDR0000062830__31"><h2 id="_CDR0000062830__31_">Changes to This Summary (02/05/2016)</h2><p id="CDR0000062830__33">The PDQ cancer information summaries are reviewed regularly and updated as
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new information becomes available. This section describes the latest
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changes made to this summary as of the date above.</p><p id="CDR0000062830__165"><b><a href="#CDR0000062830__15">Description of the Evidence</a></b></p><p id="CDR0000062830__166">Updated <a href="#CDR0000062830__119">statistics</a> with estimated new cases and deaths for 2016 (cited American Cancer Society as reference 5).</p><p id="CDR0000062830__169">Revised <a href="#CDR0000062830__120">text</a> to state that most cancers in the United States are advanced at diagnosis, which is reflected in an overall 5-year survival rate of 29.9% from 2005 to 2011 (cited Howlader et al. as reference 8).</p><p id="CDR0000062830__disclaimerHP_3">This summary is written and maintained by the <a href="http://www.cancer.gov/publications/pdq/editorial-boards/screening-prevention" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Screening and Prevention Editorial Board</a>, which is
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editorially independent of NCI. The summary reflects an independent review of
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the literature and does not represent a policy statement of NCI or NIH. More
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information about summary policies and the role of the PDQ Editorial Boards in
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maintaining the PDQ summaries can be found on the <a href="#CDR0000062830__AboutThis_1">About This PDQ Summary</a> and <a href="http://www.cancer.gov/publications/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ® - NCI's Comprehensive Cancer Database</a> pages.
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</p></div><div id="CDR0000062830__AboutThis_1"><h2 id="_CDR0000062830__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000062830__AboutThis_2"><h3>Purpose of This Summary</h3><p id="CDR0000062830__AboutThis_3">This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about stomach (gastric) cancer prevention. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.</p></div><div id="CDR0000062830__AboutThis_4"><h3>Reviewers and Updates</h3><p id="CDR0000062830__AboutThis_5">This summary is reviewed regularly and updated as necessary by the <a href="http://www.cancer.gov/publications/pdq/editorial-boards/screening-prevention" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Screening and Prevention Editorial Board</a>, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).</p><p id="CDR0000062830__AboutThis_22"> Board members review recently published articles each month to determine whether an article should:</p><ul id="CDR0000062830__AboutThis_6"><li class="half_rhythm"><div>be discussed at a meeting,</div></li><li class="half_rhythm"><div>be cited with text, or</div></li><li class="half_rhythm"><div>replace or update an existing article that is already cited.</div></li></ul><p id="CDR0000062830__AboutThis_7">Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.</p><p id="CDR0000062830__AboutThis_9">Any comments or questions about the summary content should be submitted to Cancer.gov through the NCI website's <a href="http://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Email Us</a>. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.</p></div><div id="CDR0000062830__AboutThis_10"><h3>Levels of Evidence</h3><p id="CDR0000062830__AboutThis_11">Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Screening and Prevention Editorial Board uses a <a href="/books/n/pdqcis/CDR0000304747/">formal evidence ranking system</a> in developing its level-of-evidence designations.</p></div><div id="CDR0000062830__AboutThis_12"><h3>Permission to Use This Summary</h3><p id="CDR0000062830__AboutThis_13">PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary].”</p><p id="CDR0000062830__AboutThis_14">The preferred citation for this PDQ summary is:</p><p id="CDR0000062830__AboutThis_15">PDQ® Screening and Prevention Editorial Board. PDQ Stomach (Gastric) Cancer Prevention. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: <a href="http://www.cancer.gov/types/stomach/hp/stomach-prevention-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">http://www.cancer.gov/types/stomach/hp/stomach-prevention-pdq</a>. Accessed <MM/DD/YYYY>. [PMID: 26389263]</p><p id="CDR0000062830__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in <a href="http://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>, a collection of over 2,000 scientific images.
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</p></div><div id="CDR0000062830__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000062830__AboutThis_19">The information in these summaries should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the <a href="http://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000062830__AboutThis_20"><h3>Contact Us</h3><p id="CDR0000062830__AboutThis_21">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="http://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="http://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Email Us</a>.</p></div></div></div></div>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK65822.2/?report=reader">PubReader</a></li><li><a href="/books/NBK65822.2/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK65822" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK65822" style="display:none" title="Cite this Page"><div class="bk_tt">PDQ Screening and Prevention Editorial Board. Stomach (Gastric) Cancer Prevention (PDQ®): Health Professional Version. 2016 Feb 5. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. <span class="bk_cite_avail"></span></div></div></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Version History</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter shutter_closed" title="Show/hide content" remembercollapsed="true" pgsec_name="version_history" id="Shutter"></a></div><div class="portlet_content" style="display: none;"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><span class="bk_col_itm"><a href="/books/NBK65822.17/">NBK65822.17</a></span> December 30, 2024</li><li><span class="bk_col_itm"><a href="/books/NBK65822.16/">NBK65822.16</a></span> March 19, 2024</li><li><span class="bk_col_itm"><a href="/books/NBK65822.15/">NBK65822.15</a></span> May 31, 2023</li><li><span class="bk_col_itm"><a href="/books/NBK65822.14/">NBK65822.14</a></span> February 7, 2022</li><li><span class="bk_col_itm"><a href="/books/NBK65822.13/">NBK65822.13</a></span> August 6, 2021</li><li><span class="bk_col_itm"><a href="/books/NBK65822.12/">NBK65822.12</a></span> March 18, 2021</li><li><span class="bk_col_itm"><a href="/books/NBK65822.11/">NBK65822.11</a></span> May 15, 2020</li><li><span class="bk_col_itm"><a href="/books/NBK65822.10/">NBK65822.10</a></span> April 16, 2020</li><li><span class="bk_col_itm"><a href="/books/NBK65822.9/">NBK65822.9</a></span> February 20, 2020</li><li><span class="bk_col_itm"><a href="/books/NBK65822.8/">NBK65822.8</a></span> March 6, 2019</li><li><span class="bk_col_itm"><a href="/books/NBK65822.7/">NBK65822.7</a></span> September 21, 2018</li><li><span class="bk_col_itm"><a href="/books/NBK65822.6/">NBK65822.6</a></span> March 7, 2018</li><li><span class="bk_col_itm"><a href="/books/NBK65822.5/">NBK65822.5</a></span> March 10, 2017</li><li><span class="bk_col_itm"><a href="/books/NBK65822.4/">NBK65822.4</a></span> June 17, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK65822.3/">NBK65822.3</a></span> May 27, 2016</li><li><span class="bk_col_itm">NBK65822.2</span> February 5, 2016 (Displayed Version)</li><li><span class="bk_col_itm"><a href="/books/NBK65822.1/">NBK65822.1</a></span> February 9, 2015</li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>In this Page</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="page-toc" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="#CDR0000062830__1" ref="log$=inpage&link_id=inpage">Overview</a></li><li><a href="#CDR0000062830__15" ref="log$=inpage&link_id=inpage">Description of the Evidence</a></li><li><a href="#CDR0000062830__31" ref="log$=inpage&link_id=inpage">Changes to This Summary (02/05/2016)</a></li><li><a href="#CDR0000062830__AboutThis_1" ref="log$=inpage&link_id=inpage">About This PDQ Summary</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related publications</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="document-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK66033/">Patient Version</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Similar articles in PubMed</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PBooksDiscovery_RA" id="Shutter"></a></div><div class="portlet_content"><ul><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389174" ref="ordinalpos=1&linkpos=1&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Stomach (Gastric) Cancer Screening (PDQ®): Health Professional Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Stomach (Gastric) Cancer Screening (PDQ®): Health Professional Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Screening and Prevention Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/38630970" ref="ordinalpos=1&linkpos=2&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Gastric Adenocarcinoma and Proximal Polyposis of the Stomach (GAPPS) (PDQ®): Health Professional Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Gastric Adenocarcinoma and Proximal Polyposis of the Stomach (GAPPS) (PDQ®): Health Professional Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Cancer Genetics Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/31661203" ref="ordinalpos=1&linkpos=3&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Pediatric Gastric Cancer Treatment (PDQ®): Health Professional Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Pediatric Gastric Cancer Treatment (PDQ®): Health Professional Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Pediatric Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389209" ref="ordinalpos=1&linkpos=4&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Gastric Cancer Treatment (PDQ®): Health Professional Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Gastric Cancer Treatment (PDQ®): Health Professional Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Adult Treatment Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/37669413" ref="ordinalpos=1&linkpos=5&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Genetics of Gastric Cancer (PDQ®): Health Professional Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Genetics of Gastric Cancer (PDQ®): Health Professional 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