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Gastric cancer remains a major cause of cancer-related mortality worldwide. The temporal trends for this malignancy, however, are dynamic, and reports from the past decade indicate important declines in some regions and demographic groups, as well as a few notable exceptions in which gastric cancer rates are either stable or increasing. Two main anatomical subtypes of gastric cancer exist, non-cardia and cardia, with different temporal trends and risk factors (such as obesity and reflux for cardia gastric cancer and Helicobacter pylori infection for non-cardia gastric cancer). Shifts in the distribution of anatomical locations have been detected in several high-incidence regions. H. pylori is an important aetiological factor for gastric cancer; importantly, the anticipated long-term findings from studies examining the effect of H. pylori eradication on the risk of (re)developing gastric cancer have emerged in the past few years. In this Review, we highlight the latest trends in incidence and mortality using an evidence-based approach. We make the best possible inferences, including clinical and public health inference, on the basis of the quality of the evidence available, and highlight burning questions as well as gaps in knowledge and public health practice that need to be addressed to reduce gastric cancer burden worldwide.Globally, gastric cancer is a common and highly fatal cancer with two anatomical subtypes, non-cardia and cardia gastric cancer. Helicobacter pylori causes almost 90% of distal gastric cancers worldwide. The authors of this Review summarize the current epidemiology of gastric cancer and the evidence and implications of primary and secondary prevention efforts.

•Between 1973 and 2001, oesophageal adenocarcinoma was one of the fastest rising cancers in many developed countries.•Although the rate of increase has slowed, incidence of oesophageal adenocarcinoma continues to rise and will constitute an increasingly large health burden in the years ahead.•Men are seven times more likely than women to develop oesophageal adenocarcinoma; the reasons for the striking sex disparity remain unknown.•Gastro-oesophageal reflux disease, obesity and cigarette smoking are the main risk factors for oesophageal adenocarcinoma.•In contrast, the incidence of oesophageal squamous-cell carcinoma continues to decline in Western populations.•5-year survival rates for oesophageal cancer remain less than 20%. Since the early 1970s, the incidence of oesophageal adenocarcinoma has increased dramatically in most Western populations. In contrast, the incidence of oesophageal squamous-cell carcinoma has decreased in these same populations. Epidemiological studies conducted over the past decade have provided great insights into the etiology of oesophageal cancer. These studies have identified gastro-oesophageal reflux disease, obesity and cigarette smoking as risk factors for oesophageal adenocarcinoma, while use of nonsteroidal anti-inflammatory drugs and infection with Helicobacter pylori are associated with reduced risk of oesophageal adenocarcinoma. For oesophageal squamous-cell carcinoma, alcohol and cigarette smoking are the two major risk factors underlying most cases. This review combines a synthesis of these studies with an analysis of data from the United States National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program to discuss the change in incidence of oesophageal cancer and summarize current knowledge of risk factors.

Non-alcoholic fatty liver disease (NAFLD) is increasingly common in the adult population. In the United States, the overall burden of NAFLD is unknown due to challenges with population-level NAFLD detection. The purpose of this study was to estimate prevalence of NAFLD and significant NAFLD fibrosis and identify factors associated with them in the U.S. Data came from the 2017-2018 cycle of National Health and Nutrition Examination Survey. We defined NAFLD by controlled attenuation parameter (CAP) scores of ≥248 dB/m in absence of excessive alcohol use and viral hepatitis. We defined significant fibrosis as Vibration controlled transient elastography (VCTE) liver stiffness measurements (LSM) value ≥7.9 kPa. We calculated the adjusted odds ratio (OR) and 95% confidential intervals (CI) for associations with NAFLD and significant NAFLD fibrosis using multivariable logistic regression. Overall, among 4,024 individuals aged ≥20 years included in the analysis, 56.7% had NAFLD by CAP. In comparison, when defined by elevated liver enzymes, NAFLD prevalence was 12.4%. The prevalence of significant NAFLD fibrosis by VCTE LSM was 14.5%. NAFLD prevalence increased with age, was higher among men than women and among Hispanics compared with non-Hispanic whites. Individuals who were obese, had metabolic syndrome (MetS) and type 2 diabetes were more likely to have NAFLD compared to those that who were not obese or without MetS/diabetes. Inadequate physical activity (OR = 1.57, 95% CI: 1.18-2.08) was also a factor associated with NAFLD. MetS, high waist circumstance, diabetes and hypertension were independently associated with significant NAFLD fibrosis. NAFLD and significant NAFLD fibrosis are highly prevalent in U.S. general population.

Oesophageal cancer is a global health problem; in 2018 there were more than 572,000 people newly diagnosed with oesophageal cancer worldwide. There are two main histological subtypes of oesophageal cancer, oesophageal adenocarcinoma (EAC) and oesophageal squamous cell carcinoma (ESCC), and there has been a dramatic shift in its epidemiology. While the incidence of EAC and its precursor lesion, Barrett oesophagus, has increased in Western populations over the past four decades, the incidence of ESCC has declined in most parts of the world over the same period. ESCC still accounts for the vast majority of all oesophageal cancer cases diagnosed worldwide each year. Prognosis for patients with oesophageal cancer is strongly related to stage at diagnosis. As most patients are diagnosed with late-stage disease, overall 5-year survival for oesophageal cancer remains <20%. Knowledge of epidemiology and risk factors for oesophageal cancer is essential for public health and clinical decisions about risk stratification, screening and prevention. The goal of this Review is to establish the current epidemiology of oesophageal cancer, with a particular focus on the Western world and the increasing incidence of EAC and Barrett oesophagus.Oesophageal cancer is a global health problem with two main histological subtypes, oesophageal adenocarcinoma and oesophageal squamous cell carcinoma. This Review establishes the current epidemiology of oesophageal cancer, with a particular focus on the increasing incidence of oesophageal adenocarcinoma and its precursor, Barrett oesophagus.

A number of modifiable risk factors have been designated as being causally related to cancer development. We aimed to estimate the percentage of incident cancer cases diagnosed in persons aged [greater than or equal to]25 years in Texas in 2015, overall and by race/ethnicity, that were attributable to these modifiable risk factors. We calculated population attributable fractions (PAFs) for cancers attributable to thirteen modifiable risk factors using prevalence data from the Texas Behavioral Risk Factor Surveillance System and the National Health and Nutrition Examination Survey, as well as relative risks estimates from prior studies and cancer incidence data from the Texas Cancer Registry. Overall, 32.3% of all incident cancers (N = 33,416) in 2015 were attributable to modifiable risk factors. Men (35.1%) had a numerically higher overall PAF than women (29.5%). Tobacco smoking caused the highest proportion of cancers (18.4%), followed by overweight and obesity (6.6%) and excess alcohol consumption (2.9%). Non-Hispanic Blacks had a numerically higher overall PAF (36.8%) than non-Hispanic Whites (31.9%) and Hispanics (31.7%). Further, non-Hispanic Blacks had the highest combined PAFs for 85% of cancer sites analyzed, including lung/bronchus and mouth/pharynx/larynx. Modifiable risk factors cause about one third of cancers in Texas. Non-Hispanic Blacks are especially affected by an excessive preventable cancer burden.

The risk of noncardia gastric cancer is increased in the presence of gastric intestinal metaplasia. We aimed to identify demographic and lifestyle factors independently associated with the risk of gastric intestinal metaplasia. We used data from a cross-sectional study of patients attending primary care and endoscopy clinics at the Michael E. DeBakey VA Medical Center in Houston, Texas, between February 2008 and August 2013. All patients completed standardized questionnaires and underwent endoscopy with gastric mapping biopsies. Gastric intestinal metaplasia cases included patients with intestinal metaplasia on any noncardia gastric biopsy; we defined extensive gastric intestinal metaplasia as antrum and corpus involvement. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) using multivariate logistic regression models. We identified 423 cases with gastric intestinal metaplasia and 1,796 controls without gastric intestinal metaplasia. Older age (vs <60 years: 60-69 years AdjOR, 1.50; 95% CI, 1.17-1.93; ≥70 years AdjOR, 2.12; 95% CI, 1.48-3.04), male sex (AdjOR, 2.76; 95% CI, 1.50-5.10), nonwhite race/ethnicity (vs non-Hispanic white: Hispanic, AdjOR, 2.66; 95% CI, 1.89-3.76; black, AdjOR, 2.36; 95% CI, 1.85-3.02), and current smoking status (AdjOR, 1.78; 95% CI, 1.29-2.48) were independently associated with gastric intestinal metaplasia. These risk factors remained statistically significantly associated with gastric intestinal metaplasia after adjusting for Helicobacter pylori infection, and their effect sizes were larger for associations with extensive gastric intestinal metaplasia compared with focal gastric intestinal metaplasia. Older age, male sex, nonwhite race/ethnicity, and current smoking status were the nonendoscopic factors independently associated with gastric intestinal metaplasia in a predominantly nonimmigrant US population.

BackgroundA growing number of studies that differ in design, quality, and results report an association between the use of proton pump inhibitors (PPIs) and the risk of gastric cancer (GC). We conducted a systematic review and meta-analysis, when possible, of observational and interventional studies examining PPI use and risk of GC.MethodsWe followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We identified studies fully published in English through January 2023 using MeSH and non-MeSH keywords. We used random effects models to calculate pooled risk estimates with 95% confidence interval (CI) between PPI use and overall GC, cardia GC, and non-cardia GC. We estimated heterogeneity (I2) among studies. We examined the effect of study design and quality, GC site, H. pylori infection, and PPI duration. We assessed quality using the Newcastle–Ottawa Quality Assessment Scale and Risk Of Bias In Non-randomized Studies of Interventions.ResultsWe identified 15 observational studies, of which 13 were included in the meta-analysis (six cohort and seven case–control). There was a modest 1.67-fold increase in overall GC risk (95% CI 1.39, 2.00) and no increase in cardia GC risk [odds ratio (OR) 1.12; 95% CI 0.80, 1.56] with PPI use. However, there was high heterogeneity (I2 = 61.3%, p = 0.004) among studies. All but one study had at least moderate risk of bias. In the six studies accounting for H. pylori, GC risk associated with PPI use increased slightly (OR 1.78; 95% CI 1.25, 2.52). Duration response was not reported consistently to allow pooled estimates. We identified only one interventional randomized controlled study that included GC as an outcome of interest, and it did not show increased GC risk.ConclusionsThe overall available evidence is not supportive of a meaningful change in GC risk, either cardia or non-cardia, with PPI use.

BackgroundRecent findings indicate a shift in the epidemiology of non-cardia gastric cancer in the USA. In particular, an uprising trend in incidence rates among non-Hispanic whites aged < 50 years.AimTo examine secular trends in the incidence of non-cardia gastric cancer among adults aged < 50 years in the USA by race/ethnicity and stage at diagnosis.MethodsAge-adjusted incidence rates and trends in adults aged < 50 years and ≥ 50 years were calculated using data from all 50 states in the National Program of Cancer Registries and the SEER program. We used joinpoint regression to compute average annual percent change (AAPC) in cancer incidence rates.ResultsOverall, we found an increasing trend of non-cardia gastric cancer among non-Hispanic whites aged < 50 years between 2001 and 2014 (AAPC = 1.24, 95% CI 0.49, 1.99). However, among non-Hispanic whites aged < 50 years, the rates of localized disease increased (AAPC = 5.28, 95% CI 3.94, 6.64), whereas the rates of distant stage non-cardia gastric cancer remained unchanged (AAPC = 0.68, 95% CI − 0.63, 2.00). Conversely, we found a significant increase in rates of distant stage non-cardia gastric cancer among Hispanics aged < 50 years (AAPC = 1.78, 95% CI 0.66, 2.91). Non-cardia gastric cancer incidence rates decreased over the study period among non-Hispanic whites and Hispanics aged ≥ 50 years.ConclusionGiven the rapid growth of the young Hispanic population in the USA, preventative strategies for non-cardia gastric cancer cannot neglect this population.

Overall 5-year survival rates for patients diagnosed with hepatocellular carcinoma (HCC) are poor, but vary by race/ethnicity. We undertook a comprehensive assessment of underlying contributing factors to the favorable survival outcomes of HCC among Asians compared with non-Hispanic whites (NHW). We identified 1,284 Asian and 7,072 NHW patients newly diagnosed with HCC between 1994 and 2011 in the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database. We used a novel three-step sequential matching approach to identify demographic, presentation and treatment factors that may explain survival differences between Asians and NHWs. Hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) for the association between Asian race and risk of HCC-related mortality were estimated using Cox proportional hazards models. The absolute difference in 5-year survival rates between Asians and NHWs was 8.4% (95% CI: 4.6%-12.0%) in the demographics match analysis. The disparity remained unchanged after additionally matching on stage, grade and comorbidities in the presentation match analysis. However, in the treatment match analysis, which accounts for differences in demographic, presentation and treatment factors, the absolute difference in 5-year survival rates was reduced to 5.8% (95% CI: 2.6%-9.3%). Treatment differences explained more of survival disparity in Asian and NHW patients with localized disease than for those with regional or distant stage HCC. Asian patients with HCC continue to have more favorable survival outcomes than NHWs with HCC. This persistent disparity seems to be more related to treatment differences than to differences in presentation characteristics including stage.

BackgroundThe risk and determinants of HCC in patients with primary biliary cholangitis (PBC) are unclear. We conducted a systematic review and meta-analysis of the incidence of HCC and risk factors associated with HCC risk among patients with PBC.MethodsWe searched PubMed, EMBASE, MEDLINE, Cochrane databases and reference lists from relevant articles to identify cohort studies that examined incidence of HCC in patients with PBC from inception through November 2019.ResultsA total of 29 studies including 22,615 patients met the eligibility criteria. The median cohort size was 292 patients followed for an average of 76 months. The pooled incidence rate for patients with PBC was 4.17 per 1000 patient-years (95% CI 3.17–5.47). On subgroup analysis, the incidence of HCC in patients with PBC cirrhosis was 15.7 per 1000 patient-years (95% CI 8.73–28.24). The HCC incidence rate was 9.82 per 1000 person-years (95% CI 5.92–16.28) in men and 3.82 per 1000 person-years (95% CI 2.85–5.11) in women.ConclusionsCirrhosis is the strongest risk factor for HCC in patients with PBC. Male gender was also a risk factor. Our meta-analysis supports current recommendations of HCC surveillance in patients with PBC cirrhosis. Further studies are needed to evaluate risk factors in this population.