Dr In on the Importance of Early Cancer Prevention Strategies in Gastric Cancer

Haejin In, MD, MPH, MBA, FACS, FSSO, chief diversity officer, associate director, Diversity, Equity and Inclusion, surgical oncologist, associate professor, Surgery, Robert Wood Johnson Medical School, associate professor, Health, Behavior and Policy, Rutgers School of Public Health, discusses the importance of identifying individuals at high risk for developing gastric cancer, specifically those in minority patient populations in the United States (US).

The identification of individuals at a higher risk for developing gastric cancer is an important area of unmet need in the US, In begins. Thus, significance lies in the potential for early cancer detection, offering a window of opportunity to intervene at earlier cancer stages when curative measures are more feasible. A key aspect of this risk assessment involves recognizing specific factors that contribute to an elevated risk for developing gastric cancer, she explains.

One prominent risk factor is a familial history of gastric cancer, an element that underscores the importance of understanding the genetic predisposition to this condition, In emphasizes. Additionally, within the US, people of certain ethnic minorities, such as Asian, Black, and Hispanic individuals, face a higher risk of developing gastric cancer, she states. The identification and consideration of these risk factors are instrumental when identifying individuals who may be highly susceptible to developing this form of cancer, she imparts.

In states that her focus of research lies in early gastric cancer detection. As a surgeon, she often sees the impact of effective intervention. She says that it is her hope for patients to be diagnosed with earlier-stage gastric cancer, so potential cures may become a reality. This impetus has fueled an extensive and ongoing exploration into better understanding risk factors and developing proactive methodologies for identifying high-risk individuals.

Overall, the field of gastric cancer diagnosis and treatment can make a substantial impact on public health by mitigating the burden of gastric cancer through early detection and intervention strategies, In concludes.

Videos

Haejin In, MD, MPH, MBA, FACS, FSSO, discusses the importance of identifying individuals at high risk for developing gastric cancer.

Dr In on the Increased Incidence of Gastric Cancer in Minority Populations

Haejin In, MD, MPH, MBA, FACS, FSSO, chief diversity officer, associate director, Diversity, Equity and Inclusion, surgical oncologist, associate professor, Surgery, Robert Wood Johnson Medical School, associate professor, Health, Behavior and Policy, Rutgers School of Public Health, discusses the increased incidence of gastric cancer in minority patient populations, highlighting the disparities that lead to these patient outcomes in the United States.

Through a close examination of the incidence of this disease within this patient population, investigators have come to the conclusion that gastric cancer is a common cancer among minority patients, In begins. Gastric cancer is not as common among the general patient population; however it ranks within the top 10 most frequently observed cancers within minority groups, particularly among Black and Hispanic communities, she says, adding that for specific Asian populations, gastric cancer may even be within the top 5 cancers. Increased disparities in disease outcomes and mortality among patients with gastric cancer are therefore primarily rooted in the heightened incidence of the cancer itself, In explains.

The reasons behind this varied incidence of gastric cancer remain unclear, although it is likely due to a complex interplay of various factors, In continues. One potential explanation is the presence of the bacterium 

, which has been identified as a key cause of gastric cancer, she states. 

 exhibits varying prevalence among different populations, but researchers are not certain that this factor is the predominant driver of these observed differences, In says.

Understanding these variations is crucial for healthcare practitioners when considering the possibility of a patient being diagnosed with gastric cancer, particularly in minority populations, In emphasizes. The need to recognize gastric cancer as a concern in the diagnostic stage is paramount, given the higher prevalence and potential impact on outcomes in these demographic groups, she says. As research delves into the underlying factors contributing to these disparities, the medical community aims to develop more targeted strategies for the early detection and effective management of gastric cancer in these populations, In concludes.

Haejin In, MD, MPH, MBA, FACS, FSSO, discusses the increased incidence of gastric cancer in minority patient populations, highlighting the disparities that lead to these patient outcomes in the United States.

Dr In on the Increased Incidence of Gastric Cancer in Minority Patient Populations

Assistant Professor of Surgery, Epidemiology, and Population Health Albert Einstein College of Medicine 

Stomach cancer is a deadly disease, with an overall 5-year survival rate of just 31%. It will strike an estimated 28,000 people in the United States this year.

A significant proportion of people receive a diagnosis of stomach cancer in the emergency department (ED), which is associated with worse outcomes because by then, the cancer is likely to have spread beyond the site of origin and is more challenging to treat. As with pancreatic cancer, many early symptoms, such as poor appetite, indigestion, and heartburn, might not seem life-threatening at first. It is only when the pain becomes severe that patients visit an ED.

At Montefiore Health System in The Bronx, New York, one of the busiest EDs in the nation, we conducted a retrospective study to improve understanding of stomach cancer diagnoses made in the ED.

We looked at patients who received stomach cancer diagnoses between 2009 and 2013. Of 263 patients, 52% (n = 136) received a diagnosis following presentation at the ED, and among them, 50% had stage IV cancer. A survival analysis revealed that individuals who received their diagnosis in the ED had a median survival of 12 months versus 48 months for patients who received diagnoses outside the ED.

Based on these findings, we believe it is crucial to develop screening programs for stomach cancer in the United States in order to make diagnoses at earlier stages of disease, provide better care, and improve outcomes.

In high-prevalence countries such as Korea, Mongolia, and Japan, population-wide screening for stomach cancer among middle-aged and older adults has reduced stomach cancer mortality by up to 60%.

Population-wide stomach cancer screening is not feasible in the United States because of low incidence in the general population. That said, stomach cancer has a disproportionately larger prevalence among ethnic minority groups and those with lower socioeconomic status (SES). Targeted screening of high-risk individuals could greatly reduce ethnic- and SES-related care disparities in this disease type.

In the United States, blacks, Hispanics, and Asians are 2 to 5 times more likely to receive a stomach cancer diagnosis compared with Caucasians

), and stomach cancer is a top-5 cancer for Koreans, Chinese, Japanese, Laotians, Vietnamese,

 and Native Hawaiians and other Pacific Islanders.

 Compared with non-Hispanic whites, South and Central Americans are 4 to 5 times more likely to receive a diagnosis of stomach cancer; Mexican Americans, 3 times; Puerto Ricans, 2 times.

 Having lower SES increases the risk of stomach cancer 1.25 to 4.33 times.

To develop a model for earlier detection of stomach cancer, we conducted a pilot study titled “Development of a Gastric Cancer Brief Screener to Identify Persons for Screening Endoscopy Referral.” The study included 4 phases:

A systematic review was performed to identify stomach cancer risk factors, and an exhaustive pool of risk factors from 16 existing survey instruments was developed.

Focus group studies (N = 30 patients) were conducted for feedback on wording, layout, clarity, and relevance of the questions.

The items were translated, and cognitive interviews (N = 60 patients) were conducted on the English, Spanish, Korean, and Mandarin Chinese versions to ensure the survey questions would be understood.

The resulting pool of 227 risk factors was used to conduct a case-control study of 90 participants. The study showed that ethnic and immigration items were highly predictive. In particular, being foreign born and reporting daily consumption of cultural foods had 16 times (95% CI, 2.0-123.1) and 25 times (95% CI, 2.0-308.2) increased odds of cancer, respectively. Importantly, the study showed promise that a conservative survey model with as few as 5 items had potential to identify a cohort with a stomach cancer risk of 7 to 10 times higher than that of the general population.

Figure. Racial and Ethnic Disparity in Gastric Cancer Risk

This study showed that asking a simple set of questions could identify people who are at risk of stomach cancer and would benefit from screening. The results were published as the featured cover article of the July 2018 edition of the 

 With appropriate targeting, stomach cancer screening would be feasible and cost-effective in the United States. A tool to identify persons at high risk, by necessity, must be easy and inexpensive to use in both clinical and community settings so that it can draw high-risk individuals into the healthcare system for further testing. A short prescreening questionnaire has the potential to become a handy, noninvasive tool for identifying persons at high risk during a usual wellness visit in a hospital or community setting. Thereafter, the high-risk individuals can undergo a screening endoscopy.

These exciting results are being used as preliminary data for a National Institutes of Health grant proposal to conduct a large-scale, case-control study to develop a stable risk-prediction model for stomach cancer using demographics, diet, and lifestyle factors. The grant proposal will be submitted by the time you read this article.

Solsky I, Rapkin B, Wong K, Friedmann P, Muscarella P, In H. Gastric cancer diagnosis after presentation to the ED: the independent association of presenting location and outcomes. 

. 2018;216(2):286-292. doi: 10.1016/j. amjsurg.2017.10.030.

Siegel RL, Fedewa SA, Miller KD, et al. Cancer statistics for Hispanics/Latinos, 2015. CA Cancer 

. 2015;65(6):457-480. doi: 10.3322/caac.21314.

Lui FH, Tuan B, Swenson SL, Wong RJ. Ethnic disparities in gastric cancer incidence and survival in the USA: an updated analysis of 1992-2009 SEER data. 

. 2014;59(12):3027-3034. doi: 10.1007/s10620-014-3275-3.

Haile RW, John EM, Levine AJ, et al. A review of cancer in U.S. Hispanic populations. 

. 2012;5(2):150-163. doi: 10.1158/1940-6207. CAPR-11-0447.

Noone AM, Howlader N, Krapcho M, et al. SEER cancer statistics review (CSR), 1975-2015, National Cancer Institute website. seer.cancer.gov/csr/1975_2015. Published April 2018. Accessed July 22, 2019.

Gomez SL, Noone AM, Lichtensztajn DY, et al. Cancer incidence trends among Asian American populations in the United States, 1990-2008. 

. 2013;105(15):1096-1110. doi: 10.1093/jnci/djt157.

Liu L, Noone AM, Gomez SL, et al. Cancer incidence trends among native Hawaiians and other Pacific Islanders in the United States, 1990-2008. 

. 2013;105(15):1086-1095. doi: 10.1093/jnci/djt156.

Howe HL, Wu X, Ries LA, et al. Annual report to the nation on the status of cancer, 1975-2003, featuring cancer among U.S. Hispanic/Latino populations. Cancer. 2006;107(8):1711-1742. doi: 10.1002/cncr.22193.

Uthman O, Jadidi E, Moradi T. Socioeconomic position and incidence of gastric cancer: a systematic review and meta-analysis. 

. 2013;67(10):854-860. doi: 10.1136/jech-2012-201108.

In H, Langdon-Embry M, Gordon L, et al. Can a gastric cancer risk survey identify high-risk patients for endoscopic screening? a pilot study. 

. 2018;227:246-256. doi: 10.1016/j.jss.2018.02.053.

Articles

It is crucial to develop screening programs for stomach cancer in the United States in order to make diagnoses at earlier stages of disease, provide better care, and improve outcomes.

Haejin In, MD, MPH, MBA, FACS

Articles

Dr In on the Importance of Early Cancer Prevention Strategies in Gastric Cancer

Dr In on the Increased Incidence of Gastric Cancer in Minority Patient Populations

Can We Preempt Emergency Department Diagnoses of Stomach Cancer?