| Abstract |
Introduction: Gastric cancer (GC) is a global health problem, with more than 1 million people diagnosed worldwide each year, and is the third leading cause of cancer death. The incidence rate of GC increases progressively with age, and the median age at diagnosis is 70 years. Despite reports of significant reductions in gastric cancer incidence, recent studies have observed increases in younger age groups (<50 years), particularly in low-incidence areas. About 10% of gastric cancers are detected at age 45 or younger.
Aim: To investigate the changes over time in the incidence of stomach cancer among younger and older adults on the island of Crete. Investigating major risk factors with emphasis on obesity and geographic disparities.
Methodology: In this study, a data mining (pooled study) was carried out from the database maintained by the Cancer Registration Center of Crete (K.K.K.). From this base, data were used on the new cases and deaths of malignant neoplasms (M.N) of the stomach, for a period of 30 years from 1992 to 2022 in Crete. The total sample for the study period was approximately 2795 cases with gastric cancer. First, age-specific incidence rates per 100,000 population per year (Age-Specific Incidence Rates-AsIR/100,000/year) and age-weighted incidence rates per 100,000 population per year (Age-Standardised Incidence Rates-ASIR/100,000/year) were calculated. year), through direct sampling and the standard European population [19]. These indicators were calculated for the entire population in Crete. Subsequently, these indicators were examined both over time and geographically (per Prefecture in Crete). The analysis was done using two software (R, ArcGIS), at a statistical significance level of α=0.05.
Results: Stomach cancer incidence rates (ASIR) increased significantly from 1992 to 2022 with a statistically significant annual percentage change of 1.1 (95% CI, 1.0-1.2). Stomach cancer was more common in men than in women (55% and 45%, respectively). However, women had significantly higher incidence trends (APC, 1.3%; 95% CI, 1.1-1.5). Also, sharp increases in ASIR were observed in the younger age groups of 20–34 (APC, 1.4%, 95% CI, 1.3–1.5) and 35–59 years (APC, 1.7%, 95% CI , 1.4-2.1). In addition, significant reductions in APC were seen in older adults (50-74 years: APC, -0.5%, 95%CI, -0.7- -0.3, and in >75 years: APC, -1.2 % 95% CI, -1.3- -1.0) Stage of diagnosis and place of residence were also found to be associated with APC of incidence rates (Stage II: APC, 1.8%, 95% CI, 1, 7-2.0, Chania Prefecture: APC, 0.9%, 95%CI, 0.8-1.0). The mean age-specific incidence of ASpIR in gastric cancer patients who were <50 years old was 7.1/100,000/year (95% CI 5.3– 9.5), while for patients > 50 years it was 144/100,000/year (95% CI 141-148). Statistically significant changes (%) were observed in most age groups (p<0.05). In particular, the incidence showed a 35.7% increase from 2001 to 2011 in the 20-34 age group and is expected to increase further from 2023-2030 (projected change, 53.1%). Similar trends were observed in the 35-49 age group from 2001 to 2011. Increased Body Mass Index (BMI) and Body Surface Area (BSA), smokers, increased pack years, alcohol consumption and number of drinks per week show an increased likelihood of stomach cancer for younger adults. However, several variations were observed between the three time periods. More specifically, BMI presented a significantly increasing OR with a statistically significant difference from 1.8 to 3.1 (Pvalue<0.001). Correspondingly, BSA showed similar trends with a change from 1.9 to 3.3 (Pvalue<0.001).
Conclusions: In our study, an increased incidence of gastric cancer was found in older adults and over time a rapid increase in the incidence of GC in younger adults (< 50 years) was observed in recent decades (1992-2022). It is therefore useful to discuss prevention and early diagnosis interventions and actions in younger adults, taking into account risk factors and particular geographic trends
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