Gastric cancer incidence and mortality is associated with altitude in the mountainous regions of Pacific Latin America
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ORIGINAL PAPER
Gastric cancer incidence and mortality is associated with altitude in the mountainous regions of Pacific Latin America Javier Torres • Pelayo Correa • Catterina Ferreccio Gustavo Hernandez-Suarez • Rolando Herrero • Maria Cavazza-Porro • Ricardo Dominguez • Douglas Morgan
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Received: 6 August 2012 / Accepted: 18 November 2012 / Published online: 7 December 2012 Ó Springer Science+Business Media Dordrecht 2012
Abstract In Latin America, gastric cancer is a leading cancer, and countries in the region have some of the highest mortality rates worldwide, including Chile, Costa Rica, and Colombia. Geographic variation in mortality rates is observed both between neighboring countries and within nations. We discuss epidemiological observations suggesting an association between altitude and gastric cancer risk in Latin America. In the Americas, the burden of gastric cancer mortality is concentrated in the mountainous areas along the Pacific rim, following the Javier Torres and Douglas Morgan have contributed equally to this work. J. Torres (&) Unidad de Investigacion en Enfermedades Infecciosas, Instituto Mexicano del Seguro Social, Av Cuauhtemoc 330, Mexico, Mexico e-mail: [email protected] P. Correa D. Morgan (&) University of Vanderbilt, Nashville, TN, USA e-mail: [email protected] C. Ferreccio Universidad Catolica de Chile, Santiago, Republic of Chile G. Hernandez-Suarez Grupo Investigacio´n Epidemiolo´gica, Instituto Nacional de Cancerologı´a, Bogota´, Colombia R. Herrero Prevention and Implementation Group, IARC, Lyon, France M. Cavazza-Porro Ciencias Biologicas, Instituto de Biomedicina, Caracas, Venezuela R. Dominguez Hospital de Occidente, Santa Rosa de Copan, Honduras
geography of the Andes sierra, from Venezuela to Chile, and the Sierra Madre and Cordillera de Centroame´rica, from southern Mexico to Costa Rica. Altitude is probably a surrogate for host genetic, bacterial, dietary, and environmental factors that may cluster in the mountainous regions. For example, H. pylori strains from patients of the Andean Narin˜o region of Colombia display European ancestral haplotypes, whereas strains from the Pacific coast are predominantly of African origin. The observation of higher gastric cancer rates in the mountainous areas is not universal: the association is absent in Chile, where risk is more strongly associated with the age of H. pylori acquisition and socio-economic determinants. The dramatic global and regional variations in gastric cancer incidence and mortality rates offer the opportunity for scientific discovery and focused prevention programs. Keywords Gastric cancer Helicobacter pylori Latin America Andean countries Altitude enigma
Introduction Gastric cancer is the fourth most common cancer worldwide, and the second leading cause of cancer mortality, accounting for nearly one million incident cases and 737,000 deaths in 2008 [1, 2], and is projected to rise from fourteenth to eighth in all-cause mortality in the near term, due to the growing and aging populatio
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