Leveraging High-Quality Research to Define the Gastric Cancer Landscape in India
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EDITORIAL
Leveraging High-Quality Research to Define the Gastric Cancer Landscape in India Shaila J. Merchant 1,2 & Chandramohan Krishnan Nair 3 & Christopher M. Booth 2,4
# Indian Association of Surgical Oncology 2020
Cancer is the second leading cause of death globally [1]; unfortunately, patients in low- and middle-income countries have poorer outcomes compared with those observed in high-income countries [2]. In India, a low middle-income country, the number of new cases and deaths due to cancer has been rising [3] and is expected to nearly double to 1.7 million cases by 2035 [4]. Within this statistic, gastric cancer remains an interesting area of study. Although a substantial reduction in the age-standardized incidence rate has been observed, there remains tremendous variation in incidence rates across the states of India with incidence in some states being ranked among those in well-known high incidence countries such as China and Chile [5]; furthermore, gastric cancer was responsible for the highest proportion of cancer disabilityassociated life-years in the country [3]. The incidence of and death from gastric cancer in India differ based on geographic region. Some of the highest death rates from gastric cancer are observed in states such as Mizoram, Uttar Pradesh, Uttarakhand, Sikkim, Telangana, Andhra Pradesh, and Goa [3]. These states are in the northern, eastern, and southern regions of India. Interestingly, there is relative sparing of other states such as Gujarat, Delhi, Maharashtra, and Punjab [3]. The regional variation is thought to be related to differences in genetic and environmental factors [6]. The multifactorial and complex nature of this problem
* Shaila J. Merchant [email protected] 1
Division of General Surgery and Surgical Oncology, Queen’s University, Kingston, Ontario, Canada
2
Cancer Care and Epidemiology, Queen’s Cancer Research Institute, Kingston, Ontario, Canada
3
Division of Surgical Oncology, Regional Cancer Centre, Trivandrum, Kerala, India
4
Division of Medical Oncology, Queen’s University, Kingston, Ontario, Canada
makes it difficult to pinpoint the exact contributions of individual risk factors. Literature related to gastric cancer outcomes in India remains sparse, with existing outcomes-based literature limited to single-center experiences. In a publication from Sambasivaiah et al. [7], patients with gastric cancer in Andhra Pradesh (southern India) were more likely to be male, have adenocarcinoma and distally located cancers, and present with advanced, incurable disease. Survival was poor in this cohort at 10 months. In Manipur, a state in north-eastern India, Barad et al. [8] reported male-, adenocarcinoma-, and antrumpredominance in patients with gastric cancer. In this cohort, advanced disease was common, with 37% of patients presenting with metastatic disease. Dietary factors were implicated in a crude way based on patient reports of consumption of smoked meat and fermented fish. Reviews on epidemiology and treatment of gastric cancer in India h
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