Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 14, 2021; 27(34): 5764-5774
Published online Sep 14, 2021. doi: 10.3748/wjg.v27.i34.5764
Secular decreasing trends in gastric cancer incidence in Taiwan: A population-based cancer registry study
Yen-Tzeng Lin, Chun-Ju Chiang, Ya-Wen Yang, Shih-Pei Huang, San-Lin You
Yen-Tzeng Lin, School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 242008, Taiwan
Chun-Ju Chiang, Ya-Wen Yang, Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 10617, Taiwan
Shih-Pei Huang, Department of Medical Education & Bioethics, Graduate Institute of Medical Education & Bioethics, National Taiwan University College of Medicine, Taipei 10051, Taiwan
San-Lin You, School of Medicine & Big Data Research Center, Fu Jen Catholic University, New Taipei City 242008, Taiwan
Author contributions: Lin YT, Huang SP, and You SL conceived and designed the study; Chiang CJ and You SL acquired the data; Lin YT and Yang YW performed the data analyses; Lin YT, Huang SP, and You SL drafted the manuscript; Lin YT, Huang SP, and You SL assisted in interpretation of the data; Lin YT, Chiang CJ, Yang YW, Huang SP, and You SL critically revised the manuscript for intellectual content.
Institutional review board statement: The study was reviewed and approved by the Fu Jen Catholic University Institutional Review Board.
Informed consent statement: This research protocol was approved by the Institutional Review Board of Fu-Jen Catholic University (C107034).
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE statement, and the manuscript was prepared and revised according to the STROBE statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shih-Pei Huang, MD, PhD, Adjunct Assistant Professor, Doctor, Department of Medical Education & Bioethics, Graduate Institute of Medical Education & Bioethics, National Taiwan University College of Medicine, No. 1 Jen Ai Road, Section 1, Taipei 10051, Taiwan. esphuang.imbd@gmail.com
Received: March 23, 2021
Peer-review started: March 23, 2021
First decision: April 29, 2021
Revised: May 11, 2021
Accepted: August 6, 2021
Article in press: August 6, 2021
Published online: September 14, 2021
Research background

Gastric cancer is a multifactorial cancer and is a leading cause of cancer death worldwide. In Taiwan, gastric cancer is the sixth leading cause of cancer mortality.

Research motivation

We desired to discover the association between gastric cancer incidence and potential factors, including anti-Helicobacter pylori (H. pylori) treatment.

Research objectives

The objective of this study was to observe secular trends in gastric cancer incidence according to age, sex, and the implementation of a nationwide H. pylori treatment program in Taiwan.

Research methods

We used the national Taiwan Cancer Registry database in this population-based study. Annual percent changes in incidence rates were used to describe secular trends in incidence rates and sex ratios of gastric cancer in Taiwan and to study the relationship between its incidence and potential risk factors, including anti-H. pylori treatment. Pearson’s product-moment correlation coefficients were used to analyze the correlation between annual age adjusted incidence rates and the annual number of patients treated with antibiotic therapy for H. pylori infection.

Research results

The annual percent changes showed steadily decreasing rates of gastric cancer in both sexes. However, the decreasing trends differed by sex, with an annual percent change of -2.58% in males and -2.14% in females. The age-specific incidence rates increased with age. Among the same age group, more recent time periods showed lower incidence rates than earlier time periods. Within the same age group, the sex ratio was lower in later birth cohorts than in earlier birth cohorts. In addition, age-adjusted incidence rates decreased substantially with increasing numbers of patients newly treated with antibiotic therapy during 2005 to 2016 for H. pylori infection (r = 0.72).

Research conclusions

We observed steadily decreasing trends with differential sex ratios in the incidence of gastric cancer in Taiwan. The results also support the association between trends in gastric cancer incidence and the implementation of H. pylori eradication programs in Taiwan.

Research perspectives

Further long-term cohort studies are needed to investigate the relationship between H. pylori treatment and gastric cancer histologic type and anatomic site and should include adjusting for other confounders, such as dietary and lifestyle habits and genetic susceptibility.