Epidemiology

Globally, stomach cancer is the second commonest cancer with an estimated 775 000 new cases per annum. In the UK, there were 11 851 new cases in 1990, being the sixth commonest cancer in men and the seventh in women (male:female ratio 3:2).

The diagnosis is rare prior to the sixth decade with the incidence rising steeply thereafter. Wide variations in incidence are observed, from rates of >90 per 100 000 in Japan to <10 per 100 000 for Caucasians in the US, Africa, and India. China and Eastern Europe have relatively high rates—28-50 per 100 000, whilst Western European rates are 15-20 per 100 000.

In most countries the incidence of stomach cancer is declining. However, despite this decline, several countries, including the UK, have detected an increase in cancers of the oesophageal gastric junction (OGJ).

In Japan, screening for gastric cancer is routinely performed with a double-contrast barium meal and gastroscopy. This increases the proportion of resectable early gastric cancers by 30-40%. In Western Europe and the US, screening of asymptomatic patients is not practicable because of the lower incidence of the disease. A British study in which patients over 40 years presenting with dyspepsia underwent gastroscopy detected tumours in 2%.

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