Cancer Causes & Control

, Volume 20, Issue 10, pp 2021–2029

Effects of Helicobacter pylori infection and smoking on gastric cancer incidence in China: a population-level analysis of trends and projections

  • Jennifer M. Yeh
  • Sue J. Goldie
  • Karen M. Kuntz
  • Majid Ezzati
Original paper

DOI: 10.1007/s10552-009-9397-9

Cite this article as:
Yeh, J.M., Goldie, S.J., Kuntz, K.M. et al. Cancer Causes Control (2009) 20: 2021. doi:10.1007/s10552-009-9397-9



Although gastric cancer incidence is declining in China, trends may differ from historical patterns in developed countries. Our aim was to (1) retrospectively estimate the effects of Helicobacter pylori (H. pylori) and smoking on past gastric cancer incidence and (2) project how interventions on these two risk factors can reduce future incidence.


We used a population-based model of intestinal-type gastric cancer to estimate gastric cancer incidence between 1985 and 2050. Disease and risk factor data in the model were from community-based epidemiological studies and national prevalence surveys.


Between 1985 and 2005, age-standardized gastric cancer incidence among Chinese men declined from 30.8 to 27.2 per 100,000 (12%); trends in H. pylori and smoking prevalences accounted for >30% of overall decline. If past risk factor trends continue, gastric cancer incidence will decline an additional 30% by 2050. Yet, annual cases will increase from 116,000 to 201,000 due to population growth and aging. Assuming that H. pylori prevention/treatment and tobacco control are implemented in 2010, the decline in gastric cancer incidence is projected to increase to 33% with universal H. pylori treatment for 20-year-olds, 42% for a hypothetical childhood H. pylori vaccine, and 34% for aggressive tobacco control.


The decline in gastric cancer incidence has been slower than in developed countries and will be offset by population growth and aging. Public health interventions should be implemented to reduce the total number of cases.


Gastric cancer Helicobacter pylori Smoking Cancer prevention China 

Supplementary material

10552_2009_9397_MOESM1_ESM.doc (274 kb)
(DOC 275 kb)

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  • Jennifer M. Yeh
    • 1
  • Sue J. Goldie
    • 1
    • 2
  • Karen M. Kuntz
    • 3
  • Majid Ezzati
    • 4
    • 5
  1. 1.Center for Health Decision ScienceHarvard School of Public HealthBostonUSA
  2. 2.Department of Health Policy and ManagementHarvard School of Public HealthBostonUSA
  3. 3.Division of Health Policy and Management, School of Public HealthUniversity of MinnesotaMinneapolisUSA
  4. 4.Department of Global Health and PopulationHarvard School of Public HealthBostonUSA
  5. 5.Department of Environmental HealthHarvard School of Public HealthBostonUSA

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