Abstract
Purpose
Cancer epidemiology is challenging in developing nations, in the absence of reliable pathology-based cancer registries. Clinical experience suggests that the incidence of gastric cancer is high in Honduras, in contrast to the limited available national statistics at the time of study initiation (IARC GLOBOCAN 2002: males 15.2, females 10.8). We estimate the incidence of gastric cancer for Honduras using an endoscopy registry as a complimentary resource.
Methods
We conducted a retrospective analysis of incident noncardia gastric adenocarcinoma cases in western Honduras for the period 2000–2009. This region is well circumscribed geopolitically with a single district hospital and established referral patterns, to provide a unique epidemiological niche to facilitate estimation of incidence rates. A prospective, comprehensive database of all endoscopy procedures from this hospital was utilized at the primary data source. The catchment area for gastroenterology services for the at-risk population was validated by calculating the overall endoscopy utilization rates for each municipality in western Honduras. Incident cases of gastric adenocarcinoma were determined by the endoscopic diagnosis. Pathology services are not financed by the Ministry of Health, and histology data were incorporated when available. Population statistics were obtained from the Honduras National Statistics Institute (INE). Age-standardized incidence rates (ASIRs) were calculated using world standard population fractions.
Results
The catchment area for western Honduras was validated with the municipality threshold of 30 endoscopies per 106 person-years, with inclusion of a total of 40 municipalities. In the western Honduras catchment area, there were 670 incident cases (439 M, 231 F) of noncardia gastric adenocarcinoma during the study decade 2000–2009. Notably, 67 (10.0 %) and 165 (24.6 %) of cases were under the ages of 45 and 55, respectively. The case-finding rate was 5.1 endoscopies performed for each new diagnosis of gastric cancer. The ASIRs for the decade were 30.8 for males and 13.9 for females. Clinically, 60.3 % of gastric cancers were Borrmann type 3 (ulcerated mass), and evidence of advanced disease with pyloric obstruction was common (35.2 %). Subtypes by the Lauren classification were distributed among diffuse (56 %), intestinal (34 %), and indeterminate (9.9 %), in subjects with available pathology (526/670).
Conclusions
The endoscopy procedure registry may serve as a complimentary data resource for gastric cancer incidence estimation in resource-limited nation settings wherein pathology services and cancer registries are absent. The results remain an underestimation in this setting due to the challenges of access to care and related factors. The methodology helps to more fully characterize the high incidence of gastric cancer in western Honduras and this region of Central America and demonstrate the need for additional epidemiology research, and interventions focused on prevention and treatment.
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Acknowledgments
The authors wish to express gratitude for the support from the following individuals and institutions: Hospital de Occidente and Ministry of Health (Carmen Ramos, Gloria Fajardo, Aidé Hernandez), Central American Medical Outreach (Kathy Tschiegg, Director; Lesby Castellanos, Bairon Moreno), Pathology (Francisco Herrera, Amado Rodriguez), Research assistance (Natalie Prichett, Suvi Gross, Elaine Smith, Michael Clark-Pearson), and the city of Santa Rosa de Copan (Juan Carlos Elvir, Mayor). This study was supported in part by grants from the National Institutes of Health: P30 DK 034987, T32 DK07634 (SC, JL), and CA1255884 (DRM).
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Dominguez, R.L., Crockett, S.D., Lund, J.L. et al. Gastric cancer incidence estimation in a resource-limited nation: use of endoscopy registry methodology. Cancer Causes Control 24, 233–239 (2013). https://doi.org/10.1007/s10552-012-0109-5
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DOI: https://doi.org/10.1007/s10552-012-0109-5