Pernicious anaemia as a risk factor in gastric cancer.

In order to assess the risk of gastric cancer (GC) developing in patients with pernicious anaemia (PA), the prevalence of PA was analysed in all patients with GC notified to the Danish Cancer Registry in 1972. Among 877 patients with GC, PA had previously been diagnosed in 19 (2.2%). In seven of these, PA had been diagnosed only shortly before GC. Accordingly, the diagnosis of PA could be regarded as unquestionable only in the remaining 12 cases (1.3%). In either case, the frequency of PA was significantly higher than in a reference group of patients with cancer of the colon who had been selected in the same way. Calculation of the incidence of GC in PA patients showed that this was about three times higher than in the general population. The annual risk of GC was calculated to be 0.3%. In PA patients, the tumour was primarily localized to the body and fundus of the stomach, whereas it mainly involved the antral and pyloric region in patients without PA. In view of the low cancer rate it is concluded that routine gastroscopy and barium meal examination are not indicated in PA patients in general. Whenever a patient with PA complains of dyspepsia, examinations with gastroscopy and barium meal should, however, be carried out on liberal indications.