Epidemiology of gastric cancer.

The incidence of gastric cancer varies widely by country and population, with higher rates among the lower socioeconomic groups. Although the most common cause of cancer death in the United States in 1930, its incidence has decreased dramatically during the past 60 years. Most populations show a 2-1 ratio for male to female gastric cancer cases, and a higher incidence rate among United States blacks than whites. Although rates have generally decreased, there has been a dramatic increase in the incidence of gastric cancer in the cardia. Diet has been the most studied risk factor for gastric cancer. Of particular interest have been N-nitroso compounds derived from the consumption of preserved, smoked, and cured foods. An inverse association with the consumption of fruits and vegetables has also been consistently demonstrated, though the specific nutrient(s) that this represents has been unclear, although ascorbate and beta-carotene have been intensively studied. Among nondietary factors, substantial evidence has accumulated for an increased risk with Helicobacter pylori infection. Other exposures which have been fairly consistently associated with gastric cancer include cigarette smoking, partial gastrectomy, radiation exposure, family history, pernicious anemia, blood group A, certain occupational exposures, and Epstein-Barr virus.