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Br J Cancer. Jul 2000; 83(3): 391–396.
Published online Jul 3, 2000. doi:  10.1054/bjoc.2000.1205
PMCID: PMC2374560
Decreasing incidence of both major histologic subtypes of gastric adenocarcinoma – a population-based study in Sweden
A M Ekström,1 L-E Hansson,1,2 L B Signorello,1,3 A Lindgren,4 R Bergström,1,5 and O Nyrén1
1Department of Medical Epidemiology, Karolinska Institutet, Stockholm, S-171 77, Sweden
2Department of Surgery, Mora Hospital, Mora, S-792 85, Sweden
3Department of Epidemiology, Harvard School of Public Health, Boston, MA, 02115, USA
4Department of Pathology, Falu Hospital, Falun, S-791 82, Sweden
5Department of Statistics, Uppsala University, Uppsala, S-751 20, Sweden
Received November 24, 1999; Revised February 18, 2000; Accepted February 23, 2000.
Abstract
While the overall incidence of gastric cancer has fallen, presumably to a large extent in parallel with Helicobacter pylori infection, the occurrence of the diffuse histologic type is thought to have remained more stable, questioning the aetiologic role of H. pylori. We have analysed the incidence of the intestinal and diffuse types separately, while considering subsite (cardia/non-cardia). With an extensive prospective effort we identified all incident cases of gastric adenocarcinoma (n = 1337) in a well-defined Swedish population (1.3 million) 1989–1994. Tumours were uniformly classified histologically and topographically. Subgroup-specific incidence rates were computed and modelled using multivariate logistic regression. Site-specific trends were clearly discrepant. The overall incidence of adenocarcinoma distal to the gastric cardia declined by 9% (95% confidence interval 6–12%) per year, while cardia cancer remained stable. Thus, the feared rise in cardia cancer could not be confirmed despite clear site-specific trend discrepancies. The intestinal type predominated, especially in high-risk areas, while diffuse tumours prevailed among young patients and women. Both main histologic types of gastric adenocarcinoma declined markedly, at similar rapidity, and with no significant trend differences between the intestinal and diffuse types, even after multivariate adjustments. Our results are consistent with an aetiologic role of environmental factors including H. pylori also for diffuse-type gastric cancers. © 2000 Cancer Research Campaign
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