Gastric Cancer related to Fish Intake Among the

Gastric Cancer related to Fish Intake Among the Asian Community Cassie Steck February 23, 2007

Statistics • • 2 nd leading cause of cancer worldwide. Accounts for more than 1 million deaths per year. High incidence in Korea, Japan, China. Asia accounts for 56. 4% of world population. 59. 9 Japanese men per 100, 000 population developed gastric cancer in 2000. 23. 8 Japanese women per 100, 000 population developed gastric cancer in 2000. 31. 2 Japanese men per 100, 000 population died from gastric cancer in 2000. 13. 8 Japanese women per 100, 000 population died from gastric cancer in 2000.

Developing Gastric Cancer Heliobactor pylori • Untreated infections can lead to gastric cancer. • Overcrowding allowing H. pylori to be spread • • • person to person. 60% of the younger Asian population is infected with H. pylori. 90% of the elder Asian population is infected with H. pylori. Only 30% of Western populations is infected with only 0. 1 -1% developing gastric cancer.

Developing Gastric Cancer Smoking • Smokers are more prone to stomach ulcers. • 10. 2% of Chinese people smoke. • 17. 7% of Japanese people smoke. • 21% of Koreans smoke. • 20. 9% of Americans smoke.

Developing Gastric Cancer Diet • Pickled, dried, smoked, and salted foods such as • fish contain nitrates that are converted into carcinogenic compounds in the stomach increasing the likelihood for gastric cancer. Estimated 90% of gastric cancer is due to dietary factors.

H. pylori • Induces physiological changes in gastric mucosa. • Transmitted by fecal oral route. • Neutralophile growing best at a p. H 6. 0 -8. 0. – Contains urease, which enables the organism to maintain an internal neutral p. H while in a highly acidic enviroment. – Invades stomach where p. H is highest – the antrum. – Antacids, H 2 blockers, and PPIs can worsen the situation.

H. pylori • Colonization leads to hypochlorhydria and • • gastric atrophy. Nitrogen-fixing bacteria are able to colonize permitting carcinogenic behavior. Two virulence factors CAG – & CAG +; CAG – less intense, very rare in Asians; CAG + more intense.

Smoking • Nicotine is extremely harmful to gastric mucosa. • Nicotine induces: – Tumor cell proliferation via COX-2 pathway – Angiogenesis • Caused by release of vascular endothelial growth factor (VEGF) allowing for nutrients, blood, and oxygen to support the tumor. • VEGF increases metalloproteinases promoting gastric cancer spread. – Salivation • Increases gastric acid secretion, decreasing the p. H. – Inflammatory process • Decreases histone deacetylase, increasing inflammatory response.

Diet: Fish and Nitrates • Most Asians consume diets high in salt and nitrates and low • in fruits and vegetables. – Salted or smoked fish, pickled vegetables, miso soup, soybeans. – These foods are consumed 5 days a week by 20. 6% of Japanese males and 17. 3% of females. Intake of nitrosamines – Formed during food preservation, cooking, and from smoking. – Data shows that nitrosamines are found more frequently in Asian food than in Western food.

Diet: Salt • Salt – Initiates inflammatory process leading to damage of gastric mucosa. – Induce gastritis and cell proliferation. • Amount of salt consumed – Japanese men 4082 mg day; Japanese females 3, 970 mg day – American men and women 3, 375 mg day.

Fish Is Not All Bad!! • Fish intake benefits reproduction and the • • cardiovascular system. Fish oil contains EPA and DHA, essential components of nervous cell membranes. Pre-natal DHA intake reduced premature labor. Post-natal DHA intake was correlated with visual and language development. Reduction in lipid levels and platelet aggregation provide cardiovascular benefits.

Presentation • Usually non-specific symptoms – Commonly diagnosed in later stages. • Common complaints are: loss of appetite, fullness, • • • N/V, hematemesis, abdominal pain, excessive belching, and unintentional weight loss. Secondary Sx may be due to metastatic disease. Hx of previous ulcers or PUD. Gold-standard diagnostic procedure is upper GI endoscopy.

Conclusion • Overall survival rate in US is 24%. • Overall survival rate in Asia is 53% if caught in an early stage. – Asia does mass screenings with upper GI endoscopy at age 50. • Many different causes of gastric cancer but diet and salt • • intake are the main difference between Asians and Americans. Today there is no positive link between diet and gastric cancer, but with a reduction in fish intake the risk of gastric cancer in Asians would greatly decrease. Preventative measures – Different cooking methods without changing Asian’s culture.

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