Introduction
Gastric cancer is the fourth most common malignancy in the world, with an estimated 989,600 new cases globally in 2008. According to the latest statistics compiled by the American Cancer Society, gastric cancer is the third leading cause of cancer death in men worldwide, and the fifth leading cause for women. In the United States, it is estimated that 21,600 new cases will be diagnosed in 2013, and that 10,990 people will die from the disease.1
In the U.S., 5-year survival rates for localized, early stage gastric cancer is about 63%. However, less than 25% of gastric cancers in the U.S. are diagnosed at an early stage. Metastatic gastric cancer is incurable, and the 5-year survival rate is only 3.9%.2 There is thus an urgent need for improved treatment options for advanced gastric cancer.
Gastric cancer is increasingly recognized as a heterogenous disease of distinct subtypes with different etiologies and epidemiological patterns, and driven by a range of different molecular aberrations.3 A growing understanding of the molecular aberrations underpinning the development and progression of gastric cancer is resulting in the development of new treatments for this disease. This growing molecular understanding also underpins the development of new molecular methods of classification and biomarker identification for prognosis and treatment selection. Physicians must understand these molecular advances in order to understand how to use new and emerging targeted therapies. Physicians must also keep up to date with the most current recommended treatment guidelines and classifications systems. An understanding of changing epidemiological patterns is also needed to appropriately guide patient care.
GAP 1: Physicians are unaware of changing epidemiological trends and misunderstand classifications of gastric cancers.
Current trends in epidemiology
For the last fifty years, global rates have gastric cancer have steadily declined, particularly in the developed countries of North America and Europe, where the incidence rate has dropped by more than 80%.1, 4,5 This decline in gastric cancer has been attributed to several factors, including a reduced reliance on smoked and salted foods due to the increased availability of refrigeration, and a reduction of Helicobacter pylori infections due to improvements in sanitation and use of antibiotics.1, 4, 6. However, even as overall gastric cancer rates have declined, there has been a rise in the incidence of gastric cancers arising in the stomach cardia.6, 4, 7 There has also been a recent report that incidence rates of noncardia gastric cancer may be rising in a subset of patients in the United States. An analysis of noncardia gastric cancer cases in the U.S. from 1977 to 2006 found a 67% increase in incidence rates for white patients aged 25 to 39 years over this time period; however, for all other age and race groups, rates of noncardia gastric cancer declined during this period.8 The factors behind the upward trend in young white U.S. patients, and behind the more general rise in incidence of cardia gastric cancer overall, remain unknown.8, 6
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