A Review of Gastric Cancer Research in Malaysia

Abstract

Incidence rates of gastric cancer in Malaysia has declined by 48% among males and 31% among females in the latest<br />reporting period of 13 years. Malays used to have age-standardized-rates only a fifth of those in Chinese and Indians,<br />but the incidence among them is slightly rising even as the rates drop in the other races. Besides ethnicity, a low level<br />of education, high intake of salted fish and vegetables, H pylori infection and smoking are risk factors. Consumption<br />of fresh fruit and vegetable is protective. Variation in the strains of H pylori infection affect gastric cancer risk, with<br />hspEAsia isolates among Chinese appearing linked to a high incidence than with hpAsia2 or hpEurope strains among<br />Indians and Malays. It was reported in the 1980s that only about 3% of patients presented with early gastric cancer, but<br />more encouraging rates reaching 27% with Stage 1 and 2 disease have been reported in the twenty-first century from<br />leading centres. More tumours occur in the distal stomach except in Kelantan, where the incidence is low and main site<br />is the cardia. Prompt endoscopy is advocated and open access, with direct referrals, to such services using a weighted<br />scoring system should be more utilized. In view of the high rate of late disease laparoscopic staging unnecessary<br />laparotomy needs to be avoided. Late presentation of gastric cancer however, is still predominant and the mortality to<br />incidence ratio is relatively high. Besides seeking to reduce risk factors and achieve early detection, implementation<br />of improved care for patients with late disease must be promoted in Malaysia.