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Gastric Cancer related to Fish Intake Among the Asian Community

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.

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Gastric Cancer related to Fish Intake Among the Asian Community

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

  2. Statistics • 2nd 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.

  3. Developing Gastric CancerHeliobactorpylori • 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.

  4. Developing Gastric CancerSmoking • 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.

  5. Developing Gastric CancerDiet • 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.

  6. Induces physiological changes in gastric mucosa. Transmitted by fecal oral route. Neutralophile growing best at a pH 6.0-8.0. Contains urease, which enables the organism to maintain an internal neutral pH while in a highly acidic enviroment. Invades stomach where pH is highest – the antrum. Antacids, H2 blockers, and PPIs can worsen the situation. H. pylori

  7. 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. H. pylori

  8. 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 pH. • Inflammatory process • Decreases histone deacetylase, increasing inflammatory response.

  9. 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.

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

  11. 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.

  12. 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.

  13. 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.

  14. References • American Cancer Society, What are the key statistics about stomach cancer? 2006, Available at: http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_ • What_are_ the_key_statistics_for_stomach_cancer_40.asp?sitearea=. Accessed Jan. 27, 2007. • American Lung Assocation, Smoking 101 Fact Sheet. March 2006. Available at: • http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=39853. Accessed Feb. 14, 2007. • Cai L, Yu S, Ye W, Yi Y. Fish Sauce and gastric cancer: an ecological study in FujianProvince, China. World J Gastroenterology. 2000 Oct; 6 (5): 671-675. • Campaign for Tobacco-Free kids, Benefits from tobacco cessation. 2003, Available at: http://www.worthit.org/pfds/benefitsquit.pdf. Accessed Dec 2 2006. • Dale D, Federman D, Antman K, Atkinson J, Cassel C, Feldman M et al. ACP Medicine. 2006 ed. Webmd. 2006. • eMedicine, Gastric cancer. June 2004. Available at: http://www.emedicine.com/MED/topic 845.htm. Accessed Dec 2 2006. • Gochfeld M, Burger J. Good fish/bad fish: A composite benefit – risk by dose cure. J Neurotoxicology. 2005 August; 26 (4); 511-520. • In this issue. J National Cancer Institute. 2001; 93 (14); 1039. • Internet World Stats, Internet Usage in Asia. 2001. Available at: http://www.internetworldstats.com/stats3.htm. Accessed Dec 1 2006. • Jakszyn P, Gonzalez C. Nitrosamine and related food intake and gastric and esophageal cancer risk: A systematic review epidemiological evidence. World J Gastroenterology. 2006 July 21; 12 (27): 4296-4303. • Kim Karen. Gastric cancer in Korean Americans: risks and reductions. American Studies Bullentin. 2003; 13 (1/2): 84-90. • Medscape. New data presented on the pathogenesis of smoking-induced lung injury. 2002. Available at: http://www.medscape.com/viewarticle/442808. Accessed Dec 2 2006. • Nangta Chisato, Takatsuka Naoyoshi, Shimizu Natsuki, Shimizu Hiroyuki. Sodium intake and risk of death from stroke in Japanese men and women. American Heart Association. 2004; 35: 1543. • Nanda Rita. Medical encyclopedia: Gastric cancer. 2006 Sept 11. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000223.htm. Accessed Jan. 28, 2007. • OHSU Health, Cancer Information. 2001. Available at: http://www.ohsucancer.com/index.asp?fuseaction=cancerbyType.lookup&list=stomach. Accessed Dec 2, 2006. • Prinz C, Schwendy S, Voland P. H pylori and gastric cancer: shifting the global burden. World J Gastroenterology. 2006 Sept 14; 12 (34): 5458-5464. • Rollan Antonio, Ferreccio Catterina, Gederlini Alessandra, Serrano Carolina, Torres Javiera, Harris Paul. Non-invasive diagnosis of gastric mucosal atrophy in an asymptomatic population with high prevalence of gastric cancer. World J Gastroenterology. 2006 Nov 28; 12 (44): 7172-7178. • Shin Vivian, Wu William, Chu Kent, Wong Helen, Lam Emily, Tai Emily et al. Nicotine induces cyclooxygenase-2 and vascular endothelial growth factor receptor-2 in association with tumor-associated invasion and angiogenesis in gastric cancer. Molecular Cancer Research. 2005; 3: 607-615. • Smith M, Hold G, Tahara E, El-Omar E. Cellular and molecular aspects of gastric cancer. World J Gastroenterology. 2006 May 21; 12 (19): 2979-2990. • Strumylaite L, Zickute J, Dudzevicius J, Dregval L. Salt-preserved foods and risk of gastric cancer. Medicina (Kaunas). 2006; 42 (2): 164-170. • Tsugane S. Sasazuki S, Kobayashi M, Sasaki S. Salt and salted food intake and subsequent risk of gastric cancer among middle-aged Japanese men and women. British J Cancer. 2004; 90: 128-134. • U.S. Department of Health and Human Services, Office of Applied Studies. Aug 2006. Available at: http://www.oas.samhsa.gov/nhsda/2k1nhsda/vol1/chapter4.htm. Accessed Dec 2, 2006. • World Health Organization, Media Centre. February 2006. Available at: http://www.who.int/mediacentre/factsheets/fs297/en/index.html. Accessed Dec. 2, 2006. • Wright Jacqueline, Wang Chia, Stephenson Jocelyn, Ervin Bethene. Dietary intake of ten key nutrients for public health, United States 1999-2000. Advanced data from vital and health statistics, 2003 April 17; 334.

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