Stomach cancer is the fifth leading cause of cancer death and a global health burden. It ranks as the fifth most common malignancy worldwide. Early endoscopic detection and advances in treatment have improved survival rates. In the US, survival rates have increased from 15 percent to 35.8 percent, and in South Korea, from 55.7 percent to 77 percent. However, long-term survivors of stomach cancer face increasing risks of developing second primary cancers (SPCs). There are well-recognized racial, ethnic, and geographic differences in initial primary stomach cancer incidence and mortality. Still, there is a critical gap in SPC epidemiology among stomach cancer survivors by race and ethnicity, especially in cross-national comparisons.
In a study in Gastric Cancer, Dr. Eunji Choi, assistant professor of population health sciences, and colleagues determined that SPC risk among stomach cancer survivors varies by race, ethnicity, and country. SPC risk was highest among white and Black patients in the US, and lowest in Pacific Islanders. SPC development was also linked to a higher risk of death overall, and the increase appeared larger among Asian American survivors than among white survivors. Within Asian subgroups, the increase in mortality due to SPC was greatest among Vietnamese American survivors and smallest among Filipino American survivors. Among Korean survivors in South Korea, SPC development showed only a modest increase in mortality risk.
This comparison between South Korea and the US identified several potential contributing factors for the marked differences in SPC risk and SPC-related mortality. These include differences in primary tumor etiology, such as H. pylori infection, the long-term effects of radiotherapy, national cancer screening practices, and patterns of SPC-related care across countries and racial and ethnic groups. These findings highlight the importance of addressing both clinical risk factors and health care system differences in SPC management, with a focus on early detection and improved care access for vulnerable populations.
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