Obesity and related risk factors in gastric cardia adenocarcinoma

• Published in: Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 2015, Vol.18 (1), p.23-32
• Main Authors: Olefson, Sidney, Moss, Steven F.
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adenocarcinoma - etiology; Body Mass Index; Cancer Research; Cardia - anatomy & histology; Cardia - pathology; Diabetes Complications - pathology; Diet; Europe; Gastric cancer; Gastritis, Atrophic - complications; Gastroenterology; Gastroesophageal Reflux - complications; Helicobacter Infections - complications; Helicobacter pylori - pathogenicity; Humans; Medicine; Medicine & Public Health; Obesity - complications; Obesity - pathology; Oncology; Review Article; Risk Factors; Stomach Neoplasms - epidemiology; Stomach Neoplasms - etiology; Stomach Neoplasms - pathology; Surgical Oncology; United States
• ISSN: 1436-3291; 1436-3305
• DOI: 10.1007/s10120-014-0425-4

Over recent decades, the incidence of cancers of the gastroesophageal junction, including gastric cardia tumors, has increased markedly. This is a trend that has been well documented, especially in studies from the USA and northern Europe that have also demonstrated a concomitant rise in the ratio of cardia to distal gastric cancers. The rise in the prevalence of gastric cardia adenocarcinoma has been paralleled by the worldwide obesity epidemic, with almost all epidemiological studies reporting increased body mass index and obesity increase the risk of cardia cancer development. However, the strength of this association is less marked than the link between obesity and esophageal adenocarcinoma, and the mechanisms remain poorly understood. Other possible confounders of the relationship between obesity and cardia cancer include the decline in Helicobacter pylori infection and the widespread use of proton pump inhibitors, although these have rarely been controlled for in case–control and cohort studies investigating associations between obesity and cardia cancer. We review these epidemiological trends and discuss proposed mechanisms for the association, drawing attention to controversies over the difficulty of defining cardia cancer. The relative paucity of high-quality epidemiological studies from other regions of the world should prompt further investigation of this issue, especially in populations undergoing rapid socioeconomic change.