Recent patterns in gastric cancer: A global overview Paola Bertuccio 1 , Liliane Chatenoud 1 * , Fabio Levi 2 , Delphine Praud 1,3 , Jacques Ferlay 4 , Eva Negri 1 , Matteo Malvezzi 1,5 and Carlo La Vecchia 1,5 1 Istituto di Ricerche Farmacologiche ‘‘Mario Negri’’, Via G. La Masa 19, 20156 Milan, Italy 2 Unite’ d’ epidemiologie du cancer et Registres vaudois et neuchaˆtelois des tumeurs, Institut de m edecine sociale et pr eventive (IUMSP), Centre Hospitalier Universitaire Vaudois et Universite’ de Lausanne, CHUV-Falaises 1, 1011 Lausanne, Switzerland 3 Institut d’Informatique et de Math ematiques Appliqu ees, Universit  e Joseph Fourier, BP N°53, 38041 Grenoble Cedex 9, France 4 International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France 5 Istituto di Statistica Medica e Biometria ‘‘G.A. Maccacaro’’, Universita` degli Studi di Milano, Via Venezian 1, 20133 Milan, Italy Until the mid-1990s, gastric cancer has been the first cause of cancer death worldwide, although rates had been declining for several decades and gastric cancer has become a relatively rare cancer in North America and in most Northern and Western Europe, but not in Eastern Europe, Russia and selected areas of Central and South America or East Asia. We analyzed gastric cancer mortality in Europe and other areas of the world from 1980 to 2005 using joinpoint regression analysis, and provided updated site-specific incidence rates from 51 selected registries. Over the last decade, the annual percent change (APC) in mortal- ity rate was around 23, 24% for the major European countries. The APC were similar for the Republic of Korea (APC 5 24.3%), Australia (23.7%), the USA (23.6%), Japan (23.5%), Ukraine (23%) and the Russian Federation (22.8%). In Latin America, the decline was less marked, but constant with APC around 21.6% in Chile and Brazil, 22.3% in Argentina and Mex- ico and 22.6% in Colombia. Cancers in the fundus and pylorus are more common in high incidence and mortality areas and have been declining more than cardia gastric cancer. Steady downward trends persist in gastric cancer mortality worldwide even in mid- dle aged population, and hence further appreciable declines are likely in the near future. ' 2009 UICC Key words: gastric cancer; mortality; European Union; trends; Latin America; joinpoint Until the mid-1990s, gastric cancer has been the most common cause of cancer death worldwide, although rates have been sub- stantially declining for several decades, and gastric cancer has become a relatively rare cancer in North America and in most Northern and Western European countries. 1,2 There are, however, areas of the world where gastric cancer remains common. These include Japan, Russia and other countries of the former Soviet Union, and Chile and a few other Latin American countries. Therefore, gastric cancer still accounts for over 10% of cancer deaths worldwide, and is the second most frequent cause of cancer death after lung cancer. 3,4 We considered gastric cancer trends in Europe between 1980 and 1999, and found an almost 50% fall in rates in Western and Eastern Europe and a 40% fall in Russia. 5 In proportional terms, the falls in the last decade considered were similar to previous calendar years, although in absolute terms the impact of the decline in gastric can- cer mortality became smaller, particularly in Western Europe. Over the last few decades, the incidence of non-cardia stomach cancer has substantially declined in developed regions of the world. However, non-cardia stomach cancer remains common in many geographic regions, including China, Japan, Eastern Europe and Central/South Americas. 6,7 To provide a global overview of recent rates of gastric cancer mortality and incidence in Europe and other areas of the world, we have considered gastric cancer mortality over the period 1980– 2005 for 63 countries providing data, and the European Union (EU) as a whole, and updated site-specific incidence rates from 51 selected registries. We also used joinpoint regression 8 to analyze trends for the 19 major countries considered. Material and methods Official death certification data from gastric cancer for 43 coun- tries of the European Region (according to the World Health Or- ganization (WHO) definition) and other 20 countries in the world over the period 1980–2005 were derived, whenever available, from the WHO database. 9 For the Americas, only 13 countries with more than 2 million inhabitants and with sufficiently detailed age-stratified mortality and population figures were included (i.e., Canada, USA, Argen- tina, Brazil, Chile, Colombia, Costa Rica, Cuba, Ecuador, Mexico, Puerto Rico, Uruguay and Venezuela). Mortality data from gastric cancer were also available for 4 Asian countries (Hong Kong, Japan, Republic of Korea and Singapore); 1 from Africa (Mauritius), and for Australia and New Zealand. During the 1980s up to the mid-1990s, all countries utilized the 9th Revision of the International Classification of Diseases (ICD- 9) 10 with the only exception of Northern European countries and Switzerland, that used ICD-8 11 (code no. 151). The ICD-10 12 (code C16) was adopted by some countries (33) from mid-1990s; others (19) adopted it only around 2000. Since differences between various revisions were minor, gastric cancer deaths were recoded for all countries according to the ICD-9 (code no. 151), i.e., the most commonly used classification. 10 Estimates of the res- ident populations for the corresponding calendar periods, based on official censuses, were extracted from the same WHO database. 9 For the Americas, data from certain years onward were unavail- able in the WHO database and were thus extracted from the Pan American Health Organization (PAHO). 13 Since the PAHO publi- cation provided sex and 5-year age groups (from 0–4 to 801 years) for selected years only (i.e., 1995, 2000, 2005), sex- and age-specific data for missing years were estimated, by interpola- tion using the last year available in the WHO database (1986 for Brazil, 1990 for Uruguay, 1991 for Ecuador, 1992 for Puerto Rico, 1994 for Chile, Colombia and Venezuela, 1995 for Costa Rica and Mexico, 1996 for Argentina and Cuba). From the matrices of certified deaths and resident population, we computed age-specific rates for each calender year and 5-year age group (from 0, 1–4 to 851 years). For Latin American coun- tries 801 years was the last age group available. We computed age-standardized mortality rates per 100,000 men and women Additional Supporting Information may be found in the online version of this article. Grant sponsors: Italian Association for Cancer Research (AIRC), Italian and Swiss Leagues Against Cancer, Swiss Foundation for Research Against Cancer. *Correspondence to: Istituto di Ricerche Farmacologiche ‘‘Mario Negri’’, Via Giuseppe La Masa 19, 20156 Milan, Italy. Fax: 139-0233200231. E-mail: liliana@marionegri.it Received 16 September 2008; Accepted after revision 7 January 2009 DOI 10.1002/ijc.24290 Published online 22 January 2009 in Wiley InterScience (www.interscience. wiley.com). Int. J. Cancer: 125, 666–673 (2009) ' 2009 UICC Publication of the International Union Against Cancer