Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 7, 2018; 24(25): 2722-2732
Published online Jul 7, 2018. doi: 10.3748/wjg.v24.i25.2722
Gastric cancer in Alaska Native people: A cancer health disparity
Holly A Martinson, Nancy J Shelby, Steven R Alberts, Matthew J Olnes
Holly A Martinson, Nancy J Shelby, WWAMI School of Medical Education, University of Alaska Anchorage, Anchorage, AK 99508, United States
Steven R Alberts, Department of Oncology, Mayo Clinic Cancer Center, Rochester, MN 55905, United States
Matthew J Olnes, Hematology and Medical Oncology Department, Alaska Native Medical Center, Anchorage, AK 99508, United States
Author contributions: Martinson HA, Shelby NJ, Alberts SR and Olnes MJ designed the research study; Martinson HA performed the research; Martinson HA analyzed the data; Martinson HA, Shelby NJ, Alberts SR, and Olnes MJ wrote the manuscript.
Supported by the Debbie’s Dream Foundation-AACR Gastric Cancer Research Fellowship, No. 16-40-41-MART (to Martinson HA); and an Institutional Development Award (IDeA) from the National Institute of General Medical Sciences of the National Institutes of Health (NIH), No. P20GM103395 (to Martinson HA, Shelby NJ and Olnes MJ). The content is solely the responsibility of the authors and does not necessarily reflect the official views of the NIH.
Institutional review board statement: This study was reviewed and approved by the University of Alaska Anchorage Institutional Review Board (IRB), Alaska Area IRB, Southcentral Foundation Research Review Board, and the Alaska Native Tribal Health Consortium Health Research Review Committee.
Informed consent statement: Patients were not required to give informed consent to this study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors have no conflicting financial interests.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Holly A Martinson, PhD, Assistant Professor, WWAMI School of Medical Education, University of Alaska Anchorage, 3211 Providence Drive, Anchorage, AK 99508, United States. hamartinson@alaska.edu
Telephone: +1-907-7864672 Fax: +1-907-7864700
Received: March 31, 2018
Peer-review started: April 2, 2018
First decision: April 19, 2018
Revised: May 9, 2018
Accepted: June 2, 2018
Article in press: June 2, 2018
Published online: July 7, 2018
Abstract
AIM

To evaluate recent trends in gastric cancer incidence, response to treatment, and overall survival among Alaska Native (AN) people.

METHODS

A retrospective analysis of the Alaska Native Medical Center patient database was performed. Patient history, clinical, pathological, response to treatment and patient outcomes were collected from one-hundred and thirty-two AN gastric cancer patients. The Surveillance, Epidemiology and End Result database 18 was used to collect comparison United States non-Hispanic White (NHW) and AN gastric cancer patient data between 2006-2014.

RESULTS

AN gastric cancer patients have a higher incidence rate, a poorer overall survival, and are diagnosed at a significantly younger age compared to NHW patients. AN patients differ from NHW patients in greater prevalence of non-cardia, diffuse subtype, and signet ring cell carcinomas. AN females were more likely to be diagnosed with later stage cancer, stage IV, compared to AN males. Diminished overall survival was observed among AN patients with increasing stage, O+ blood type, < 15 lymph nodes examined at resection, and no treatment. This study is the first report detailing the clinicopathologic features of gastric cancer in AN people with outcome data.

CONCLUSION

Our findings confirm the importance of early detection, treatment, and surgical resection for optimizing AN patient outcomes. Further research on early detection markers are warranted.

Keywords: Alaska Native, Gastric cancer, Helicobacter pylori, Gender, Health disparities

Core tip: Gastric cancer (GC) is a leading cancer health disparity among the Alaska Native (AN) people. The aim of this study was to evaluate recent trends in AN gastric cancer incidence and survival. AN patients differ from non-Hispanic White patients in increased incidence, younger age at diagnosis, a higher presence of non-cardia, diffuse subtype, signet ring cell carcinomas, Helicobacter pylori, and greater proportion of GC among women. AN patients diagnosed at an early stage and whom receive surgical treatment have better overall survival compared to later stage patients. Therefore, additional screening programs and early detection measures for AN people, may improve patient outcomes.