Stomach Cancer (Gastric Carcinoma): Prevention

To prevent gastric cancer (stomach cancer), attention must be paid to reducing individual risk factors. Behavioral risk factors

  • Diet
    • Too little fruit and vegetable consumption
    • Too little fish consumption; inverse correlation between fish consumption and risk of disease.
    • Diets high in nitrates and nitrites, such as cured or smoked foods: Nitrate is a potentially toxic compound: Nitrate is reduced to nitrite in the body by bacteria (saliva/stomach). Nitrite is a reactive oxidant that reacts preferentially with the blood pigment hemoglobin, converting it to methemoglobin. Furthermore, nitrites (also contained in cured sausage and meat products and ripened cheese) form nitrosamines with secondary amines (contained in meat and sausage products, cheese and fish), which have genotoxic and mutagenic effects. Among other things, they promote the development of stomach cancer. The daily intake of nitrate is usually about 70% from the consumption of vegetables (lettuce and lettuce, green, white and Chinese cabbage, kohlrabi, spinach, radish, radish, beet), 20% from drinking water (nitrogen fertilizer) and 10% from meat and meat products and fish.
    • Benzo(a)pyrene is considered a risk factor for gastric carcinoma (stomach cancer). It is formed during toasting and charcoal grilling. It is found in all grilled, smoked or burnt foods. Cigarette smoke also contains benzo(a)pyrene, which in turn can lead to bronchial carcinoma.
    • Eating foods that may be infested with the mold Aspergillus flavus or Aspergillus parasiticus. These molds produce aflatoxins, which are carcinogenic. Aspergillus flavus is found in peanuts, pistachios and poppy seeds; Aspergillus parasiticus is found in peanuts.
    • Sodium or salt intake: there is debate as to whether long-term high sodium or salt intake leads to an increased risk of gastric cancer. For example, there is circumstantial evidence that atrophic gastritis (gastritis of the gastric mucosa) develops more frequently with high salt intake. In addition, carcinogens can penetrate the barrier of the gastric mucosa (stomach lining) more easily when high concentrations of table salt are present in the stomach.
    • Micronutrient deficiency (vital substances) – see prevention with micronutrients.
  • Consumption of stimulants
    • Alcohol (woman: > 20 g/day; man: > 30 g/day)
      • Heavy drinkers (> 4 to 6 drinks): 1.26-fold increased risk; very heavy drinkers (> 6 drinks): 1.48-fold increased risk
      • Only individuals who did not have H. pylori-specific IgG antibodies increased gastric cancer risk by heavy drinking (alcohol for > 30 years, ≥ 7 times per week, or amount ≥ 55 g on a single occasion (binge drinking))
    • Tobacco (smoking); about 3-fold increased risk of disease.
  • Psycho-social situation
    • Night service (+ 33%)
  • Overweight (BMI ≥ 25; obesity); adenocarcinomas in the transition from the stomach to the esophagus (+ 80%).

Environmental pollution – intoxications (poisonings).

  • Ingestion of nitrosamines
  • Benzpyrene – found in exhaust fumes, smoke and tar. Among other things, it is considered a risk factor for gastric cancer.

Other risk factors

  • Blood group A

Prevention factors (protective factors)

  • H. pylori eradication (“screen-and-treat strategy”).
  • High versus low leisure-time physical activity is associated with a lower risk of gastric cancer (-22%; HR 0.78, 95% CI 0.64-0.95).
  • Green tea – Studies on gastric cancer indicate that flavonoids inhibit the growth of gastric cancer cells. Since especially in the regions of China and Japan is traditionally drunk a lot of green tea, there men as well as women showed a fivefold lower mortality rate (mortality rate) from gastric cancer than the average population A high intake of flavonoids in the form of green tea causes a lower risk of gastric, colon carcinoma (colon and rectal cancer) and mammary carcinoma (breast cancer) in humans.
  • Acetylsalicylic acid (ASA) – daily intake; risk reduction of 35%.

Prophylaxis

  • In confirmed carriers of a pathogenic CDH1 mutation, prophylactic gastrectomy should be offered from the age of twenty [guidelines: S3 guideline].
  • In HNPCC patients and persons at risk for HNPCC, an esophago-gastro-duodenoscopy (OGD; endoscopy of the esophagus, stomach, and duodenum) should be performed regularly from the age of 35 in addition to colonoscopy [guidelines: S3 guideline].