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Mortality from cancer of the stomach in Costa Rica
Abstract
Accuracy of clinical diagnosis of gastric cancer in patients dying in Hospital San Juan de Dios, San José, Costa Rica, has been studied by comparing clinical and necropsy diagnoses in a random sample of deaths. Necropsy diagnoses were used as the “standard.” The total number of deaths assigned to gastric cancer seemed closely approximated by the clinical diagnoses. Cancer of the stomach accounted for 36% of all cancer deaths among males in all necropsied cases during a 2-year period. The relative frequency of gastric cancer in the random sample of deaths which were necropsied was 33% of all cancer deaths among males. Age-adjusted death rates for cancer of the stomach and mortality rates computed from deaths in well-documented cases in San José Province plus a conservative estimate of additional deaths from cancer of the stomach suggest that mortality from this form of cancer in Costa Rica is high compared with other countries.
... Most of the patients in our study belonged to rural areas amongst whom 69.6 percent in D1 and 70.4 percent in modified D2 were unskilled (mostly farmers). High incidence of disease was confirmed by Strong et al. in Cost Rica, in the Japanese farmers [19]. Excessive use of nitrate fertilizers (and hence exposure to nitrates) could be a possible explanation. ...
Armijo R [Division of Epidemiology, School of Public Health, University of California, Los Angeles, CA 90024 (USA)], Sayre J, and Llavina de Navarro R. The epidemiology of gastric cancer in Chile. III. Diagnostic practices in Santiago, Chile, 1976–8. International Journal of Epidemiology 1982; 11:323–328.
The purpose of this paper is to estimate the validity of current diagnostic procedures used in Santiago, Chile, in identifying gastric cancer (GC) patients among people with gastric complaints, many of whom suffer possible premalignant conditions.
Review of diagnoses on 2296 patients seen at the University Hospital during 1976 and 1977 revealed 103 confirmed cases of adenocarcinoma. This review permitted us to estimate the validity of clinical/radiological and endoscopic methods versus diagnosis made from pathological specimens. A code of diagnostic categories was generated for application in eight hospitals participating in a subsequent case-control study of GC.
A high prevalence of chronic atrophic gastritic (CAG) and chronic gastric ulcer (CGU) was found, both conditions together accounting for 50% of diagnoses on 845 clinic controls during the study period 1977–8. The value of gastroscopy and biopsy to separate out GC from other gastric conditions, the importance of studying the epidemiology of premalignant conditions in Chile, and differences between GC in Chile and the United States are discussed.
Available evidence on the variation in stomach-cancer incidence and mortality with respect to time trends, age, sex, race, country, geographic latitude, nativity, socioeconomic class, and urban-rural residence is reviewed. In the search for exogenous factors that might influence the distribution of stomach-cancer cases, dietary effects appear to be the most obvious possibilities. The use of retrospective studies of cancer patients and matched controls to explore associations between stomach cancer and items of diet is discussed. Also included is a summary of variations in per capita consumption of several food items among population groups within the United States supplemented by observations for some countries with high stomach-cancer rates, which may be useful in providing leads for controlled, retrospective studies.
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