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Aragonés N, Pérez-Gómez B, Pollán M, Ramis R, Vidal E, Lope V, García-Pérez J, Boldo E, López-Abente G. The striking geographical pattern of gastric cancer mortality in Spain: environmental hypotheses revisited. BMC Cancer 2009; 9:316. [PMID: 19737377 PMCID: PMC2746229 DOI: 10.1186/1471-2407-9-316] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Accepted: 09/08/2009] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Gastric cancer is decreasing in most countries. While socioeconomic development is the main factor to which this decline has been attributed, enormous differences among countries and within regions are still observed, with the main contributing factors remaining elusive. This study describes the geographic distribution of gastric cancer mortality at a municipal level in Spain, from 1994-2003. METHODS Smoothed relative risks of stomach cancer mortality were obtained, using the Besag-York-Molliè autoregressive spatial model. Maps depicting relative risk (RR) estimates and posterior probabilities of RR being greater than 1 were plotted. RESULTS From 1994-2003, 62184 gastric cancer deaths were registered in Spain (7 percent of all deaths due to malignant tumors). The geographic pattern was similar for both sexes. RRs displayed a south-north and coast-inland gradient, with lower risks being observed in Andalusia, the Mediterranean coastline, the Balearic and Canary Islands and the Cantabrian seaboard. The highest risk was concentrated along the west coast of Galicia, broad areas of the Castile & Leon Autonomous community, the province of Cáceres in Extremadura, Lleida and other areas of Catalonia. CONCLUSION In Spain, risk of gastric cancer mortality displays a striking geographic distribution. With some differences, this persistent and unique pattern is similar across the sexes, suggesting the implication of environmental exposures from sources, such as diet or ground water, which could affect both sexes and delimited geographic areas. Also, the higher sex-ratios found in some areas with high risk of smoking-related cancer mortality in males support the role of tobacco in gastric cancer etiology.
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Affiliation(s)
- Nuria Aragonés
- Environmental and Cancer Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Parc de Recerca Biomèdica de Barcelona, Doctor Aiguader, 88 1ª Planta, 8003 Barcelona, Spain
| | - Beatriz Pérez-Gómez
- Environmental and Cancer Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Parc de Recerca Biomèdica de Barcelona, Doctor Aiguader, 88 1ª Planta, 8003 Barcelona, Spain
| | - Marina Pollán
- Environmental and Cancer Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Parc de Recerca Biomèdica de Barcelona, Doctor Aiguader, 88 1ª Planta, 8003 Barcelona, Spain
| | - Rebeca Ramis
- Environmental and Cancer Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Parc de Recerca Biomèdica de Barcelona, Doctor Aiguader, 88 1ª Planta, 8003 Barcelona, Spain
| | - Enrique Vidal
- Environmental and Cancer Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Parc de Recerca Biomèdica de Barcelona, Doctor Aiguader, 88 1ª Planta, 8003 Barcelona, Spain
| | - Virginia Lope
- Environmental and Cancer Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Parc de Recerca Biomèdica de Barcelona, Doctor Aiguader, 88 1ª Planta, 8003 Barcelona, Spain
| | - Javier García-Pérez
- Environmental and Cancer Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Parc de Recerca Biomèdica de Barcelona, Doctor Aiguader, 88 1ª Planta, 8003 Barcelona, Spain
| | - Elena Boldo
- Environmental and Cancer Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Parc de Recerca Biomèdica de Barcelona, Doctor Aiguader, 88 1ª Planta, 8003 Barcelona, Spain
| | - Gonzalo López-Abente
- Environmental and Cancer Epidemiology Unit, National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Parc de Recerca Biomèdica de Barcelona, Doctor Aiguader, 88 1ª Planta, 8003 Barcelona, Spain
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Ruiz-Ramos M, Expósito Hernández J. Tendencia de la mortalidad por cáncer en Andalucía entre 1975 y 2003. Med Clin (Barc) 2007; 128:448-52. [PMID: 17408537 DOI: 10.1157/13100561] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND OBJECTIVE To describe cancer mortality trends in Andalusia for cancer as a whole and for their main locations, by age and gender groups during 1975-2003. MATERIAL AND METHOD Mortality rates age and gender-adjusted have been estimated through cancer mortality data coming from mortality and polpulation official statistics. Joinpoint regression analysis has been used in order to quantify trends and their points of change. RESULTS Cancer as a whole has showed a descending trend among women and an ascending trend among men, for the period 1975-2003. Annual change rates were -0.45% and 0.42% for women and men respectively, and both of them, statistically significant (p < 0.05). By age, except for the elder group, a fall is noted, both among women and among men. Among women, breast cancer was the first cause of cancer death; in 1993 it appeared a statistically significant change from ascendent to descendent trend. Among men, lung cancer was the first mortality cause; in 1996 appeared a significant trend change and it began to go down. Colon and rectum cancer was the second one in magnitude, both among men and women, but far from the first one and with an ascendent trend, specially among men. CONCLUSIONS Cancer mortality shows a descending trend among andalusian women, with a similar rate to the Spanish average. Among men, the trend is ascendent with a higher magnitude than the national average.
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