Stomach cancer in young women is a growing problem

More than ten years ago, Shria Kumar, a gastroenterologist and researcher at the University of Miami (USA), began to notice something alarming. Patients with stomach cancer were increasingly coming to her, much younger than usual, and many of them were women. This trend continues today.

The scientific community is trying to figure out why this happens, but last spring they received confirmation that the phenomenon is real, at least in the United States. By studying extensive cancer registries in many states across the country, researchers concluded that stomach cancer is growing at a faster rate among younger women. Over nearly two decades, the incidence rate among women under 55 has risen by 3%, twice the rate among young men. This comes as rates for seniors are being cut. The increase in young women is occurring primarily among non-Hispanic white women, a group that has traditionally been less likely to develop the disease than black, Hispanic and Asian women.

In the United States, men over 55 still make up the bulk of stomach cancer patients, but the increase in younger women is particularly concerning because their disease tends to be more severe.

“These tumors are more widespread and more aggressive at the time of diagnosis,” leading to worse prognoses, Kumar says.

The overall five-year survival rate for stomach cancer in the United States is 36 percent. This figure has been declining in recent years, especially among people of Asian and black descent. But for people diagnosed after the cancer has spread (a likely scenario for younger people with more aggressive tumors), the survival rate is just 6.6 percent.

There are several theories about the reason for this rally, but there is no clear understanding of why this is happening. “This is a question that no one has a good answer to,” says Michael Cecchini, a medical oncologist at the Gastrointestinal Cancer Center at Yale Cancer Center.

Srinivas Gaddam, a gastroenterologist at Cedars-Sinai Medical Center in Los Angeles and lead author of the follow-up study, said lifestyle and environmental changes over the past few decades may be affecting young women.

“The environment your stomach sees is everything you take into your body,” Gaddam says. Young women drink and smoke more, which may play a role. Or perhaps new chemicals have been introduced into the food system. Even toxins we breathe can end up in your stomach if your lungs cough them up and you swallow them, he notes.

Young women diagnosed with stomach cancer are often surprised by the news. Camille Rowe, then 39 and a mother of two young children in Los Angeles, remembers thinking, “I didn’t even know you could get stomach cancer.”

But Rowe wasn’t the only one who didn’t consider the possibility. His doctors also ignored his symptoms. Over the previous two years, when he periodically experienced burning and stabbing sensations in his stomach, three doctors diagnosed him with gastrointestinal reflux and prescribed antacids. Every time Rowe tried to stop taking them, she experienced severe pain. It was only after she called her GP in tears that she was referred for an endoscopy, which diagnosed her with cancer.

Besides heartburn and abdominal pain, other symptoms of stomach cancer include nausea, weight loss and bloody vomiting. But since the initial phase is usually silent, these types of symptoms likely indicate late-stage disease.

One of the main reasons is that the underlying cause of most cases of stomach cancer is bacteria. Helicobacter pylori, the same microbe that causes many stomach ulcers. He H. pylori It is endemic in many parts of the world due to poor sanitation systems. Other known risk factors for the disease include a diet based on smoked, salted or cooked foods; obesity; and smoking history, Cecchini says.

Genetics also play a role, especially in cancer in young people. This includes people with Lynch syndrome, a disease in which mutations in genes involved in DNA repair increase the risk of numerous types of cancer, including colorectal, small bowel, stomach, ovarian, pancreatic and brain cancers.

A mutation in another gene, called CDH1, caused stomach cancer in Courtney Zentz, a 42-year-old woman from West Chester, Pennsylvania, USA. His mother died in 2006 at age 54, four months after she was diagnosed with sudden, aggressive stomach cancer. Four years ago, Zentz decided to undergo genetic testing and discovered that he had inherited this rare mutation.

The only way to avoid her mother’s fate was to prophylactically remove Zentz’s stomach, along with her gall bladder and both breasts, which were also at high risk of cancer. Zentz followed this advice, prompting surgeons to connect his esophagus directly to his small intestine so he could continue to eat, albeit in smaller amounts. Cells removed and analyzed after surgery showed he was already suffering from stage 1 stomach cancer.

“My mother’s death saved my life,” Zentz says. He also saved his brother, who had inherited a mutation and had to have his stomach removed.

Treatment for stomach cancer usually includes surgery, chemotherapy, radiation therapy and/or immunotherapy.

Camilla Rowe’s cancer was discovered when it had spread to just a few nearby lymph nodes. He initially had good results after gastric sleeve surgery followed by chemotherapy. However, three years later, the disease reappeared and spread to the lining of the abdominal cavity, known as the peritoneum.

Rowe had her ovaries removed and was given additional intravenous chemotherapy. This was followed by an experimental treatment known as hyperthermic intraperitoneal chemoperfusion, in which chemotherapy drugs are injected directly into the abdominal cavity at a concentration 40 times higher than that of intravenous chemotherapy. Results supporting the effectiveness of this method have been mixed.

For now it works. Rowe, now 45, has undergone seven rounds of treatment at City of Hope Cancer Center in Los Angeles and is currently free of any signs of cancer. She knows that everything is against her, but she is determined to remain positive.

“I might be one of the six percent who survive long term,” he says; “That’s why I pray.”

Unlike mammography for breast cancer or colonoscopy for colorectal cancer, no screening protocol is currently recommended for the early detection of gastric cancer.

Widespread screening, including endoscopy and a biopsy of any lesion, doesn’t make sense for everyone in the U.S. over a certain age because the cancer isn’t common enough, Kumar said.

Kumar hopes that future research can identify subgroups of people at highest risk who may one day be referred for annual screening, just as some former smokers are advised to undergo annual screening for lung cancer.

Meanwhile, as incidence is rising among young people, those with a family history of gastrointestinal cancer or persistent symptoms should consult their doctor.

“Increasing incidence among younger people means we need to be more aware and take symptoms seriously, both as patients and as doctors,” says Cecchini; “can mean more than just a nuisance.”