female health care provider speaks with female patient

ROCHESTER,
Minn. — Many people under 60 who develop stomach cancer have a “genetically
and clinically distinct” disease, new Mayo Clinic research has discovered. Compared to stomach
cancer in older adults, this new, early onset form often grows and spreads more
quickly, has a worse prognosis, and is more resistant to traditional chemotherapy
treatments, the study finds. The research was published
recently in the journal Surgery.

While
rates of stomach cancer in older patients have been declining for decades, this
early onset cancer is increasing and now makes up more than 30% of stomach
cancer diagnoses.

“I
think this is an alarming trend, as stomach cancer is a devastating disease,”
says senior author Travis Grotz,
M.D.
,
a Mayo Clinic surgical oncologist. “There is little awareness in the U.S. of
the signs and symptoms of stomach cancer, and many younger patients may be
diagnosed late — when treatment is less effective.”

The
research team studied 75,225 cases using several cancer databases to review
stomach cancer statistics from 1973 to 2015. Today, the average age of someone
diagnosed with stomach cancer is 68, but people in
their 30s, 40s and 50s are more at risk than they used to be.

Although
there’s no clear cutoff age for the definition of early onset and late-onset
stomach cancer, the researchers found the distinctions held true whether they
used an age cutoff of 60, 50 or 40 years. The researchers found that the
incidence of late-onset stomach cancer decreased by 1.8% annually during the
study period, while the early onset disease decreased by 1.9% annually from
1973 to 1995 and then increased by 1.5% through 2013. The proportion of early onset
gastric cancer has doubled from 18% of all cases in 1995 to now more than 30%
of all gastric cancer cases.

“Typically,
we see stomach cancer being diagnosed in patients in their 70s, but
increasingly we are seeing 30- to 50-year-old patients being diagnosed,”
Dr. Grotz says.

The
increased rate of the early onset disease is not from earlier detection or
screening, Dr. Grotz adds. “There is no universal screening for stomach
cancer, and the younger patients actually presented with later-stage disease
than the older patients,” he says.

In addition to being more deadly, early onset stomach cancer is also genetically and molecularly distinct, researchers found. Furthermore, traditional risk factors for developing stomach cancer among older Americans, such as smoking tobacco, did not appear to correlate with its early onset counterpart.

“Hopefully,
studies like this will raise awareness and increase physician suspicion of
stomach cancer, particularly in younger patients,” Dr. Grotz says. Younger
patients who feel full before finishing a meal, or have reflux, abdominal pain,
unintentional weight loss and difficulty eating should see their health care
provider, he adds.

Stomach
cancer is the 16th most common
cancer

in the U.S., according to the American Cancer Society. It has a five-year
survival rate of 31.5%
, and there will be an estimated 27,510 new cases in
2019, according to the National Cancer Institute.

Next
the research team hopes to better identify risk factors for early onset stomach
cancer using the Rochester
Epidemiology Project

and potentially other large databases.

The
study’s lead author is John Bergquist, M.D., now with Stanford University. At
the time of the study, Dr. Bergquist was a surgical outcomes fellow in the Mayo Clinic
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery
. Study
co-authors are Jennifer Leiting, M.D.; Elizabeth
Habermann, Ph.D.
;
Sean Cleary,
M.D.
;
Michael
Kendrick, M.D.
;
Rory Smoot, M.D.; David Nagorney, M.D.; and Mark Truty, M.D. — all of Mayo
Clinic.

The
research was supported in part by the Mayo Clinic Robert D. and Patricia E.
Kern Center for the Science of Health Care Delivery.

The
researchers report no conflicts of interest.

###

About the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery
The Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery seeks to discover new ways to improve health; translate those discoveries into evidence-based, actionable treatments, processes and procedures; and apply this new knowledge to improve care for patients everywhere. Learn more about the research center.

About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news and An Inside Look at Mayo Clinic for more information about Mayo.

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