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Risk of stomach cancer in Aotearoa/ New Zealand: A Māori population based case-control study

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Authors:
Summary:

These researchers sought to determine why Māori experience disproportionate rates of stomach cancer compared to non-Māori and to identify priorities for prevention. The study examined 165 Māori stomach cancer cases from the New Zealand Cancer Registry between 1 February 2009 and 31 October 2013; 480 randomly selected Māori controls from the NZ electoral roll were matched by 5-year age bands to cases. The diffuse subtype made up nearly half of all cancers (47.9%). The following risk factors were all associated with increased odds of stomach cancer: having >2 people sharing a bedroom in childhood (OR 3.30; 95% CI, 1.95 to 5.59), being tested for Helicobacter pylori (OR 12.17; 95% CI, 6.15 to 24.08), being an ex-smoker (OR 2.26; 95% CI, 1.44 to 3.54) and adult exposure to environmental tobacco smoke (OR 3.29; 95% CI, 1.94 to 5.59). Some results were attenuated following post-stratification weighting. The researchers call for populationlevel strategies to reduce the incidence of stomach cancer in Māori, including expanding measures to screen and treat those infected with H. pylori and a continued policy focus on reducing tobacco consumption and uptake.

Comment:
Familial stomach cancer in a few Māori whānau (due to E-cadherin germline mutation) is often touted as an excellent example of the usefulness of genomic research to address health inequities in Aotearoa. However, as highlighted here, inequities in stomach cancer incidence and mortality rates between Māori and non-Māori are more likely due to wider determinants such as overcrowded living conditions, smoking, inadequate health care (poor screening for and treatment of H. pylori infection) and diet. Perhaps our limited health funding is better focused in these areas.
Reference: PLoS ONE. 2017;12(7):e0181581
Independent commentary by Dr. Matire Hardwood

Dr Matire Harwood (Ngapuhi) has worked in Hauora Māori, primary health and rehabilitation settings as clinician and researcher since graduating from Auckland Medical School in 1994. She also holds positions on a number of boards, committees and advisory groups including the Health Research Council. Matire lives in Auckland with her whānau including partner Haunui and two young children Te Rangiura and Waimarie.

Research Review publications are intended for New Zealand health professionals.

Disclaimer: This publication is not intended as a replacement for regular medical education but to assist in the process. The reviews are a summarised interpretation of the published study and reflect the opinion of the writer rather than those of the research group or scientific journal. It is suggested readers review the full trial data before forming a final conclusion on its merits.

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