Ethnic Disparities in Gastric Cancer Presentation and Screening Practice in the United States: Analysis of 1997-2010 Surveillance, Epidemiology, and End Results-Medicare Data

Abstract

Background: Chronic infection with Helicobacter pylori (H. pylori) is the strongest risk factor for distal gastric cancer. Although gastric cancer incidence has decreased, variation by race and ethnicity is observed. This study describes gastric cancer presentation and screening services among Medicare patients by race/ethnicity, place of birth, and history of gastric cancer-related conditions. Methods: Using demographic, location, and disease staging information, extracted from the Surveillance, Epidemiology and End Results-Medicare gastric cancer database (1997-2010), we compared frequencies of gastric cancer-related conditions (e.g., peptic ulcer, gastric ulcer, gastritis) and screening (H. pylori testing and endoscopy) from inpatient and outpatient services claims by selected race/ethnicity and place of birth. Results: Data included 47,994 incident gastric cancer cases with Medicare claims. The majority (48.0%) of Asian/Pacific Islanders (API) were foreign-born, compared with non-Hispanic whites (NHW), Hispanics, and blacks (with 64.4%, 33.9%, and 72.9% U.S.-born, respectively). For NHWs, the most frequently diagnosed gastric cancer site was the cardia (35.6%) compared with < 15%(P < 0.001) for APIs, Hispanics, and blacks. Although more than 57% of all cases had a history of gastric cancer-related conditions, H. pylori testing was reported in only 11.6% of those cases. H. pylori testing was highest for APIs (22.8%) and lowest for blacks (6.5%). Conclusions: Noncardia gastric cancer, associated with H. pylori infection, was diagnosed more frequently among APIs, blacks, and Hispanics than NHWs. Testing for H. pylori was low among all gastric cancer cases despite evidence of risk factors for which screening is recommended. Studies are needed to increase appropriate testing for H. pylori among higher risk populations. Impact: This study sheds light on poor screening practices despite presence of gastric cancer-related conditions.