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INTRODUCTION
American Indian (AI) and Alaska Native (AN) people are disproportionately affected by gastric cancer when compared with their non-Hispanic white (NHW) counterparts (1,2), a pattern that has been observed among indigenous peoples globally (3). In contrast to the relatively consistent rates observed across NHW people nationally, gastric cancer incidence among AIAN people also varies regionally from a low of 6.1/100,000 in the Eastern United States to a high of 24.5/100,000 in Alaska (4). Gastric cancer is the fifth leading cause of cancer death among AN people, and only a fifth of AN patients are diagnosed at the local stage when there may be some chance of a cure (5). This is a leading health disparity for AN people, with both incidence and mortality rates over 3 times than those observed among NHW people (6). Similarly, high rates are observed in Asia (7) and among other indigenous populations across the circumpolar North (8,9). Risk factors for gastric cancer that are shared among these populations include chronic Helicobacter pylori infection, tobacco use, and high intake of salted and smoked foods (10–12).
Despite sharing a high burden of gastric cancer with other circumpolar and Asian populations, there are unique pathologic and molecular genetic features of gastric cancer among AN people. A recent examination of gastric cancer tumors showed that compared with their NHW counterparts, a higher proportion of AN patients with gastric cancer were diagnosed with noncardia and diffuse subtype cancers, including signet-ring cell carcinomas (SRCC) (5). Diffuse-type gastric adenocarcinomas tend to be highly metastatic, have worse prognosis, and are more difficult to identify using endoscopy (13). This has implications not only for prognosis and survival but also for the design and implementation of screening programs like those in Japan and South Korea, where cancer is predominately intestinal-type (14). These pathologic and molecular differences highlight the need to specifically evaluate the gastric cancer within this population.
Our group recently convened a symposium of international experts, community members, and Tribal health leaders to identify the best strategies to reduce the burden of gastric cancer among AN people (15). Recommendations offered by the symposium included the creation of a gastric cancer screening program for particularly high-risk patients (e.g., first degree relatives of patients with gastric cancer and patients with...