Document Type: Systematic Review and Meta-analysis
Department of Surgery, Clinical Campus, International Medical University, Jalan Rasah, Seremban, Negeri Sembilan, Malaysia.
Incidence rates of gastric cancer in Malaysia has declined by 48% among males and 31% among females in the latest
reporting period of 13 years. Malays used to have age-standardized-rates only a fifth of those in Chinese and Indians,
but the incidence among them is slightly rising even as the rates drop in the other races. Besides ethnicity, a low level
of education, high intake of salted fish and vegetables, H pylori infection and smoking are risk factors. Consumption
of fresh fruit and vegetable is protective. Variation in the strains of H pylori infection affect gastric cancer risk, with
hspEAsia isolates among Chinese appearing linked to a high incidence than with hpAsia2 or hpEurope strains among
Indians and Malays. It was reported in the 1980s that only about 3% of patients presented with early gastric cancer, but
more encouraging rates reaching 27% with Stage 1 and 2 disease have been reported in the twenty-first century from
leading centres. More tumours occur in the distal stomach except in Kelantan, where the incidence is low and main site
is the cardia. Prompt endoscopy is advocated and open access, with direct referrals, to such services using a weighted
scoring system should be more utilized. In view of the high rate of late disease laparoscopic staging unnecessary
laparotomy needs to be avoided. Late presentation of gastric cancer however, is still predominant and the mortality to
incidence ratio is relatively high. Besides seeking to reduce risk factors and achieve early detection, implementation
of improved care for patients with late disease must be promoted in Malaysia.