South Florida counties have above-average rates of mortality from gastric cancer, according to a new study published in the journal Gastroenterology by investigators at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine.
Sylvester faculty were part of an international collaboration of gastroenterologists, epidemiologists, and oncologists to study gastrointestinal (GI) deaths by U.S. county, looking at factors associated with inter-county differences in mortality and potential avenues for reducing the disparities.
The multidisciplinary nature of this work allowed us to evaluate the factors that may explain differences in cancer mortality rates from the perspectives of screening, diagnosis, and treatment."
David Goldberg, M.D., Sylvester researcher, associate professor of medicine in the Division of Digestive Health and Liver Diseases at the Miller School
Calculating county-level mortality from esophageal, gastric, pancreatic, and colorectal cancers, the authors found significant geographic disparities in GI cancer-related county-level mortality across the U.S. from 2010 to 2019. According to the paper, counties with the highest 5% mortality rates for gastric, pancreatic, and colorectal cancer were primarily in the Southeastern U.S. Colorectal cancer mortality was particularly high in counties in Arkansas, Louisiana, Kentucky, Tennessee, Mississippi, Alabama, Georgia, South Carolina, and northern Florida.
Cigarette smoking and living in rural areas were the factors most closely linked with GI cancer-related mortality.
Different rates of various GI cancer types
South Florida had mixed results when it came to mortality from the different GI cancer types.
"Compared to the rest of the U.S., in South Florida we have much lower rates of mortality from esophageal and pancreatic cancer, average rates of mortality from colorectal cancer, and above-average rates of mortality from gastric cancer," Dr. Goldberg said.
For consumers in Sylvester's catchment area, the high mortality rate from gastric cancer likely bespeaks the fact that the primary risk factor for a common gastric cancer type, non-cardia gastric cancer, a bacteria called Helicobacter pylori (H. pylori), is more common in parts of the world such as South America, according to Dr. Goldberg.
"Our diverse population that includes many immigrants from countries with above-average rates of Helicobacter pylori is likely one of the reasons for our higher rates of mortality from gastric cancer. It is important for clinicians to be aware of this, and to evaluate patients with possible symptoms of the infection, such as abdominal pain and dyspepsia, in especially those who were born in countries with a high prevalence of the infection."
Public health efforts
The study's findings support not only public health efforts to reduce smoking but also programs that help improve care for rural populations.
The high rate of gastric cancers diagnosed in South Florida underscores the importance of identifying and eradicating modifiable risk factors like H. pylori, and screening exams for individuals considered high risk based on family history, according to study author and Sylvester researcher Daniel Sussman, M.D.
"We are conducting those studies as we speak. Sylvester researchers Shria Kumar, M.D., MSCE, is working to identify community prevalence rates for H. pylori using Sylvester's Game Changer vehicles, and Ami Panara Shukla, M.D., is working to identify antimicrobial susceptibility of H. pylori, a major barrier to its eradication," said Dr. Sussman, who also is associate professor of clinical medicine at the Miller School.
Screening and education
The Game Changer vehicles, part of the Sylvester Office of Outreach and Engagement under the direction of Erin Kobetz, Ph.D., M.P.H., serve South Florida's highest-risk and highest-need communities with cancer control and prevention outreach, according to Tracy E. Crane, Ph.D., RDN, associate professor of medical oncology and co-lead of cancer control at Sylvester.
"In addition to the results of this study in Gastroenterology, we know that people living in these communities disproportionately experience higher rates of obesity and type 2 diabetes. Using the Game Changer vehicles not only increases access to screening for cancer prevention, but they also offer education and care in the community, systematically working to close the gap in equitable care," Dr. Crane said.
The Game Changer vehicles also help to address smoking cessation, offering referrals to free services for quitting tobacco, such as Tobacco Free Florida, where people can work one on one with a quit coach to help them stop using tobacco products.
"This paper illustrates the importance of considering contextual factors of communities when analyzing epidemiological data," Dr. Crane said. "To best serve our catchment area, we need to work with our communities to better understand their needs and design interventions that meet the community where they are at, such as using the Game Changer vehicles for not only screening but as a mode for increasing access to cancer care."