Goh Li-Yen, Leow Alex Hwong Ruey, Goh Khean-Lee
Faculty of Medicine, University of Nottingham, Nottingham, United Kingdom.
J Dig Dis. 2014 Sep;15(9):463-8. doi: 10.1111/1751-2980.12164.
Gastric cancer (GC) has long been thought to be an Asian type of cancer that is broadly associated with poverty, whereas colorectal cancer (CRC) has been thought to be a Western type of cancer associated with affluence. The incidence of GC has declined dramatically in the West but has a very high incidence in East Asia. The age-standardized incidence rates (ASR) have also declined. The decrease in the incidence of GC is associated with the decrease in the prevalence of Helicobacter pylori (H. pylori) infection worldwide. The discrepancy between a high H. pylori infection rate and a low GC incidence is seen chiefly among southern Asians of Indian origin and has been aptly termed the "Indian enigma". CRC is a new emerging cancer in this region. Some of the highest CRC ASR have been reported from Asian countries, in many of which it has now surpassed that of GC. Liver cancer is also an important cancer in the Asia-Pacific region. The highest ASR worldwide is reported from the Asian countries of Mongolia, Korea and Japan. The predominant underlying etiology across the region has been hepatitis B virus infection, except in Japan, where hepatitis C is an important cause of hepatocellular carcinoma (HCC). With mass vaccination of hepatitis B at birth and improved public health measures in many countries, hepatitis B and C are set to decline with time. However, the exponential increase in obesity and consequent non-alcoholic fatty liver disease portends a future epidemic of fatty liver-related HCC.
长期以来，胃癌一直被认为是一种与贫困广泛相关的亚洲型癌症，而结直肠癌则被认为是一种与富裕相关的西方型癌症。胃癌的发病率在西方已大幅下降，但在东亚地区却非常高。年龄标准化发病率（ASR）也有所下降。胃癌发病率的下降与全球幽门螺杆菌（H. pylori）感染率的降低有关。幽门螺杆菌高感染率与低胃癌发病率之间的差异主要出现在印度裔南亚人中，这一现象被恰当地称为“印度之谜”。结直肠癌是该地区一种新出现的癌症。一些亚洲国家报告了一些最高的结直肠癌ASR，其中许多国家的结直肠癌发病率现已超过胃癌。肝癌在亚太地区也是一种重要的癌症。全球最高的ASR来自蒙古、韩国和日本等亚洲国家。除了日本，该地区主要的潜在病因一直是乙型肝炎病毒感染，在日本，丙型肝炎是肝细胞癌（HCC）的一个重要病因。随着许多国家在出生时大规模接种乙肝疫苗以及公共卫生措施的改善，乙肝和丙肝发病率将随着时间的推移而下降。然而，肥胖症的指数级增长以及随之而来的非酒精性脂肪性肝病预示着未来与脂肪肝相关的肝癌将流行。
