Gastric cancer: a reality to be changed.

I read with special interest the article by TorresRoman and Grados-Sanchez about “Gastric cancer in Peru, a reality that has to change” (1). They highlighted that up to 80% of cases are detected when the serosa and muscle layers of the stomach are affected; and cigarette smoking, diets rich in salt, smoked foods, sedentary lifestyle and obesity, and Helicobacter pylori infection as major associated risk factors in 90% of the cases (1). Moreover, they emphasized the lack of cancer specialists and endoscopy resources, which could explain the high rate of death from cancer gastric in poor regions of Peru (1). Worthy of note, was the absence of comments about the alcohol abuse in this setting. Chirinos et al. compared 96 Peruvian patients with confirmed diagnosis of gastric cancer and 96 control individuals with diagnosis either of gastritis or peptic ulcer (2). Cancer gastric patients had low socioeconomic level; were from the Andean zone and jungle; had low consumption of fruits, vegetables and milk; utilized firewood, charcoal, or kerosene to cook, and had not refrigerator; tubular adenocarcinoma predominated (2). No significant differences were found about ethnicity; tobacco and alcohol use; mineral, wood and metal dust exposures; red meat and salt consumption; and food temperature (2). Interestingly, neither tobacco smoking or alcohol abuse seemed to be main risk factors (2).