Environmental Contributions to Gastrointestinal and Liver Cancer in the Asia-Pacific Region

Journal of Gastroenterology and Hepatology
Accepted manuscript online: 28 SEP 2017

Environmental Contributions to Gastrointestinal and Liver Cancer in the Asia-Pacific Region
Kwang-Pil Ko1, Aesun Shin2, Sooyoung Cho2, Sue K. Park2, Keun-Young Yoo2,3

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Abstract 
In the Asia-Pacific region, gastric, colorectal and hepatocellular [liver] cancer show substantial regional variation in incidence consistent with the presence of important environmental factors. For gastric cancer, global incidence is concentrated in Asia with substantially higher rates in East Asia than in South-East Asia and Australia. The differences in incidence rates for gastric cancer in the Asia-Pacific region may be due, in part, to differences in the prevalence of H. pylori infection and the prevalence of H. pylori virulence factors. Smoking is also correlated with gastric cancer risk, and is responsible for the highest population attributable fraction among men in East Asia. Colorectal cancer has increased rapidly in incidence to become the third most common digestive cancer in Asia. According to cohort studies in Asia, smoking, alcohol use, obesity and physical inactivity increase the risk of colorectal cancer. Unlike West Asia, East Asia and Australia have high incidence rates for colorectal cancer that correlates with a high Human Development Index and a high prevalence of alcohol consumption and obesity. Liver cancer is the second most common digestive cancer in Asia. The high incidence of liver cancer in East Asia and South-East Asia is concordant with the high prevalence of hepatitis B virus and hepatitis C virus infection. Other important risk factors include alcohol use, smoking, and diabetes. The identification of the above and other environmental factors [currently under investigation] is central to the development and implementation of effective cancer control programs for the region. 

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