Worldwide, stomach cancer is the fourth most common cancer and the second most common cause of cancer deaths, accounting for approximately 989 000 new cases and 850 000 deaths in 2001 and 2002, respectively. Stomach cancer can be classified as diffuse or intestinal. The former has an earlier onset with similar occurrences by sex and by geographic areas, whereas the latter has a later onset and develops more often in men than women. There is a wide variation (more than 10-fold) in the incidence of the intestinal type, suggesting that environmental factors are important determinants. Japan, Korea, China, Eastern Europe, Central America, and South America have higher incidences, whereas southern Asia, India, North America, and Africa have lower incidences. A wide range of incidence also occurs within countries.
The incidence and mortality rates of stomach cancer have been declining for several decades because of a reduction in childhood Helicobacter pylori infection, improved nutritional status, and reductions in exposures to carcinogens in preserved food. However, because of increases in life expectancy, the absolute number of stomach cancer cases has been increasing.
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