CHRONIC NON-COMMUNICABLE

DISEASES

Dr Mokhtar Gusbi
Defines as

"Comprising all impairments or deviations from normal,

which have one or more of the following":
They are permanent
They leave residual disability
The are caused by non-reversible pathological alteration
They require special patient training to look after himself
The may be expected to require long period of
supervision
Non-communicable diseases (NCDs) include
cardiovascular, renal, nervous, and mental diseases,
arthritis, allied diseases, chronic non-specific respiratory
diseases (e.g., chronic bronchitis, emphysema, asthma),
accidents, senility, blindness, cancer, diabetes, metabolic
and degenerative diseases and chronic results of
communicable diseases.

Non-communicable diseases (NCD,s)

Changing patterns of disease (epidemiological
Transition)

The general shift from acute infectious and deficiency

diseases characteristic of underdevelopment to chronic
non-communicable diseases characteristic of
modernization and advanced levels of development is
usually referred to as the “epidemiological transition”.
The most evident indicators of this transition are changes
in the pattern of mortality, particularly in relation to
the cause of death, as well as changes in morbidity.
These changes require a change in the approach of
national authorities to the emerging problems.
The epidemiological transition

It used to be thought that the epidemiological transition

the shift from infectious and deficiency diseases to
chronic non-communicable diseases—was a
unidirectional process, beginning when infectious
diseases were predominant and ending when non-
communicable diseases dominated the causes of death.
It has, however, become apparent that this transition is
more complex and dynamic: the health and disease
patterns of a society evolve in diverse ways as a result of
demographic, socioeconomic, technological, cultural,
environmental and biological changes. It is rather a
continuous transformation process, with some diseases
disappearing and others appearing or re-emerging.

Mechanisms involved in the epidemiological

transition

There are several factors involved in the epidemiological

transition. The most important are considered below
Changes in risk factors
The risk factors involved in the epidemiological
transition include biological factors (microorganisms),
environmental factors, social, cultural and behavioural
factors and the practices of modern medicine.

Size of the problem

The problem of NCD's in on increase, affecting many
parts of the world, developed and developing countries.
with few exceptions. It is accounting for about 75% of
deaths.
Reasons behind that:

1) Increasing life expectancy

2) Change in life-style
3) Modern medical care

Risk factors:

Modifiable Non modifiable

1) Cigarette use 1) Age
2) Alcohol use and abuse 2) Sex
3) Unhealthy diet 3) Race
4) Life-style change 4) As genetics
5) Physical inactivity
6) No health services
7) Stress factors
8) Environmental risk factors
9) Other factors associated with higher risk of NCDs
include a person᾿s economic and social conditions.

Gaps in natural history of NCD's

These gaps can be summarized as follows:

1. Absence of known agent. 2. Multifactorial
causation.
3. Long latent period. 4. Indefinite onset.

Key risk factors include:

The key risk factors include high blood pressure, high

cholesterol, low fruit and vegetable intake, Overweight
and obesity and smoking.
Prevention
1. Case finding( screening, examination).
2. Application of improved methods of diagnosis (U/S).
3. Treatment & Rehabilitation.
4. Control of food, water, and air pollution.
5. Reducing accidents.
6. Improving life style and human behavior (health
education).
7. Improving health care (primary health care).

Major risk factors:

WHO report, 2002 identified five important risk factors

for non-communicable disease in the top ten leading
risks to health. These are:
- Raised blood pressure,
- Raised cholesterol,
- Tobacco use,
- Alcohol consumption,
- And overweight.

High Blood Pressure

Blood pressure is a measure of the force that the

circulating blood exerts on the walls of the main arteries.
The pressure wave is easily felt as the pulse; the highest
(systolic) pressure is created by the heart contracting, and
the lowest (diastolic) as the heart fills. Raised blood
pressure is almost always without symptoms.
High blood pressure levels damage the arteries that
supply blood to the heart, brain, kidneys and elsewhere,
producing a variety of structural changes.
Globally, this indicates that about two thirds of strokes
and half of heart disease, are attributable to sub-optimal
blood pressure (systolic blood pressure >115 mmHg).
World wide, high blood pressure is estimated to cause 7.1
million deaths, about 13% of the total and about 4.4% of
the total disease burden. There are, by a conservative
estimate, at least 600 million hypertension sufferers
worldwide.

High cholesterol:

Cholesterol is a key component in the development of

artherosclerosis, the accumulation of fatty deposits on
the inner lining of arteries. Mainly as a result of this,
cholesterol increases the risks of heart disease, stroke
and other vascular diseases.
Almost one fifth (18%) of global stroke events (mostly
nonfatal events) and about 56% of global heart disease
are attributable to total cholesterol levels above 3.2
mmol/l.
This amounts to about 4.4 million deaths (7.9% of the
total) and 2.8% of the global disease burden.

Low Fruit and Vegetable Intake

Fruits and vegetables are important components of a

healthy diet. Accumulating evidence suggests that they
could help prevent major diseases such as CVD and
certain cancers, principally of the digestive system.
There are several mechanisms by which these
protective effects may me mediated, involving
antioxidants and micronutrients, such as carotenoids,
vitamin C and folic acid, as well as dietary fibres.
These and other substances block or suppress the
action of carcinogens and, as antioxidants, prevent
oxidative DNA damage.
Fruit and vegetable intake varies considerably among
countries, in large part reflecting the prevailing
economic, cultural and agricultural environments.

Physical inactivity

Physical inactivity, along with other key risk factors, is

a significant contributor to the global burden of
chronic disease. Regular physical activity reduces the
risk of heart disease, stoke, breast, and colon cancers.
These benefits are mediated through a number of
mechanisms. In general, physical activity improves
glucose metabolism, reduces body fat and lowers
blood pressure; these are the main ways in which it is
thought to reduce the risk of CVD and diabetes. It can
also help manage and mitigate the effects of these
diseases.

Overweight and obesity

The prevalence of overweight and obesity is

commonly assessed by using body mass index (BMI),
defined as the weight in kilograms divided by the
square of the height in metres (kg/m2). A BMI over 25
kg/m2 is defined as overweight, and a BMI of over 30
kg/m2 as obese.
 People with a BMI below 18.5 kg/m2 tend to be
underweight.
Overweight and obesity lead to adverse metabolic
effects on blood pressure, cholesterol, triglycerides
and insulin resistance
The non-fatal, but debilitating health problems
associated with obesity include respiratory difficulties,
chronic musculoskeletal problems, skin problems and
infertility. The more life-threatening problems fall into
four main areas: CVD problems; conditions associated
with insulin resistance such as type 2 diabetes; certain
types of cancers, especially the hormonally related and
large-bowel cancers; and gallbladder disease.

Globally, WHO estimated 35 million person will died

every year due to main four diseases: cardiovascular,
diabetes mellitus, cancers and chronic obstructive
airways diseases.
60% of total death in the world.
WHO estimated, the next ten years, the total death will
be increase to 17% due to of non-communicable
diseases.

In LIBYA

Huge and not different from the rest of the world (no data
is available). National survey ( STEPS 2009): age
(25-64)
The percentage of people that have three or more risk
factors is 57.4%.
Smoking is 49.6% of male and 0.7% of female.
Alcohol consumption is 2.3% of male and 0% of female.
Vegetables and fruits taking (five portion per day) is vary
low is 2.6% of both male and female.
Physical inactivity is 69.35 of male and 87.4% of female.

Body mass Index (BMI) is a simple index of

weight-for-height = weight(kg) /height(M²). The
overweight is (>25) the percentage is 63.5%
(57.5% of male and 69.8% of female). While the obesity
(≥30) the percentage is 30.5% (21.4% of male and
41.1 of female). The people who are suffering from high
blood pressure (>140/90).The percentage is 40.6%
(45.8% of male and 35.6% of female).
the people who are suffering from high blood sugar and
Under treatment. Percentage is16.4% (17.6% of male
and 15.1% of female). If added the number of people
have high Fasting blood sugar, the percentage is 23.7%.
The people who are suffering from high cholesterol, the
percentage is 20.9% (19.0% of male and 22.7% of
female).

Integrated approach

To develop an overall integrated programme for the

prevention and control NCDs AS A PART OF PRIMARY
HEALTH CARE SYSTEMS. By attacking several risk
factors known to be implicated in the development of
non-communicable diseases.
Cardiovascular Diseases

Cardiovascular diseases (CVD) comprise of a group of

diseases of the heart and vascular system. The major
conditions are ischaemic heart disease (IHD),
hypertension, cerebrovascular disease (stroke) and
congenital heart disease.

Problem statement

WORLD
In todayʼs world, most deaths are attributable to non-
communicable diseases (35 million) and just over half of
these (17 million) are as a result of CVD; more than one-
third of these deaths occur in middle-aged adults.
In developed countries, heart diseases and stroke are the
first and second leading cause of death for adult men and
women.
The incidence of CVD is greater in urban areas than in
rural areas.
CVDs are now in decline in the industrialized countries.
The decline is largely a result of success of primary
prevention.

Hypertension

The definition of hypertension is difficult, the who in its

Expert committee report (1978) defined hypertension in
Adults as a systolic pressure ≥ 160 mm Hg and/or a
diastolic pressure ≥ 95mmHg.
BP classification SBP mmHg DBP mmHg
Normal <120 and <80
Prehypertension 120-139 or 80-89
Stage 1 140-159 or 90-99
Hypertension
Stage 2 160-179 or 100-109
Hypertension
Stage 3 ≥ 180 or ≥ 110

140/90 mmHg is the cut-off point above which is

considered
as hypertensive .. But still physicians use other criteria
for Diagnosis.
Blood pressure measurement
Sources of errors (variability):
a- Observer errors
b- Instrumental errors
c- Subject errors

A. Age: BP rises with age

B. Genetic: Twin & Family studies.

2. Modifiable Risk Factor

a. obesity b. physical inactivity
c. salt intake d. alcohol
e. saturated fatty acids f. others(oral contraception)

Prevention of Hypertension

1. Primary prevention

“all measures to reduce the incidence of disease in a

population by reducing the rest of onset”
 a) Population strategy:- Nutrition
Weight reduction
Exercise promotion
Behavioural changes
Self care
b) High risk strategy (family history)

Hypertension is a major risk factor:

- Stroke (CVA)
- Coronary heart disease (CHD)
- Heart failure
- Kidney failure
Mortality:

Still„ Mortality Rate are misleading because of under

reporting. (undiagnosed cases)
Risk factors for hypertension
non-modifiable risk factors (Risk markers)

2- Secondary prevention

a) Early case detection

b) Treatment:- below 140/90mmHg
C) Patient compliance (life treatment).

STROKE

“Rapidly developed clinical signs of focal(or global)

disturbance of cerebral function: lasting more than 24
hours or leading to death, with no apparent causes other
than vascular origin” (excludes TIA).
The problem

World Wide:
Morbidity:- 0.2 – 2.5 per 1000 population/year.
Variation due to differences in the age structure of
population
Involved.
Mortality:- one of the leading of death developed:- CHD
+ Stroke 40 -50 % (10-12% stroke)
Developing countries on rise.

NATURAL HISTORY

1- Risk factors: Hypertension, Cardiac abnormalities,

Diabetes, Blood lipids, Smoking, Obesity.
2- Transient ischaemic attack (TIA) reversible less than
24 h.
3- host factors; Age (80% of 65y) Sex (M) personal
History.

CONTROL

Hypertension, TIA, Diabetes, Smoking…ect

CORNARY HEART DISEASE

Coronary heart disease has been defined as ‘‘impairment

of heart function due to inadequate blood flow to the
heart compared to its needs, caused by obstructive
changes in the coronary circulation to the heart’’.CHD
may manifest itself in many presentations:
a. angina pectoris of effort.
b. myocardial infarction.
c. irregularities of the heart.
d. cardiac failure.
e. sudden death

Measuring the burden of disease

a. Proportional mortality ratio, CHD is held responsible
for about 30 per cent of deaths in men and 25 per cent
of deaths in women in most western countries.
b. Loss of life expectancy: the benefit would range for
men from 3.4 years to 9.4 years, and even greater for
women.
c. CHD incidence rate: difficult to compute, mortality
rates can be used as a crude indicator of incidence.

d. Age-specific death rates.

e. Prevalence rate: the prevalence of CHD can be
estimated from cross-sectional surveys using ECG for
evidence of infarction and history of prolonged chest
pain.
f. Case fatality rate: this is defined as the proportion of
attacks that are fatal within 28 days of onset.
j. Measurement of risk factor levels: measurement of
levels of cigarette smoking, blood pressure, alcohol
consumption and serum cholesterol in the community.
h. Medical care: measurement of levels of medical care
in the community are also pertinent.
Epidemicity

in many developed countries, CHD still poses the largest

public health problem. But even in those showing a
decline, CHD is still the most frequent single cause of
death among men under 65.

International variations

With 7.2 million deaths and 12.2 per cent of total deaths,
CHD is a worldwide disease. Mortality rates vary widely
in different parts of the world.

Mortality and morbidity due to CHD global estimates

for 2004

Region Deaths DALYs* last

Africa 346 3,513

SEAR 2,011 21,583
Americas 925 6,523
East 579 6,154
Mediterranean 2,296 16,826
Europe 1,029 7,882
Western pacific 7,198 62,587
World
*DALYs Disability adjusted life year

Risk factors
1. Smoking.
2. Hypertension.
3. Serum cholesterol
 when we look at the various types of lipoproteins, it is
the level of low-density lipoproteins (LDL)
cholesterol that is most directly associated with CHD.
Lipoprotein (VLDL) has also been shown to be
associated with premature atherosclerosis. High-
density lipoprotein (HDL) cholesterol is protective
against the development of CHD.

4. other risk factors

(i) Diabetes
(ii) Genetic factors
(iii) Physical activity
(iv) Hormones
(v) Type A personality
(vi) Alcohol
(vii) Oral contraceptives
(viii) Miscellaneous

PREVENTION OF CHD
this is best expressed in a report of the WHO Expert
Committee on the prevention of CHD, which
recommended the following strategies:
a. population strategy (i) prevention in whole
populations (ii) primordial prevention in whole
populations
b. High risk strategy
c. secondary prevention

Specific interventions
1. Dietary changes
2. No Smoking
3. Control of Blood pressure
4. Physical activity
 DIABETES MELLITUS

Group of diseases, characterised by a state of chronic

Hyperglycemia, resulting from a diversity of aetiologies,
Environmental and genetic and genetic, acting jointly.
Diabetes mellitus is along-term disease with variable
clinical manifestations and progression.
Chronic hyperglycemia, from whatever cause, lead to a
Number of complications: Cardiovascular, renal,
neurolo-
Gical, ocular and other such as intercurrent infections.

Classification
1. Diabetes mellitus (DM)
i) IDDM (type 1) most severe abrupt below 30 years
II) NIDDM (type 2) more common by chance above
40 years
iii) Malnutrition-related diabetes mellitus (MRDM)
iv) Other types; Drug-induced, 3. Gestational Diabetes )
Mellitus (GDM ) Genetic and other abnormalities.
2. Impaired glucose tolerance (IGT)
3. Gestational Diabetes mellitus (GDM)

The problem
Globally

Diabetes is an “Iceberg” disease. Although increase in

both the prevalence and incidence of type 2 diabetes
have occurred globally, they have been especially
dramatic in societies in economic transition, in newly
industrialized countries and in developing countries. The
number of cases of diabetes worldwide is estimated to be
around 150 million.
Prevalence:- Ranging from 2 to 5% or even higher

Natural history
1- Agent: a) pancreatic disorder (inflammatory)
b) defects in insulin formation (abnormal)
c) destruction of beta cells (viral)
d) decreased insulin sensitivity (decreased
adipocytes)
e) genetic defects (mutation of insulin gene)
f) auto-immunity

2. Host factors: a) age (increase with age (NIDDM)

b) sex (open question ).
c) genetic factors (twins, NIDDM
concordance 90%).
(twins, IDDM concordance 50%).
d) genetic markers (IDDM with HLA-
B8, HLA-DR3)
(NIDDM not associated with HLA)
e) immune mechanism ( attack insulin
producing cells).
f) obesity (NIDDM, resistance to insulin
action).
3. Environmental risk factors:
a) sedentary life style NIDDM)
b) diet (Quantity)
c) malnutrition (PEM; damage to beta cells)
d) viral infection (mumps, rubella, coxakie
virus B4
e) chemical agent (valcor, allxan, cyanide)
f) stress
Screening for diabetes

1- urine examination 2 hours after meal (urine testing is

not considered an appropiate tool for case-finding or
epidemiological surveys
2- Blood sugar testing: FBS is unsatisfactory (CRUDE)
mass screening programmes have used glucose
measurements of fasting or random blood sample is
considered unsatisfactory for epidemiological use; at
the most, it can give only accurate estimate of the
frequency of diabetes in a population.
3. GTT ( standard oral glucose test remains the
cornerstone of diagnosis of diabetes). Therefore, for
epidemiological purposes, the 2-hour value after
75 g oral glucose.
Screening usually done for high risk groups.

CANCER

Cancer may be regarded as a group of diseases

characterised by;
1) an abnormal growth of cells
2) an ability to invade adjacent tissues and even distant
organs, and
3) the eventual death of effected patient
4) Cancer can occur at any site or tissue of the body and
may involve any type of cells.

The major categories of cancer are :

a) Carcinomas, which arise from epithelial cells lining
the internal surfaces of the various organs e.g.
(mouth, oesophags.intestines, uterus) and skin.
 b) Sarcomas, which arise from mesodermal cells cons-
tituting the various connective tissues e.g. (fibro

c) Lymphomas, myelomas and leukaemias arise from

the cells of bone marrow and immune systems.

Causes of cancer:

1) Environmental factors:
a) Tobacco is the major environmental causes of
Cancers of the lung, larynx, mouth, pharynx,
oesophagus, bladder, pancreas.
b) Alcohol is associated with oesophageal and liver
cancer.
c) Dietary factors are also related to cancer. Smoked
fish related to stomach cancer, beef consumption to
bowel cancer.
d) Occupational exposures: these include exposure to
benzene, arsenic, cadmium etc.
e) Viruses: viral origin (hepatitis B and C virus is
causally related to hapatocellular carcinoma.
f) Parasites (for example schistosomiasis producing
carcinoma of the bladder.
g) Customs, habits and life-styles.
h) Others: There are numerous other environmental
factors such as sunlight, radiation air and water
pollution.
2) Genetic factors:
For example, retinoblastoma occurs in children of
the same parent.
Problems
Globally
Cancer afflicts all communities worldwide,
approximately 10 million people are diagnosed with
cancer and more than 6 million die of that disease every
year.
About 22.4 million persons were living with cancer in
the year 2000.
In terms of incidence. The most common cancers
worldwide are lung cancer (12.3 per cent of all cancers),
breast cancer (10.4 per cent) and colorectal (9.4per cent)
The total cancer burden is highest in effluent societies,
mainly due to a high Incidence of tumour
associated with smoking and western lifestyle, i.e.,
cancer of the lung, colorectum, breast and prostate.
In developing countries, up to 25 per cent of tumours are
associated with chronic infections, e.g. hepatitis

In LIBYA
No data (No national cancer registry).

Cancer control

The basic control approach to the control of cancer is

through primary and secondary prevention.
It is estimated that at least one-third of all cancers are
preventable.

1. Primary prevention
a) control of Tobacco and Alcohol consumption
b) Personal hygiene
c) Radiation
d) Occupational exposures
 e) Foods, drugs and cosmetics
f) Immunization
h) Air pollution
i) Treatment of precancerous lesions
j) Cancer education (warning signs )

Warning signs:(danger signals) of the cancer these are:

a) a lump or hard area in the breast
b) a change in a wart or mole
c) a persistent change in digestive and bowel
habits
d) a persistent cough or hoarseness
e) excessive loss of blood at the monthly period
f)blood loos from any natural orifice
g) a swelling or sore that dose not get better
h) unexplained loss of weight

2. Secondary prevention
i) Cancer registration
ii) Early detection of cases (screening)
iii) treatment

3.Tertiary prevention
Rehabilitation, psychological assurance, palliative
treatment of associated symptoms and pains.

Epidemiology of selected cancers

1. Oral cancer
Oral cancer is one of the ten most common in the
world. Its high frequency in Central and South East
Asian countries. Each year, bout 5.75,000 new cases
and 3,35,000 deaths occur world-wide.
Approximately 90 per cent of oral cancers in South
East Asia are linked to tobacco chewing and tobacco
smoking. Other factors: Alcohol, pre-cancerous
stage (leukoplakia, erythroplakia). High- risk groups
and Cultural patterns (tobacco in powdered form is
inhaled as snuff).

2. Cancer of the cervix

This is the second most common cancer among
women world-wide, with an estimated 524,000 new
cases in 1995. Developing countries, where it is
often the most common cancer among women.
Natural history
(a) The disease: Cancer cervix seems to follow a
progressive course from epithelial dysplasia to
carcinoma in situ to invasive carcinoma.
(b) Causative agent: There is evidence pointing to
Human papilloma virus (HPV) sexually
Transmitted – as the cause of cervical cancer.

Risk factors:
● Age: Cancer cervix affects relatively young
women (25-45).
● Genital warts.
● Marital status cases are less likely to be single.
● Early marriage
● Oral contraceptive
● Socio-economic class

3. Breast cancer
Breast cancer is one of the commonest causes of
death in many developed countries in middle-aged
women, and is becoming frequent in developing
countries. Breast cancer causes 5,19,000 a year
world-wide; about 9,00,000 women are diagnosed
every year with the disease.

Risk factors
●Age: Breast cancer is uncommon below the age
35, the incidence increasing rapidly between the
Age of 35 and 50.
● Family history, especially if a mother or sister
developed breast cancer when premenopausal.
●Parity An early first, full-term pregnancy seems to
Have a protective effect. Unmarried women tend
to have more breast tumours than married single
women.
● Age at menarche and menopause, early menarche
and late menopause are established risk factors
● Hormonal factors
● Prior breast biopsy for benign breast disease is
associated with an increased risk of breast cancer
● Diet cancer of the breast is liked with a high fat
diet and obesity
●Socio-economic status is common in higher
socio-economic groups
● Others; Radiation, Oral contraceptive

4. Lung cancer
According to WHO reports, between 1960 and
1980, the death rate due to lung cancer increased by
76 per cent in men and by 135 per cent in women.
Globally, 85% of cases in men and 46% in women
are due to smoking. In developed countries the
proportions are 91% for men and 62% for women,
and in developing countries 76% for men and 24%
for women. It is not easy to assess the problem of
lung cancer in developing countries because of lack
of accurate statistics.
If the “smoking epidemic” is not controlled, an
epidemic of lung cancer can be predicted in many
developing countries.

Epidemiological Features
a. Age and Sex
About a third of all lung cancer death occur below
the age 65. In many industrialized countries, the
incidence of lung cancer is at present increasing
more in females than in males.
b. Risk Factors
(i) Smoking: Tobacco smoking was first suggested
as a cause of lung cancer in the 1920s. Subsequent
studies proved the causal relationship between
cigarette smoking and lung cancer. The risk is
strongly related to the number of cigarettes
smoked, the age of starting to smoke and smoking
habits, such as inhalation and the number of puffs
and the nicotine, the tar content and the length of
cigarettes. Those who are highly exposed to
“passive smoking” (somebody else᾿ smoke) are at
an increased risk of developing lung cancer. It has
been calculated that in countries where smoking
has been a widespread habit, it is responsible for 90
per cent of lung cancer deaths. The strongest
evidence that cigarette smoking is responsible for
lung cancer is the incidence reduction that occurs
after cessation of smoking. The most noxious
components of tobacco smoke are tar, carbon
 monoxide and nicotine. The carcinogenic role of tar
is well established. Nicotine and carbon monoxide,
particularly, contribute to increased risk of
cardiovascular diseases through enhancement of
blood coagulation in the vessels, interference with
myocardial oxygen delivery, and reduction of the
threshold for ventricular fibrillation.
(ii) Other factors: Besides cigarette smoking , there
are other factors which are implicated in the
aetiology of lung cancer, these include air pollution,
radioactivity, and occupational exposure to
asbestos, arsenic and its compounds, chromates,
particles containing polycyclic aromatic
hydrocarbons and contain nickel-bearing dusts. A
number of studies have shown an interaction
between smoking and asbestos exposure.
Prevention
1. Primary prevention
In lung cancer control, primary prevention is of
greatest importance. Methods of controlling the
“smoking epidemic” have been described by WHO
expert committees in their reports broadly these
methods include:
a. Public information and education
b. Legislative and restrictive measures
c. Smoking cessation activities
d. National and international coordination
2. Secondary prevention
This rests on early detection of cases and their
Treatment. At present, there are only two procedures
capable of detecting presymptomatic, early-stage lung
cancer. These are the chest X-ray and sputum cytology.
5.Stomach cancer
Stomach cancer is the world᾿s second most common
cancer, with over 1 million new cases per year. Nearly
two-third occur in developing countries. Incidence in
men is nearly twice that in women. Cases have
declined steadily in most affluent countries over the
last 30 years. Similar trends are apparent in some less
developed regions of the world. Most gastric cancer
are adenocarcinoma. The constant decline of stomach
cancer in industrialized countries is linked to
improved food preservation practices; better nutrition
more rich in vitamins from fresh vegetables and fruits;
and less consumption of preserved, cured and salted
foods. Infection with the bacterium Helicobacter
pylori contributes to the risk, probably by interacting
with other factors.
Diagnosis is performed by barium X-rays and with
biopsy.