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The paper by Sonnenberg,1 in a recent issue of Gut, describing a strong cohort effect on the incidence of gastric cancer extends our own observation of a strong cohort effect for gastric but not for pancreatic cancer.2 We examined mortality data for England from 1950, and reported the downward slope of cohort incidence of gastric cancer from 1870. The international comparisons made by Sonnenberg are fascinating, and suggest a possible link with industrialisation.
We are not social historians, but we read in Wikipedia3 that in Britain, the first Industrial Revolution, which began in the 18th century, merged into the Second Industrial Revolution around 1850, when technological and economic progress gained momentum with the development of steam-powered ships and railways. Similar changes occurred in other European nations at this time. In Japan, industrialisation began in the late 19th century. In the 1870s, the Meiji government vigorously promoted technological and industrial development that eventually changed Japan to a powerful modern country.
The different timing of industrialisation in these countries corresponds to the different peak cohorts reported by Sonnenberg. He discusses the possible role of Helicobacter pylori in these epidemiological changes. Other risk factors including diet may also play a role. Diet is widely recognised as an important contributory factor in gastric cancer; and the cohort effect suggests that diet in early life may contribute to the risk of gastric cancer. A protective effect of fresh fruit and vegetables and micronutrients, particularly vitamin C, has been proposed.4
It is possible that population shifts from agricultural work in the countryside to industrial cities may have been associated with reduced availability of fresh food. The possible contribution of micronutrients to cancer prevention, and interactions with the effects of H pylori deserve further exploration.
Competing interests None declared.
Provenance and peer review Not commissioned; not externally peer reviewed.