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April 7, 2004

Dietary Risk Factors for Gastric Carcinoma—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(13):1564. doi:10.1001/jama.291.13.1564-b

In Reply: We agree with Dr Weisburger that infection with H pylori is not a sole or sufficient cause of gastric cancer. Like most malignancies, gastric cancer has a multifactorial etiology. In individuals with H pylori infection, factors that appear to influence cancer outcome include the host's genetic makeup, the infecting strain of H pylori, and environmental exposures, including diet. Although adenocarcinoma in the absence of H pylori infection is rare in countries with high rates of gastric malignancy,1 the decline in gastric cancer incidence in developed countries cannot be explained purely by decreasing prevalence of infection.2 Improved diet and a reduced dependency on long-term food preservation could account for some part of this difference. However, the critical public health question is how to intervene to reduce incidence rates in those high-risk populations. A simple change in dietary behavior, such as long-term reduction in salt intake, is easy to recommend but extremely difficult to implement as a population-based health intervention. We are not aware of any evidence base that indicates how effective the strategy advocated by Weisburger would be against gastric cancer.

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