Stomach cancer survival in the United States by race and stage (2001-2009): Findings from the CONCORD-2 study

Abstract

Background: Stomach cancer was a leading cause of cancer-related deaths early in the 20th century and has steadily declined over the last century in the United States. Although incidence and death rates are now low, stomach cancer remains an important cause of morbidity and mortality in black, Asian and Pacific Islander, and American Indian/Alaska Native populations.

Methods: Data from the CONCORD-2 study were used to analyze stomach cancer survival among males and females aged 15 to 99 years who were diagnosed in 37 states covering 80% of the US population. Survival analyses were corrected for background mortality using state-specific and race-specific (white and black) life tables and age-standardized using the International Cancer Survival Standard weights. Net survival is presented up to 5 years after diagnosis by race (all, black, and white) for 2001 through 2003 and 2004 through 2009 to account for changes in collecting Surveillance, Epidemiology, and End Results Summary Stage 2000 data from 2004.

Results: Almost one-third of stomach cancers were diagnosed at a distant stage among both whites and blacks. Age-standardized 5-year net survival increased between 2001 to 2003 and 2004 to 2009 (26.1% and 29%, respectively), and no differences were observed by race. The 1-year, 3-year, and 5-year survival estimates were 53.1%, 33.8%, and 29%, respectively. Survival improved in most states. Survival by stage was 64% (local), 28.2% (regional), and 5.3% (distant).

Conclusions: The current results indicate high fatality for stomach cancer, especially soon after diagnosis. Although improvements in stomach cancer survival were observed, survival remained relatively low for both blacks and whites. Primary prevention through the control of well-established risk factors would be expected to have the greatest impact on further reducing deaths from stomach cancer. Cancer 2017;123:4994-5013. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Keywords: CONCORD study; Epidemiology; National Program of Cancer Registries (NPCR); Surveillance; and End Results (SEER); cancer registries; gastric cancer; population-based cancer survival; stomach cancer.

Figure 1

Stomach cancer: age-standardized 5-year net survival (%) for males and females (ages 15–99 years) who were diagnosed from 2001 to 2003 and from 2004 to 2009, with absolute changes (%). Survival estimates for each state are ranked within US Census Region by the survival estimate for 2004 to 2009. Dark-colored bars denote states affiliated with the National Program of Cancer Registries; pale-colored bars denote states affiliated with the Surveillance, Epidemiology, and End Results Program. An asterisk denotes states affiliated with both federal surveillance programs. †indicates the percentage change was not plotted if a survival estimate was not available for 1 calendar period or if 1 or more estimates were not age-standardized.

Figure 2

Stomach cancer: age-standardized 5-year net survival (%) for males and females (ages 15–99 years) by state, race, and calendar period of diagnosis. The pooled survival estimate for all 37 states combined in each calendar period is indicated by a solid horizontal line, and corresponding 95% and 99.8% control limits are indicated by dashed lines.