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To the Editor: In their Editorial about the relationship between Helicobacter pylori and gastric carcinoma, Drs Parsonnet and Forman¹ did not discuss the dramatic decline in the use of salting and pickling food for preservation, which has mirrored the decline in US cases of gastric cancer during this period.² Worldwide, there has been an ongoing reduction in salt intake.^3-4 There is some evidence that the relevant carcinogens are produced from specific food items, such as those in fish, by salting and pickling, which involves the use of large amounts of salt and nitrates.⁵ Reducing salt intake may decrease the risk of gastric cancer, irrespective of the presence of H pylori.

John H. Weisburger, PhD
jweisbur{at}ifcp.us
Institute for Cancer Prevention
American Health Foundation
Valhalla, NY

1. Parsonnet J, Forman D. Helicobacter pylori infection and gastric cancer—for want of more outcomes. JAMA. 2004;291:244-245. FREE FULL TEXT 2. Howson CP, Hiyama T, Wynder EL. The decline in gastric cancer: epidemiology of an unplanned triumph. Epidemiol Rev. 1986;8:1-27. FREE FULL TEXT 3. Hirohata T, Kono S. Diet/nutrition and stomach cancer in Japan. Int J Cancer. 1997;Suppl 10:34-36. FULL TEXT | PUBMED 4. Correa P. Human gastric carcinogenesis: a multistep and multifactorial process—First American Cancer Society Award Lecture on Cancer Epidemiology and Prevention. Cancer Res. 1992;52:6735-6740. FREE FULL TEXT 5. Tsugane S, Sasazuki S, Kobayashi M, Sasaki S. Salt and salted food intake and subsequent risk of gastric cancer among middle-aged Japanese men and women. Br J Cancer. 2004;90:128-134. FULL TEXT | WEB OF SCIENCE | PUBMED

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

JAMA. 2004;291:1564.

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