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Dietary Risk Factors for Gastric Carcinoma—Reply
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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 . . . [Full Text of this Article]
David Forman, PhD
School of Medicine
University of Leeds
Leeds, England
Julie Parsonnet, MD
School of Medicine
Stanford University
Stanford, Calif
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