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  • Review Article
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Updated epidemiology of gastrointestinal cancers in East Asia

Nature Reviews Gastroenterology & Hepatology volume 20, pages 271–287 (2023)Cite this article

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Abstract

Globally, gastrointestinal cancers represent more than one-fourth of all cancer incidence and one-third of cancer-related mortality. Although there has been much progress in screening colorectal cancer, the prognosis of other gastrointestinal cancers tends to be poor. The highest burden of gastrointestinal cancers, including stomach, liver, oesophageal and gallbladder cancers, was observed in regions in East Asia. The increasing burden of gastrointestinal cancers in East Asian regions is related to population growth, ageing and the westernization of lifestyle habits in this region. Furthermore, the rising incidence of young-onset colorectal cancer is an emerging trend in East Asia. This Review provides a comprehensive and updated summary of the epidemiology of gastrointestinal cancers in East Asia, with emphasis on comparing their epidemiology in East Asia with that in Western regions, and highlights the major risk factors and implications for prevention. Overall, to optimally reduce the disease burden incurred by gastrointestinal cancers in East Asian regions, a concerted effort will be needed to modify unhealthy lifestyles, promote vaccination against the hepatitis virus, control Helicobacter pylori, liver fluke and hepatitis virus infections, increase the uptake rate of colorectal cancer screening, enhance detection of early cancers and their precursors, and improve cancer survivorship through an organized rehabilitation programme.

Key points

  • There is a substantial burden of gastrointestinal cancers in East Asia, with the highest incidence observed in colorectal and stomach cancer and the highest mortality in liver and stomach cancer.

  • Compared with Western regions, East Asia has a higher burden of stomach, liver, oesophageal and gallbladder cancer, but the burden of colorectal and pancreatic cancer is increasing.

  • There is an increasing trend in young-onset colorectal, pancreatic and gallbladder cancer in East Asia attributed to the bigger increase in risk factors among the younger population.

  • Common modifiable risk factors for gastrointestinal cancers in East Asia include smoking, alcohol intake, diet, sedentary lifestyle, obesity and metabolic diseases.

  • East Asian regions have a higher prevalence of Helicobacter pylori, liver fluke, and hepatitis B and C virus infections, hot beverage consumption and biliary cyst development, which might have increased the risk of gastrointestinal cancers.

  • Key preventive strategies for gastrointestinal cancers in the East Asian population include lifestyle modifications, hepatitis vaccination, H. pylori infection control, cancer screening, early diagnosis and improving cancer survivorship.

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Fig. 1: Gastrointestinal cancer incidence and mortality in East Asia and Western regions.
Fig. 2: Gastrointestinal cancer mortality-to-incidence ratios in East Asia and Western regions.
Fig. 3: Gastrointestinal cancer incidence trends in East Asia and Western regions.
Fig. 4: Gastrointestinal cancer trends by risk factors in East Asia and Western regions.

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Data availability

The geographical definition of the regions follows the rules as defined by the United Nations (https://unstats.un.org/sdgs/indicators/regional-groups). Data were retrieved from international publicly available databases such as GLOBOCAN 2020 and GBD 2019 and are available upon request. Literature regarding the epidemiology of colorectal cancer, stomach cancer, liver cancer, oesophageal cancer, pancreatic cancer and gallbladder cancer in East Asian regions were comprehensively reviewed.

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Authors and Affiliations

  1. The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China

    Junjie Huang & Martin C. S. Wong

  2. Centre for Health Education and Health Promotion, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China

    Junjie Huang & Martin C. S. Wong

  3. Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK

    Don Eliseo Lucero-Prisno III

  4. Centre of Cancer Research, Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia

    Lin Zhang

  5. Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia

    Lin Zhang

  6. School of Public Health, The Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Lin Zhang & Martin C. S. Wong

  7. School of Public Health, Fudan University, Shanghai, China

    Wanghong Xu

  8. Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China

    Sunny H. Wong & Siew C. Ng

  9. State Key Laboratory for Digestive Disease, Institute of Digestive Disease, Li Ka Shing Institute of Health Science, Chinese University of Hong Kong, Hong Kong SAR, China

    Sunny H. Wong & Siew C. Ng

  10. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore

    Sunny H. Wong

  11. Center for Gut Microbiota Research, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China

    Siew C. Ng

  12. Department of Global Health, School of Public Health, Peking University, Beijing, China

    Martin C. S. Wong

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  1. Junjie Huang
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  2. Don Eliseo Lucero-Prisno III
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Contributions

J.H. researched data for the article. M.C.S.W., J.H., S.H.W. and S.C.N. contributed substantially to discussion of the content. J.H. wrote the article. M.C.S.W., D.E.L.-P., L.Z., W.X., S.H.W. and S.C.N. reviewed and/or edited the manuscript before submission.

Corresponding author

Correspondence to Martin C. S. Wong.

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Nature Reviews Gastroenterology & Hepatology thanks Eishi Baba, Jianguang Ji and the other, anonymous, reviewer for their contribution to the peer review of this work.

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Related links

GBD 2019: https://vizhub.healthdata.org/gbd-results/

GLOBOCAN 2020: https://gco.iarc.fr/

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Huang, J., Lucero-Prisno, D.E., Zhang, L. et al. Updated epidemiology of gastrointestinal cancers in East Asia. Nat Rev Gastroenterol Hepatol 20, 271–287 (2023). https://doi.org/10.1038/s41575-022-00726-3

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