title: Incidence of esophageal carcinoma among Malays in North-Eastern Peninsular Malaysia: an area with an exceptionally low prevalence of Helicobacter pylori infection.
abstract: BACKGROUND
  Obesity, gastroesophageal reflux, and Barrett's esophagus have all been linked to esophageal adenocarcinoma. In addition, the decline in Helicobacter pylori (H. pylori) infection in affluent societies has also been suggested to be a major factor in the recent rise in the incidence of esophageal adenocarcinoma. If H. pylori infection has a protective role, populations with a naturally low prevalence of H. pylori infection such as the ethnic Malays of Northeastern Peninsular Malaysia should have high rates of esophageal adenocarcinoma.
  
  
  OBJECTIVE
  To test this hypothesis, we investigated the incidence of esophageal carcinoma among the ethnic Malays of the state of Kelantan in Northeastern Peninsular Malaysia.
  
  
  METHODS
  The pathology services in the state of Kelantan are provided by two main hospitals. The histopathological records of both hospitals were systematically examined to retrieve all cases of esophageal carcinoma diagnosed between 2004 and 2008. Incidence rates were determined based on the most recent population census.
  
  
  RESULTS
  The age-standardized incidence rates (per 100,000 population) of esophageal adenocarcinoma among Malay men and women were 0.75 and 0.69, respectively. The corresponding rates for squamous cell carcinoma of the esophagus were 0.66 and 1.34, respectively.
  
  
  CONCLUSIONS
  The low rates of adenocarcinoma and squamous cell carcinoma of the esophagus in the study area, despite the fact that H. pylori infection is virtually absent, does not support the hypothesis that the absence of H. pylori infection is a pivotal factor in the pathogenesis of these cancers.
authors.affiliation: Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia. justnleeyy@gmail.com
authors.forename: Yeong Yeh
authors.initials: YY
authors.lastname: Lee
authors.forename: S Mahendra
authors.initials: SM
authors.lastname: Raj
authors.forename: Sharifah Emilia Tuan
authors.initials: SE
authors.lastname: Sharif
authors.forename: Rosemi
authors.initials: R
authors.lastname: Salleh
authors.forename: Mukarramah Che
authors.initials: MC
authors.lastname: Ayub
authors.forename: David Y
authors.initials: DY
authors.lastname: Graham
mesh_terms: D017677:Age Distribution; D044466:Asian People; D002277:Carcinoma / Q000150:complications / Q000453:epidemiology* / Q000208:ethnology; D004938:Esophageal Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000208:ethnology; D005260:Female; D016481:Helicobacter Infections / Q000150:complications / Q000453:epidemiology* / Q000208:ethnology; D016480:Helicobacter pylori; D006801:Humans; D015994:Incidence; D008297:Male