Possible association between gastric cancer and bracken fern in Venezuela: an epidemiologic study

To explore a possible connection between specific environmental factors that might explain the high rates of stomach cancer in people living in the highlands of western Venezuela, an epidemiologic study was conducted in 2 regions of contrasting topography. The regions embrace 3 Andean states, Mérida, Táchira and Trujillo, and the vicinal lowland surrounding the Maracaibo lake basin of Zulia State. Statistical sanitary records from 1986 to 1996 comprising 5.5 million people in the study area indicated that age-sex-adjusted gastric cancer death rate per 100,000 people (DR) was up to 3.64 times higher in highland than lowland areas, although total cancer-related DRs were comparable in both regions. DRs of other less frequent cancers from the upper alimentary tract [esophagous (1.18/0.99) and mouth-throat (1.39/2.64)] showed comparable values in both regions as well as colorectal, breast, and uterus-cervix cancers, suggesting that the stomach cancer DRs were related to geographically determined factors. Comparison of some nutrition issues, incidence of Helicobacter pylori infection in selected areas, the discovery of the bracken carcinogen ptaquiloside in milk from bracken-fed cows, the prevalence of this plant in mountain cattle households and pasturelands and the rates of bracken-evoked bovine enzootic hematuria led us to conclude that consumption of ptaquiloside-contaminated milk may contribute to human gastric cancer in the Andean states of Venezuela.