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Environmental and ecological factors of stomach cancer incidence and mortality: a systematic review study on ecological studies

  • Salman Khazaei ORCID logo , Abolfazl Mohammadbeigi ORCID logo EMAIL logo , Ensiyeh Jenabi ORCID logo , Azadeh Asgarian ORCID logo , Hamidreza Heidari ORCID logo , Abedin Saghafipour ORCID logo , Shahram Arsang-Jang ORCID logo and Hossein Ansari ORCID logo



Stomach cancer (SC) is one of the most common and deadly types of cancer. It is the third leading cause of cancer deaths worldwide. The effect of environmental and ecological factors in SC have been assessed in some studies. Thus, we aimed to synthesize the environmental and ecological factors of SC incidence and mortality.


In this systematic review study, the scientific databases, including Web of Science, Scopus and PubMed, were searched from inception to November 2019 for all primary articles written in English by using relevant Medical Subject Heading (Mesh) terms. Two independent authors conducted the screening process to decide on the eligibility and inclusion of the articles in the study. The third author acted as an arbiter to resolve any disagreements.

Summary and Outlook

A total of 157 potentially relevant articles were identified from the initial search 38 of which met the eligibility criteria; finally, 34 articles were included in the systematic review. The results revealed that soil arsenic exposure, coal and other opencast mining installations, living near incinerators and installations for the recovery or disposal of hazardous waste, installations for the production of cement, lime, plaster, and magnesium oxide, proximity to a metal industry sources, dietary iron, ingested asbestos, farming, arsenic in soil, altitude, organochlorines and environmental exposure to cadmium and lead have positive associations with SC incidence or death. Most of the ecological and environmental factors such as living near the mineral industries, the disposal of hazardous waste, metal industry sources and environmental exposure to cadmium and lead are positively related to SC mortality and incidence. However, solar UV-B, heat index and dietary zinc can be taken into account as protective factors against SC mortality and incidence.

Corresponding author: Abolfazl Mohammadbeigi, Associated Professor, Department of Epidemiology and Biostatistics, Neuroscience Research Center, Faculty of Health, Qom University of Medical Sciences, Qom, Iran, E-mail:


The authors are very grateful to the research deputy of Qom University of Medical Sciences that financially supports this project and all coworkers that cooperate with us for collecting and extracting data.

  1. Research funding: Qom University of Medical Sciences.

  2. Author contributions: All authors have the same contributions to the conception or design of the work, or interpretation of data for the work; and final approval of the article

  3. Competing interests: None.

  4. Informed consent: Not applicable.

  5. Ethical approval: Not applicable.


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Received: 2020-02-17
Accepted: 2020-05-10
Published Online: 2020-07-19
Published in Print: 2020-11-18

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