The long decline of gastric cancer in Connecticut, 1935-1979: From birth cohorts to contemporary risk.
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BACKGROUND: Gastric cancer incidence declined markedly during the twentieth century in the United States, and birth-cohort patterns are recognized. Whether the rate of decline changed across generations, and when, is less characterized. We examined Connecticut birth cohorts to identify changes in the tempo of decline and assess their timing against etiologic and environmental explanations. METHODS: We analyzed 17,958 gastric cancers recorded in the Connecticut Tumor Registry (1935-1979). Birth-cohort analyses included 16,148 cases aged 45-84 years and were conducted separately by sex using age-period-cohort and segmented models. Robustness was assessed by excluding early registry periods, age groups, and calendar periods. Historical public-health, typhoid mortality, and refrigeration data characterized environmental changes. RESULTS: Among men, the cohort decline accelerated around the 1885 birth cohort (likelihood-ratio χ² = 87.5). The breakpoint remained near 1885 after exclusion of early registry periods, seven of eight age groups, and each of nine calendar periods. Among women, the best-fitting candidate breakpoint was 1865, but improvement over the single-slope model was smaller (likelihood-ratio χ² = 9.9), and the breakpoint was less stable across age-group exclusions. The male transition coincided with sanitary changes and declining typhoid mortality but preceded widespread household mechanical refrigeration by decades. CONCLUSIONS: By identifying a change within an established generational decline, these findings localize a robust acceleration in male gastric cancer decline to generations born around 1885. Although temporal correspondence cannot establish causation, the timing supports a life-course interpretation in which changing childhood environments, potentially affecting Helicobacter pylori acquisition, contributed to gastric cancer declines.