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There, in a small concrete and tin-roofed home nestled in the scenic, fog-covered mountains, lives Jose Bonifacio Sanchez Lemus, his wife Sandra Dominguez, and their five children. San Francisco de Opalaca is one of the poorest regions of Honduras, with more than 90 percent of the population living in poverty and 70 percent living in extreme poverty. Heifer International, in partnership with Keurig Green Mountain, is working with families in this region to build sustainable solutions to poverty and hunger. During the rainy season, access to the tiny coffee-producing communities that make up San Francisco de Opalaca can be difficult, if not impossible.

Poor infrastructure, washed-out roads, and landslides further isolate these remote communities. On a recent visit to meet with Jose Bonifacio, we had to trade our truck in for a more suitable mode of transportation that could handle the slick, muddy roads: a mule.

After a long, bumpy ride up the mountain, Jose Bonifacio and his children greeted us. In June of , the family received the gift of a family garden from Heifer International, which included seeds, fruit trees, and education and training on how to prepare and maintain the garden. Diagnosis was based on endoscopy and confirmatory histopathology.

Geospatial methods were applied using the ArcGIS v Three hundred seventy-eight incident cases met the inclusion criteria mean age Areas of higher gastric cancer incidence were identified. The intestinal subtype was randomly distributed. Geospatial methods have identified a significant cluster of incident diffuse type adenocarcinoma cases in rural Central America, suggest of a germline genetic association. Further genomic and geospatial analyses to identify potential spatial patterns of genetic, bacterial, and environmental risk factors may be informative.

Gastric adenocarcinoma is the leading global cause of infection-related cancer mortality and overall is the third leading cause of cancer death [ 1 , 2 , 3 , 4 ]. Approximately 1 million incident cases are projected annually, with the majority of incident cases observed in eastern Asia, Latin America, and eastern Europe. Gastric cancer has marked geographic variability, assessed at the regional, country, and within-country levels [ 5 ].

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Helicobacter pylori H. There is also evidence that disrupted host- H. The principal subsets of gastric adenocarcinoma per the Lauren histologic classification are intestinal and diffuse, and recent findings in The Cancer Genome Atlas TCGA NIH initiative confirm these subtypes [ 17 , 18 , 19 ]. Some familial clustering may also be attributable to shared bacterial or environmental exposures. Globally, intestinal gastric cancer is more common than diffuse by a 4. Geospatial methods and the use of geographic information systems GIS can delineate disease distributions and etiology, as well as inform prevention programs, however, few studies have applied spatial techniques to examine gastric cancer [ 23 , 24 , 25 , 26 ].

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The objective of this study was to utilize geospatial methods to examine the spatial distributions of gastric cancer subtypes, in the context of an ongoing population-based, case-control study in Central America. The identified clusters of high gastric cancer incidence may implicate germline genetic associations, along with bacterial, dietary, or environmental co-factors. We performed spatial cluster analyses in the context of an active population-based, case-control study centered in western Honduras. The hospital catchment area has been previously described [ 28 ].

The diagnosis of gastric cancer was based on endoscopic appearance and confirmatory histopathology. Each state is comprised of counties municipalities consisting of villages aldeas of 30—50 households on average, each with a unique geocode. Incident cases in the villages of the three western states in the referral area were included in the analysis.

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The crude incidence rates for each village were calculated for GIS mapping : number of cases per village population per , persons for the overall study period. The population data for each village was obtained from the Honduras Census Institution Instituto Nacional de Estadistica from the census year [ 30 ]. This antibody detection technology uses 15 H. Each GST-X-tag fusion protein was bound and affinity-purified on a different bead set with glutathione surface and marked with a distinct internal fluorescent color SeroMap, Luminex Corp. Seropositivity against each of the 15 H. Positive H.

This method analyzes each feature in the context of its neighboring features e. A village aldea with a high value surrounded by other villages with high values may be a statistically significant hot spot. The local sum of cases for each aldea and its neighbors is compared proportionally to the sum of all cases in the study area. If the local sum is very different from the expected local sum and is too large to be random it is a statistically significant hot or cold spot. A discrete Poisson model was used to identify high gastric cancer incidence clusters. Counts that are higher than expected relative to the underlying population and study area are designated as a cluster.

Cluster significance was determined using Monte Carlo simulation permutations. Diffuse histology cancer cases and intestinal histology cancer cases were analyzed separately. Cases of mixed or indeterminate histology were excluded from the geospatial analysis. The H.

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Gastric cancer cases without aldea geocodes and aldea population data, were excluded from the geospatial analysis, by necessity, but included in the overall descriptive analyses of the study population. Demographic and clinical data were analyzed by chi-squared and univariable multinomial logistic regression analyses. A total of gastric cancer patients were identified in the western Honduras gastric cancer registry from to There were subjects with either intestinal or diffuse subtypes, with a mean age of Three hundred seventy-eight patients had validated village-level aldea geocode data for the spatial analysis.

The subjects without village-level geocodes were primarily from the early study period, which primarily focused on county-level geocoding. Over three quarters of cancer patients In this setting, tobacco and alcohol use was limited, with proportions of never-used of A family history of gastric cancer was only noted in 6. In the study period, in the catchment area, incident cases were identified in villages within a total of 58 counties.

Hot spots of diffuse gastric cancer incidence were identified by both independent methodologies Fig. The spatial scan statistic results corroborated the hotspot findings. The intestinal subtype cancers were randomly distributed, and without high incidence clusters. Spatial clustering of diffuse gastric cancer incident cases were identified by two independent GIS methodologies.

Clusters of aldeas with a higher relative number of cases of H. The location of the H.

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The overlap of the clustering areas of diffuse cancer and CagA areas was noted, indicating that CagA may be a co-factor in the area where germline mutations may be important. CagA was randomly distributed outside of the diffuse cancer cluster hotspot, and also among the intestinal cancers within this hotspot area. Spatial analysis of H. Clusters with a higher relative number of cases with H. This indicates that CagA may be a co-factor in the diffuse gastric cancer cluster area. CagA was randomly distributed among the diffuse cancers outside of the hotspot.

CagA was also randomly distributed among the intestinal cancers in the hotspot area and in the western Honduras as a whole. We examined differences in demographic and exposure factors between cases that were located in the diffuse hotspot versus cases that were intestinal as well as all cancers outside of the cluster area. The modest number of cases within the diffuse cancer hot spot may have limited the power to detect some significant differences in other risk exposures. Gastric cancer, the leading infection-associated cancer, demonstrates remarkable geographic variability.

In Latin America, the burden is concentrated in the Pacific littoral mountainous regions of Mexico, Central America, and the Andes [ 6 ]. We have identified hot spots of the diffuse gastric cancer subtype, in the mountainous region of western Honduras, with rigorous geospatial methods.

We postulate that the geographic clustering and younger age of the diffuse gastric cancer patients may implicate a germline genetic association. This may represent a cluster of subjects with germline mutations of CDH1, another tumor suppressor gene, or other recently described associations [ 20 , 39 , 40 , 41 , 42 ].

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Kaurah et. While all of the Central American populations originally derived from Asian migrations, it is possible that they were founded by different sub-groups, a migration Founder effect. This could be tested using large-scale genomic data. Similarly, following Spanish colonization there were substantial bottlenecks across Central America with high mortality due to newly introduced infections eg.

The patterns of diffuse cancer may be affected by varying degrees of host bottlenecks across our sites. Lastly, endogamy may affect genetic risk in the isolated mountain villages, either due to mating patterns, patterns or the small effective population sizes. In the latter case, we would predict that the clusters would have smaller village population sizes.

Geospatial analyses identify regional hot spots of diffuse gastric cancer in rural Central America

Specific H. They kept him for days without medical attention, interrogating him at the crime scene over and over. After they told him that he was free to return to Mexico, he was nearly arrested at the airport.

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  6. Fortunately for him, the Mexican ambassador was accompanying him, and she literally wrapped her arms around Castro and declared, "Consular protection," allowing him to leave the airport, though not the country. After yet more interrogation, Castro was finally able to return to Mexico and reunite with his family almost a month later. Honduran officials charged all eight with murder and attempted murder; all but one of the suspects have denied any involvement with the murder. The arrests immediately cast a shadow on the Agua Zarca dam.

    When federal police arrested two DESA employees in connection with the murder, the company halted work. The project remains suspended today. DESA did not respond to interview requests via email and phone. But not the main perpetrators. The entire case file, for example, was supposedly stolen from the trunk of a judge's car.

    Zelaya had raised the national minimum wage, proposed turning the massive U. Such a program ran counter to the interests of Honduras's entrenched elite, which deposed him in the middle of the night and put him on a plane in his pajamas. Soon after the coup, in , a single act of congress granted 41 concessions for hydroelectric dams on rivers across the country.

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    In April of that year, the Honduran government held an international investment convention called "Honduras Is Open for Business. According to human rights groups, illegal logging increased in the wake of the coup.

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    At the same time, threats against, and murders of, activists began to climb.