Endoscopic Surveillance in Patients with the Highest Risk of Gastric Cancer: Challenges and Solutions

Abstract

Gastric cancer is one of the most significant causes of cancer-related morbidity and mortality worldwide. Recognized modifiable risk factors include Helicobacter pylori infection, geographic location, select dietary factors, tobacco use and alcohol consumption. In addition, multiple hereditary cancer predisposition syndromes are associated with significantly elevated gastric cancer risk. Endoscopic surveillance in hereditary gastric cancer predisposition syndromes has the potential to identify gastric cancer at earlier and more treatable stages, as well as to prevent development of gastric cancer through identification of precancerous lesions. However, much uncertainty remains regarding use of endoscopic surveillance in hereditary gastric cancer predisposition syndromes, including whether or not it should be routinely performed, the surveillance interval and age of initiation, cost-effectiveness, and whether surveillance ultimately improves survival from gastric cancer for these high-risk individuals. In this review, we outline the hereditary gastric cancer predisposition syndromes associated with the highest gastric cancer risks. Additionally, we cover current evidence and guidelines addressing hereditary gastric cancer risk and surveillance in these syndromes, along with current challenges and limitations that emphasize a need for continued research in this field.

Gastric Cancer Risk and Pathogenesis in BRCA1 and BRCA2 Carriers

“…A number of hereditary cancer predisposition syndromes are associated with elevated risk of GC, which has led to a multitude of syndrome-specific guidelines for GC surveillance [ 77 ]. Patients with hereditary diffuse gastric cancer syndrome (HDGC) due to a PV in CDH1 or CTNNA1 have the highest lifetime cumulative risk of GC [ 57 , 78 , 79 ].…”

Endoscopic surveillance for familial intestinal gastric cancer in low‐incidence areas: An effective strategy

“…Contrarily to other syndromes, such as in HDGC where the surveillance is better established, 21,22 in FIGC there is no clear evidence for the best approach. Surveillance is recommended in a research environment, 23 and recommendations vary between different European societies, from just eradicating Hp, to performing endoscopies with different periodicities (annually, every 3 or 5 years). 2,4,[24][25][26][27] For example, the European Society of Digestive Oncology expert panel recommends annual EGD with a detailed exploration of the gastric mucosa with random biopsies, starting at the latest at the age of 40 years or 5 years before disease onset in the youngest affected relative.…”