Mass Eradication of Helicobacter pylori to Prevent Gastric Cancer: Theoretical and Practical Considerations

Abstract

Although the age-adjusted incidence of gastric cancer is declining, the absolute number of new cases of gastric cancer is increasing due to population growth and aging. An effective strategy is needed to prevent this deadly cancer. Among the available strategies, screen-and-treat for Helicobacter pylori infection appears to be the best approach to decrease cancer risk; however, implementation of this strategy on the population level requires a systematic approach. The program also must be integrated into national healthcare priorities to allow the limited resources to be most effectively allocated. Implementation will require adoption of an appropriate screening strategy, an efficient delivery system with a timely referral for a positive test, and standardized treatment regimens based on clinical efficacy, side effects, simplicity, duration, and cost. Within the population, there are subpopulations that vary in risk such that a “one size fits all” approach is unlikely to be ideal. Sensitivity analyses will be required to identify whether the programs can be utilized by heterogeneous populations and will likely require adjustments to accommodate the needs of subpopulations.

Eradicating gastric cancer

“…The gastric cancer incidence has been gradually declining globally not only because of improvement in sanitation and hygiene but also because H. pylori testing and treatment nowadays are routine in patients with peptic ulcer and dyspeptic symptoms. Consequently, a program to eradicate H. pylori with the intention of accelerating the decline in gastric cancer incidence in a given population should focus on the high‐risk or intermediate‐risk subpopulation and be integrated with programs dealing with other pressing healthcare issues …”

Helicobacter pylori vacuolating cytotoxin and gastric cancer risk: reconsidered

“…They are also common in India, Thailand, Bangladesh and Pakistan, sites where gastric cancer is rare. For example, in Taiwan vacA m2 strains are present in 87.4% (11) and the ASR of gastric cancer is considered high (i.e., 17 cases/100,000 population/year) (12). …”

Strategies for Prevention of Gastric Cancer: Progress from Mass Eradication Trials

“…Although the interim analysis showed a reduction of premalignant conditions as well as a steady decline of gastric cancer incidence (by 25% at 2011), it did not reach statistical significance [9]. The final results were not reported yet, but a 47% reduction in gastric cancer incidence is expected in 2015 [10]. Based on this pilot study, a larger scale trial was started in Changhua County of mainland Taiwan.…”

“…If the subjects were identified as H. pylori positive, they were offered eradication therapy. Initial data showed about 36.2% were H. pylori positive and 88% who received sequential therapy were eradicated [10]. …”