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

Abstract

Background:Helicobacter pylori infection is the cause of the majority of gastric cancer. Meta-analyses on several interventional trials, irrespective of the target population, unanimously demonstrated the benefit of eradication therapy in reducing the occurrence of gastric cancer. Based on the evidence for the preventive effects on gastric cancer by eradication therapy in the general population, the International Agency for Research on Cancer advocated eradication of H. pylori as the primary preventive strategy for gastric cancer. Consensus reports on H. pylori gastritis by experts also recommended eradication of H. pylori as the strategy for prevention of gastric cancer. Key Messages:H. pylori is responsible for the majority of gastric cancer. As the eradication of the infection has been shown to reduce subsequent development of gastric cancer, a number of large-scale controlled trials involving a large number of subjects are currently underway in various countries to further verify the feasibility and effects of H. pylori eradication on gastric cancer prevention. However, such studies might be considered unethical as we already knew that the criminal role of H. pylori in gastric carcinogenesis. In Japan, rather than conducting clinical trials, the government adopted insurance coverage for H. pylori gastritis irrespective of symptoms. This policy brought about a massive surge in eradication therapy, which will ensue in a drastic reduction in the prevalence of H. pylori by 2030 as well as gastric cancer. Conclusions: Primary prevention of gastric cancer is now moving into implementation phase in Japan and will be spreading in other counties where long-term clinical trials have started.

Reliable information for cancer control in Cali, Colombia

“…Due to the above, it is necessary to develop 1) monotherapies to facilitate adherence to antibiotic treatment and 2) accurate non-invasive tests to identify premalignant gastric lesions and thus serve as a risk stratification tool of patients. The simultaneous detection of serum pepsinogens and antibodies against H. pylori has achieved this goal in Japan 35 , 36 . This strategy has not been adequately validated in Latin America and continues to be an option that requires exploration with a well-founded project of implementation.…”

“…Es necesario desarrollar monoterapias para facilitar la adherencia al tratamiento antibiótico y pruebas no invasivas que identifiquen las afecciones gástricas premalignas para estratificar el riesgo de los pacientes. La detección simultánea de pepsinógenos séricos y anticuerpos contra H. pylori ha conseguido este objetivo en el Japón 35 , 36 . Esta estrategia no ha sido validada de manera adecuada en Latinoamérica y continúa siendo una opción que requiere exploración con metodología válida.…”

Gastric cancer prevention targeted on risk assessment: Gastritis OLGA staging

“…Cleansing the world of H. pylori infection by vaccination (when it becomes available), or globally applying eradication strategies is now a priority …”

“…[65][66][67] Cleansing the world of H. pylori infection by vaccination (when it becomes available), or globally applying eradication strategies is now a priority. 68,69 Among gastritis patients, histological staging may provide clinicians with solid information to enable secondary prevention strategies tailored to single patients' clinicopathological status. This takes the effort of a task force of general practitioners, gastroenterologists, endoscopists, and pathologists.…”

Helicobacter pylori the Latent Human Pathogen or an Ancestral Commensal Organism

“…In some countries a national program to eradicate H. pylori has been established. The main argument for the establishment of these programs is that existing populations with a high risk to develop severe diseases associated to H. pylori , like Japan, that justify its implementation due the high prevalence of gastric cancer ( Sugano, 2016 ). However, before applying this massive eradication policy we need to document the interesting changes in H. pylori’s epidemiology and tendencies.…”