The relative and attributable risks of cardia and non-cardia gastric cancer associated with Helicobacter pylori infection in China: a case-cohort study

Abstract

Background Helicobacter pylori infection is a major cause of non-cardia gastric cancer (NCGC), but its causal role in cardia gastric cancer (CGC) is unclear. Moreover, the reported magnitude of association with NCGC varies considerably, leading to uncertainty about population-based H pylori screening and eradication strategies in high-risk settings, particularly in China, where approximately half of all global gastric cancer cases occur. Our aim was to assess the associations of H pylori infection, both overall and for individual infection biomarkers, with the risks of NCGC and CGC in Chinese adults.Methods A case-cohort study was done in adults from the prospective China Kadoorie Biobank study, aged 30-79 years from ten areas in China

Nationwide gastric cancer prevention in China, 2021–2035: a decision analysis on effect, affordability and cost-effectiveness optimisation

“…Our analyses further revealed that the health effects of Hp eradication only become obvious in the long term, helping to explain the conflicting results observed in small studies with different follow-up durations 39. Because approximately 80% of non-cardia and over 60% of cardia GC cases currently occurring in China are attributable to Hp infection,5 our results have important implications for policy-making in this large, developing country. It is suggested that, like other approaches (eg, vaccines for hepatitis B virus) aiming to control the spread of infectious diseases today and associated cancers in the future, general Hp eradication should be considered for inclusion in long-term national health plans, with delivery to both developed regions and economically disadvantaged regions so as to minimise regional disparity.…”

“…Eradication of Helicobacter pylori (Hp), a group I carcinogen that accounts for over 0.3 million annual new cases of non-cardia and cardia GC among Chinese people,5 has been shown to be associated with a 52% reduction in GC incidence and a 38% reduction in mortality in a 22-year follow-up study (1995–2017) conducted in a county of eastern China 6. Additionally, screening via electronic endoscopy, a secondary prevention approach in GC, has been part of government-funded programmes for the early diagnosis and treatment of cancer in selected rural (since 2006) and urban (since 2012) areas of China 3.…”

Native and Indigenous Populations and Gastric Cancer: A Worldwide Review

“…Among Indigenous populations, H. pylori infections are seen at greater prevalence for the non-cardia subtype of gastric cancer compared to cardia subtypes [17]. Exact prognosis based on non-cardia versus cardia is inconclusive, but a recent study (2021) indicated that cardia variants may lead to worse outcomes [43]. A cause of concern among Alaska Native individuals is the high rate of antimicrobial resistance, which may affect the treatment efficacy of therapies targeted against H. pylori [7,44].…”

Susceptibility-Guided Therapy vs. Bismuth-Containing Quadruple Therapy as the First-Line Treatment for Helicobacter pylori Infection: A Systematic Review and Meta-Analysis

“…H. pylori gastritis was defined as an infectious disease in the Kyoto global consensus report ( 2 ). As a type-1 carcinogen, H. pylori infection is closely associated with an incidence of gastric cancer (GC) ( 3 ). Due to the public health burden and threat caused by H. pylori infection and the thought that successfully clearing H. pylori could eliminate a carcinogen and reduce a source of infection, recent consensus reports have raised the importance of H. pylori screening and eradication for GC prevention ( 4 , 5 ).…”