Microbiota in Health and Disease (Oct 2023)
Review – Gastric malignancies: Prevention & clinical aspects
Abstract
Gastric cancer is the fifth most common type of cancer and the third most common cause of cancer related mortality worldwide. Although its incidence and prevalence continue to decrease in most countries, the absolute number of gastric cancers will continue to grow due to increasing lifespan and increasing in the world population. Helicobacter pylori is a type I carcinogen and is responsible for 89% of all gastric cancers except those from the cardia. Prospective and retrospective cohort studies have demonstrated that population based screening and H. pylori eradication therapy significantly reduced the risk of gastric cancer and provided significant economic benefits in China and Japan. Secondary prevention, that is in place in Japan and Korea, reduces the death rate from gastric cancer and costs for gastric cancer. Programs based on endoscopy are more successful than upper gastrointestinal series in early gastric cancer detection and patients enrolled in such programs have a better 5 year survival. When the screen and treat approach is implemented, before preneoplastic changes develop in gastric mucosa due to H. pylori infection, up to a 63% reduction in gastric cancer can be achieved. Important cost savings, beside life savings, have been achieved in Japan since 2013 when H. pylori eradication was offered to all infected patients. Without any prevention, the projected number of gastric cancer related deaths would be 124,000 in 2040, therefore 49,000 lives could be potentially saved in the optimal case of prevention strategies being implemented across Europe. In our opinion there are enough scientific data and results of cost benefit models to claim that the time has come for primary gastric cancer prevention programs to be implemented not only in Asia but also in other parts of the world, especially in those countries with medium to high gastric cancer incidence.
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