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. 2010 Dec;15(6):486-90.
doi: 10.1111/j.1523-5378.2010.00799.x.

Strategy for eliminating gastric cancer in Japan

Masahiro Asaka  1 , Mototsugu Kato, David Y Graham
Affiliations

Strategy for eliminating gastric cancer in Japan

Masahiro Asaka et al. Helicobacter. 2010 Dec.

Abstract

A study conducted by the Japan Gast Study Group showed that eradication of Helicobacter pylori reduced the risk of gastric cancer by about one-third. However, it did not completely prevent the onset of latent gastric cancer among those at high risk (i.e., with atrophic gastritis). To prevent deaths from gastric cancer, it is necessary to eradicate H. pylori infection. We propose a program of risk stratification based on the presence of H. pylori infection with or without atrophic gastritis followed by targeted interventions. Those at no risk for gastric cancer (no H. pylori, no atrophic gastritis) need no therapy or follow-up. Those at low risk (H. pylori infected, nonatrophic gastritis) need only H. pylori eradication therapy. The smaller groups at high or very high risk need eradication and cancer surveillance. We estimated the costs and the benefits of this strategy. Gastric cancer screening by simultaneous measurement of serum pepsinogen and H. pylori antibody combined with eradication of H. pylori in all individuals at risk would initially increase national healthcare expenditure, but this would be offset by markedly reducing the cost of treating gastric cancer. The proposed strategy should prevent about 150,000 deaths from gastric cancer during the 5 years after its adoption. If the loss caused by these deaths is also taken into account, the economic effect of this strategy becomes enormous. It would probably reduce the incidence of gastric cancer by more than 80-90% within 10 years. The Japanese government should take the initiative to implement this strategy as soon as possible.

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Conflict of interest statement

Dr. Asaka declares no conflicts of interest.

Figures

Figure 1
Figure 1
Numbers of age related gastric cancer death in 2006 in Japan: Gastric cancer death in Japan is abruptly increased after 50 years.
Figure 2
Figure 2
Surveillance of gastric cancer after screening: Simultaneous measurement of serum pepsinogen and H. pylori status so as to be grouped (A–D) according to the results is recommended for all Japanese persons aged 50 years or more as surveillance of gastric cancer in Japan.
See this image and copyright information in PMC

References

    1. Fukase K, Kato M, Kikuchi S, et al. Japan Gast Study Group: Effect of eradication of Helicobacter pylori on incidence of metachronous gastric carcinoma after endoscopic resection of early gastric cancer: an open-label, randomised controlled trial. Lancet. 2008;372:392–397. - PubMed
    1. Asaka M, Kato M, Takahashi S, et al. Japanese Society for Helicobacter Research: Guidelines for the management of Helicobacter pylori infection in Japan: 2009 revised edition. Helicobacter. 2010;15:1–20. - PubMed
    1. Asaka M. Helicobacter pylori infection and gastric cancer. Intern Med. 2002;41:1–6. - PubMed
    1. Koinuma N, Ogata T, Misawa J. Pharmacoeconomic assessment of gastric cancer treatment(In Japanese) Nippon Rinsho. 2008;66:639–652.
    1. Asaka M, Kato M, Graham D. Prevention of gastric cancer by Helicobacter pylori eradication. Intern Med. 2010:633–636. - PubMed

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