Prevention strategies for gastric cancer: a global perspective

Abstract

Despite the substantial burden of gastric cancer worldwide, population strategies for primary prevention have not been introduced in any country. Recognizing the causal role of Helicobacter pylori infection, there is increasing interest in population-based programs to eradicate the infection to prevent gastric cancer. Nonetheless, the paucity of available evidence on feasibility and effectiveness has prevented implementation of this approach. There are very few secondary prevention programs based on screening with endoscopy or radiography, notably in the Republic of Korea and Japan, two of the countries with the highest incidence rates of gastric cancer. In Korea, where the organized screening program is in place, survival rate of gastric cancer is as high as 67%. More research is needed to quantify the specific contribution of the screening program to observed declines in mortality rates. Gastric cancer screening is unlikely to be feasible in many Low-Middle Income Countries where the gastric cancer burden is high. Prevention strategies are still under development and the optimal approach may differ depending on local conditions and societal values. The present review gives an overview of the etiology and burden of the disease, and possible prevention strategies for countries and regions confronted with a significant burden of disease.

Keywords: Mass screening; Prevention; Stomach neoplasms.

Fig. 1

Estimated age-standardized incidence rates of gastric cancer (ASR-World) per 100,000, IARC GLOBOCAN 2012. Adapted from Ferlay et al. GLOBOCAN 2012 v1.0.

Fig. 2

Trends of mortality from gastric cancer in selected countries with high or low burden in men (A) and women (B). Adapted from Ferlay et al. Cancer incidence in five continents.

Fig. 3

Growth patterns of early gastric carcinoma. Adapted from Lauwers et al. WHO Classification of Tumours of the Digestive System, with permission from with permission from Dr D.Y. Graham and the International Agency for Research on Cancer International Agency for Research on Cancer.