Mass Eradication of Helicobacter pylorito Prevent Gastric Cancer: Theoretical and Practical Considerations

Abstract

Although the age-adjusted incidence of gastric cancer is declining, the absolute number of new cases of gastric cancer is increasing due to population growth and aging. An effective strategy is needed to prevent this deadly cancer. Among the available strategies, screen-and-treat for Helicobacter pylori infection appears to be the best approach to decrease cancer risk; however, implementation of this strategy on the population level requires a systematic approach. The program also must be integrated into national healthcare priorities to allow the limited resources to be most effectively allocated. Implementation will require adoption of an appropriate screening strategy, an efficient delivery system with a timely referral for a positive test, and standardized treatment regimens based on clinical efficacy, side effects, simplicity, duration, and cost. Within the population, there are subpopulations that vary in risk such that a "one size fits all" approach is unlikely to be ideal. Sensitivity analyses will be required to identify whether the programs can be utilized by heterogeneous populations and will likely require adjustments to accommodate the needs of subpopulations.

Keywords: Eradication; Helicobacter pylori; Population screening; Stomach neoplasms.

Fig. 1

The preventable phase of a cancer includes (A) the preclinical detectable phase (PCDP; the number in parenthesis indicates the length of the PCDP in years for a specific cancer) and (B) the carcinogenic phase related to exposure to risk factors (well-known risk factors for the development of a specific cancer are shown in parentheses).

Fig. 2

The efficacy/effectiveness of the population-based interventions for prevention of gastric cancer according to the surrogate end-points of premalignant gastric lesions and primary end-points of gastric cancer incidence and mortality in the Correa’s multistate model. GCA, gastric cancer; s/p, status post.

Fig. 3

Cost-effectiveness analysis comparing different regimens/strategies using acceptability curves: (A) the choice between sequential and triple therapies in the treatment of H. pylori infection and (B) the choice between screen-and-treat for H. pylori infection and endoscopic screening based on the serum pepsinogen method to prevent death from gastric cancer. Adapted from Liou JM, et al. Lancet 2013;381:205–213, and Lee YC, et al. Cancer Epidemiol Biomarkers Prev 2007;16:875–885.

Fig. 4

The presence of confounders in the observed relationship between Helicobacter pylori infection and extragastric diseases.