Screening and treating Helicobacter pylori infection for gastric cancer prevention on the population level

• Published in: Journal of gastroenterology and hepatology 2017-06, Vol.32 (6), p.1160-1169
• Main Authors: Lee, Yi‐Chia, Lin, Jaw‐Town
• Format: Article
• Language: English
• Subjects: Cancer screening; Colorectal carcinoma; Disease prevention; Female; Gastric cancer; Gastric cancer: clinical practice and treatment (including surgery); Gastric cancer: clinical research; Gastric cancer: epidemiology and surveillance; Gastritis - complications; Gastritis - diagnosis; Gastritis - drug therapy; Gastritis - microbiology; Health risk assessment; Helicobacter Infections; Helicobacter pylori; Helicobacter pylori: diagnosis; Helicobacter pylori: treatment and antimicrobial resistance; Humans; Infections; Integration; Male; Mass Screening; Medical screening; Occult Blood; Pathogens; Population; Risk; Risk factors; Standardization; Stomach Neoplasms - etiology; Stomach Neoplasms - prevention & control; Taiwan
• ISSN: 0815-9319; 1440-1746
• DOI: 10.1111/jgh.13726

Helicobacter pylori infection is the major cause of gastric cancer, and removal of H. pylori infection from a population could theoretically decrease the number of cases by about 89%. However, in real‐life settings, few studies have reported the effect of screening and treating this pathogen in population‐based programs. This is mainly because of the lack of an adequate infrastructure for delivery of systematic screening services to asymptomatic individuals, the lack of standardization to ensure that each subject receives the correct diagnostic testing and antibiotic treatment, and limited resources. We illustrate our method of implementing two population‐based screen‐and‐treat programs in Taiwan, where the epidemiological characteristics of disease burden have changed from the traditionally Eastern pattern towards that of the Western countries. Our first example is a high‐risk population that resides on an offshore island, in which a strategy of mass eradication of H. pylori was applied. The other example is an intermediate‐risk population, which is representative of the general average‐risk population, in which there is integration of the screen‐and‐treat method with the established framework of colorectal cancer screening using the fecal‐occult blood test. The information provided here may be useful for integration of gastric cancer prevention measures into the healthcare priorities of populations with different gastric cancer risks, such as those with limited resources.