Gastric cancer is still common worldwide and can be predicted and prevented

Review by Prof. Eamonn Quigley (USA)

Study Summary 

Though less common in Western Europe and North America, the prevalence of, and mortality from, gastric cancer remains high in parts of Asia, in Central and South America and Eastern Europe. Given that there is a well described sequence of events leading to gastric cancer, this systematic review and meta-analysis set out to define the global prevalence of these precursor lesions. One hundred and sixty-six articles were identified that described the prevalence of gastric cancer precursor lesions (atrophic gastritis, intestinal metaplasia and/or dysplasia); over 350,000 individual patients were included. Two important conclusions were reached: first, around the world the prevalence of precursor lesions paralleled that of both gastric cancer and Helicobacter pylori infection and, second, symptoms were not predictive of H. pylori infection. It was also be noted that the prevalence of precursor lesions decreased progressively over time.

Commentary 

The message here is very clear. Pathologic precursors of gastric cancer such as atrophic gastritis and intestinal metaplasia are common where gastric cancer is common and are linked to the prevalence of infection with Helicobacter pylori. Even in low gastric cancer-risk countries, H. pylori prevalence predicted the presence of precursor lesions. Unfortunately, confining screening or surveillance efforts to those with symptoms will not be effective. Infection with Helicobacter pylori is clearly the global common denominator. What seems to be needed, therefore, is large-scale screening for, and treatment of, H. pylori in high-risk populations. Several questions remain unanswered and will require further study. For example, what is the H. pylori prevalence threshold at which screening/surveillance becomes effective, do at-risk populations retain their risk for gastric cancer when they migrate to low-incidence countries?

Citation

Mülder DT, Hahn AI, Huang RJ, Zhou MJ, Blake B, Omofuma O, Murphy JD, Gutiérrez-Torres DS, Zauber AG, O'Mahony JF, Camargo MC, Ladabaum U, Yeh JM, Hur C, Lansdorp-Vogelaar I, Meester R, Laszkowska M. Prevalence of Gastric Precursor Lesions in Countries With Differential Gastric Cancer Burden: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2024;22:1605-1617.

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