Gastric cancer prevention strategies: A global perspective

Abstract

Gastric cancer (GC) is the fifth most common cancer worldwide, and mortality rates are still high. Primary preventive strategies, aimed to reduce risk factors and promote protective ones, will lead to a decrease in GC incidence. Helicobacter pylori infection is a well-established carcinogen for GC, and its eradication is recommended as the best strategy for the primary prevention. However, the role of other factors such as lifestyle, diet, and drug use is still under debate in GC carcinogenesis. Unfortunately, most patients with GC are diagnosed at late stages when treatment is often ineffective. Neoplastic transformation of the gastric mucosa is a multistep process, and appropriate diagnosis and management of preneoplastic conditions can reduce GC-related mortality. Several screening strategies in relation to GC incidence have been proposed in order to detect neoplastic lesions at early stages. The efficacy of screening strategies in reducing GC mortality needs to be confirmed. This review provides an overview of current international guidelines and recent literature on primary and secondary prevention strategies for GC. Epidemiology of gastric cancer The incidence of gastric cancer (GC) has been steadily declining worldwide in the last decades; nevertheless, GC still represents the fifth most common cancer with more than 1 000 000 cases in 2018, almost two-thirds occurring in developing countries. 1, 2 The regions with the highest incidence of GC are Eastern Asia, Central and Eastern Europe, and several Central and South American countries, whereas North America, Australia, and North Africa are considered to be low-incidence areas. However, the distribution of GC does not follow a strict geographical pattern, because low-rate countries have been reported within the highest risk areas, such as India in Asia, while within low-incidence populations, there are subgroups of subjects at higher risk, such as Koreans living in the USA.

Establish a Scoring Model for High-Risk Population of Gastric Cancer and Study on the Pattern of Opportunistic Screening

“…Worldwide, the incidence of GC has been steadily declining in these years; nevertheless, GC is still a common malignant tumor [ 6 ], and its incidence and mortality rates are also one of the most common malignant tumors in China [ 2 ]. Ningxia is a higher incidence area of GC, and its incidence and mortality of GC are both at the forefront in the local malignant diseases [ 7 ].…”

Recent Developments of Systemic Chemotherapy for Gastric Cancer

“…The high mortality of GC is primarily due to late diagnosis. Therefore, early detection and treatment is critical to reduce GC mortality [11]. Some high-risk East Asian countries have employed their own nationwide screening programs (Japan, South Korea, and Matsu Islands in Taiwan) [12].…”

Gastric Cancer Staging: Is It Time for Magnetic Resonance Imaging?

“…Fortunately, in the 21st century, improvements in worldwide sanitary conditions, diet, and medical advances have effected a significant reduction in the incidence of GC, especially in those patients with advanced disease, usually called advanced GC [ 2 ]. However, this malignant tumor still remains a significant cause of morbidity and mortality worldwide (fifth most common malignancy in the world) due to its global diffusion, associated with common risk factors such as diet, Helicobacter pylori , tobacco, obesity, adenomatous polyps, chronic atrophic gastritis, and the male sex [ 4 ].…”