Preventing Stomach Cancer: The Power of Early Intervention

The Rising Incidence of Stomach Cancer

Stomach cancer, or gastric cancer, has become a concerning health issue globally, particularly among younger populations. Recent studies have shown a significant increase in stomach cancer cases in individuals under the age of 50. As we explore the trends and implications of this rise, it becomes crucial to spotlight effective preventive measures that could substantially reduce the burden of this disease.

Understanding the Role of Helicobacter Pylori

A significant factor contributing to the development of stomach cancer is chronic infection with Helicobacter pylori (H. pylori), a common bacterial pathogen known to inhabit the gastric mucosa. Epidemiological data indicates that this infection is the strongest known risk factor for gastric cancer, underscoring its relevance in the fight against this condition. Importantly, unlike many cancer risks that are unavoidable or linked to genetic predisposition, H. pylori infection is preventable and treatable. This fundamental aspect positions it as a target for public health initiatives aimed at curbing the rising rates of stomach cancer.

Treatment Options and Their Efficacy

The treatment of Helicobacter pylori involves a combination of antibiotics and proton pump inhibitors (PPIs). The antibiotics work to eradicate the bacteria, while PPIs reduce stomach acid, creating a less favorable environment for the bacteria’s survival and facilitating healing of any resultant damage to the stomach lining. Current research suggests that early screening and treatment of H. pylori could prevent upwards of 75% of stomach cancer cases in the future. This proactive approach could effectively diminish the incidence of gastric cancer and could safeguard countless lives.

Implementing routine screening for H. pylori, especially in high-risk populations, is a critical step in cancer prevention strategies. By identifying and addressing this infection early, healthcare systems can take a significant stride toward reducing the significant global health burden posed by stomach cancer.

Regardless of its preventability, there has been an alarming rise in stomach cancer in people under 50. Now, research led by the International Agency for Research on Cancer (IARC), the specialized cancer agency of the World Health Organization (WHO), has projected the future incidence of stomach cancer, including cases attributable to H. pylori infections, among people born between 2008 and 2017.

The researchers first used large-scale modeling to estimate the future burden of stomach cancer, assuming there were no changes in current prevention or treatment strategies. Then they estimated how many of those cases are linked to H. pylori. National, age-specific incidence rates were pulled from GLOBOCAN 2022, a global cancer statistics database, with mortality projections coming from the United Nations. The simulation model estimated how many people will develop cancer during their lifetime based on how often the cancer occurs at different ages, how likely people are to die before they can develop cancer, and demographic trends like population growth and aging.

If current treatment practices were to continue unchanged, based on these simulations, it’s expected that during the lifetime of all men and women born between 2008 and 2017, there will be 15.6 million new gastric cancer cases globally. Of those cases, 76% – or three-quarters – are attributable to infection with H. pylori and are therefore potentially preventable. Asia is projected to bear the highest burden, with 10.6 million cases, followed by the Americas (2 million) and Africa (1.7 million cases).

A 100% effective H. pylori screening and treatment program could reduce cases by up to 75%. Even programs that are 80% to 90% effective would still prevent between 60% and 68% of stomach cancer cases. These strategies are cost-effective, the researchers said, even in lower-income settings, and comparable to vaccination campaigns for human papillomavirus (HPV) or hepatitis B.

“A shift in focus toward the life course of today’s young people and their prospects of developing gastric cancer, with or without interventions, underscores the need for greater investment in gastric cancer prevention, including the implementation of population-based H. pylori screen-and-treat strategies,” said the researchers.

The study had limitations. Many lower-income countries lack reliable cancer registries, especially in Africa, leading to possible underestimation, and some data for stomach cancer location (upper versus lower stomach) were incomplete or imprecise. As has been mentioned, the simulation model assumed no change in cancer incidence rates or screen practices over time, and it also assumed that the prevalence of H. pylori remained constant.

The findings suggest that the majority of future stomach cancer cases are preventable with better public health action. Eradicating H. pylori is a proven, affordable strategy that should be prioritized, according to the researchers. Programs can be tailored for high-, middle- and low-income countries. For example, endoscopy-based screening and insurance-supported treatment for the former; population-level screening and early treatment for the latter. The researchers also note the importance of investing in developing an H. pylori vaccine.

This study sends a clear message: stomach cancer remains a significant global health threat, particularly for today’s youth. But with targeted, evidence-based interventions like screening for and treating H. pylori, millions of lives could be saved.

The study was published in the journal Nature Medicine.

Source: IARC/WHO