Is Your Practice Missing the Next Gastric Cancer Surge?

A study published in Nature Medicine estimated that Helicobacter pylori infection could lead to 11.8 million cases of gastric cancer over the lifetime of today’s children if current prevention strategies remain unchanged.

The International Agency for Research on Cancer, World Health Organization, analyzed global cancer incidence data 2022 and United Nations demographic information to estimate future mortality. The study focused on people born between 2008 and 2017 to estimate their lifetime cancer risk linked to chronic H pylori infection.

According to the study, gastric cancer is the fifth leading cause of cancer death worldwide. Two thirds of future cases are projected in Asia (10.6 million), followed by the Americas (2.0 million), Africa (1.7 million), and Europe (1.2 million), with 900,000 in Europe linked to H pylori. Researchers emphasized that gastric cancer is largely preventable and called for stronger global prevention strategies, including the development of a vaccine against H pylori. 

Speaking with Univadis Spain, Javier P. Gisbert, MD, PhD, highlighted the urgent need to address H pylori infection. He is the head of the Inflammatory Bowel Disease Unit at Hospital Universitario de La Princesa in Madrid, Spain, associate professor of medicine at Universidad Autónoma de Madrid, and affiliated researcher with the Instituto de Investigación Sanitaria Princesa, Madrid. “Gastric cancer is a major global health concern, ranking as the fifth most common cancer worldwide. The main cause is H pylori infection. If we could eradicate this bacterium, we would eliminate at least 90% of the gastric tumors it causes. In Spain alone, approximately 60,000 new cases of gastric cancer are expected in this birth cohort, with approximately 40,000 linked to H pylori infection. These figures show that this bacterium, and efforts to diagnose and prevent it, must be taken very seriously,” he said.

Preventive Measures

In 2021, the European Union launched the Beating Cancer Plan, followed by European Council recommendations that highlight population-based screening and treatment of H pylori, as key tools to prevent gastric cancer.

According to Gisbert, H pylori is usually acquired in early childhood, but the cancer it can cause typically appears decades later, often after the age of 50 or 60 years.

“Chronic H pylori infection gradually damages the stomach lining,” he explained. “It starts with superficial gastritis, progresses to atrophic gastritis, then intestinal metaplasia, and finally dysplasia the last stage before cancer. If we treat the infection early, before these changes occur, we can prevent gastric cancer.”

Despite this risk, the incidence of gastric cancer in Spain remains relatively low, under 10 cases per 100,000 people per year. For this reason, screening asymptomatic people for H pylori is not considered necessary nationwide.

“In countries with higher gastric cancer rates, H pylori screening would be cost-effective,” Gisbert said. “But in Spain, it’s not clearly justified.”

Practice Gaps

Gisbert is also a researcher at the Biomedical Research Network Centre for Liver and Digestive Diseases. He also serves as principal investigator of the European H pylori Registry, a multinational initiative tracking real-world management of the infection. He recently led a study assessing how Spanish gastroenterologists outside the registry manage H pylori infections.

The results, published in Helicobacter, revealed the following gaps in clinical practice: “17% of specialists did not test for H pylori in patients with gastrointestinal bleeding from peptic ulcers, and 35% did not start treatment at the time of diagnosis in these cases. Only 25% were aware of local clarithromycin resistance rates, and only 37% regularly assessed the effectiveness of eradication treatments. Additionally, 74% of the specialists did not confirm penicillin allergy before prescribing the treatment. Moreover, 32% did not investigate first-degree relatives of patients with gastric cancer,” summarized Gisbert.

Conclusion

“Given that gastric cancer is largely preventable, more active intervention and control programs should be implemented in these high-resource East Asian countries. This indicates that, as in human papillomavirus vaccine programs for cervical cancer prevention or hepatitis B vaccine programs to reduce the risk of liver cancer, an H pylori vaccine would greatly advance the fight against gastric cancer, given that vaccination is one of the most context-responsive prevention strategies and is highly adaptable, especially in low- and middle-income settings where we expect to see a high number of H pylori-attributable gastric cancer cases,” the authors concluded.

Gisbert reported having no conflicts of interest. 

This story was translated from Univadis Spain.