Review article: the epidemiology and prevention of gastric cancer

Abstract

Summary: Background: Gastric cancer can be divided into cardia and noncardia gastric adenocarcinoma (NCGA). Non cardia gastric cancer is a disease that has declined in global incidence but has remained as an extremely lethal cancer. Aim: To review recent advances in epidemiology and strategies in prevention of non cardia gastric cancer. Methods: A rapid literature search strategy was developed for all English language literature published before March 2013. The search was conducted using the electronic databases PubMed and EMBASE. The search strategy included the keywords ‘stomach neoplasms’, ‘gastric cancer’, ‘epidemiology’, ‘risk factor’, ‘early detection of cancer’, ‘mass screening’, ‘cancer burden’, ‘prevention’ and ‘cost‐effectiveness’. The search strategy was adjusted according to different requirements for each database. The specific search was also performed in cancer‐related websites for country‐specific information. The search was limited to past 10 years. Results: Gastric cancer is the fifth most common cancer but the third leading cause of cancer death. The case fatality rate is 75%. Screening by radiological or endoscopic methods has limited success in prevention of gastric cancer. Helicobacter pylori has been identified as a carcinogen, accounting for 60–70% of gastric cancer globally and eradication is a potential preventive measure. A meta‐analysis in 2009 demonstrated that individuals treated with H. pylori eradication therapy can reduce gastric cancer risk. The extended Shandong Intervention trial that lasted 14.3 years showed that H. pylori eradication therapy significantly reduced gastric cancer incidence by 39%. Consensus groups from Asia, Europe and Japan have recommended H. pylori eradication as primary prevention in high‐risk areas. Following eradication therapy, endoscopic surveillance of pre‐malignant lesions using enhanced imaging appears to be another promising preventive strategy. Conclusions: Gastric cancer remains a major diagnostic and therapeutic challenge. There is emerging evidence that H. pylori eradication in high gastric cancer regions can lead to a decline in the incidence of this highly lethal disease.