Should We Screen Gastric Cancer in an Intermediate Gastric Cancer Risk Country?: International Award

Abstract

Introduction: Gastric cancer is the fifth most common cancer and the third most common cause of cancer—related death worldwide. In high risk gastric cancer countries, gastric cancer screening is implemented but in intermediate risk countries it is debatable. The aims of this study were to evaluate the prevalence of active infection of Helicobacter Pylori as well as the presence of gastric cancer and gastric cancer precursors in an asymptomatic population submitted to colon cancer screening. Methods: We made a prospective study in an intermediate risk country of gastric cancer of patients undergoing colorectal cancer screening colonoscopy with general anesthesia and performed at the same time the upper endoscopy with blind biopsies from the gastric body and antrum, according to Sydney protocol. Results: We included 1364 Caucasian patients, 54.4% female, with mean age of 57.1±11.1 years. There was gastric cancer family history in 1.7% of the patients. Helicobacter Pylori infection was present in 41% in the gastric body and in 41.1% in the antrum. We found an incidence of gastric atrophy in both locations (gastric body and antrum) in 5.1% and intestinal metaplasia in 13.3%. There were 4 cases of low grade dysplasia and we diagnosed 12 gastric cancers (0.9%). Conclusion: The prevalence of Helicobacter Pylori was 41% and we found 12 gastric cancer in an asymptomatic population (0.9% incidence). As an intermediate risk gastric cancer country, we would recommend gastric cancer screening at the same time of colon cancer screening, followed by a structured surveillance program in case of intestinal metaplasia, dysplasia or gastric cancer.