Abstract Purpose of review This review article aims to provide an overview of existing and emerging screening strategies for gastric cancer and discuss potential measures to improve its efficacy in countries with different risk profiles for the disease. Recent findings Recent developments in endoscopic technology, including image enhancement and computer-guided diagnosis, can improve further early cancer detection in countries with primary endoscopic screening. Moreover, accumulating data on upper endoscopy quality underlines the pivotal role of appropriate examination time and the vital role of premedication (sedation, defoaming agents, and antispasmodics). In regions with low-to-intermediate incidence, the “test-and-treat” approach for H. pylori infection seems feasible for gastric cancer screening and prevention. Possibly, a family-based approach to test for the condition within family households could further improve the efficacy of this approach. In addition, other non-invasive methods to identify at-risk individuals are being evaluated, such as breath testing, serological markers, and circulating tumor cells. Summary Gastric cancer screening practices vary widely globally based on incidence, local healthcare facilities, and funding. However, wide-ranged screening programs for gastric cancer may be feasible even in countries with low-to-intermediate incidence if the approach is tailored towards the local disease burden and focused on the pre-selection of at-risk individuals. 

/pdf/how-to-improve-the-efficacy-of-gastric-cancer-screening-3uisno33.pdf

How to Improve the Efficacy of Gastric Cancer Screening?

Gastric cancer (GC) is a preventable disease, and Helicobacter pylori infection is the most important controllable risk factor. Despite numerous studies confirming that eradicating H. pylori can reduce the risk of GC, there remains a significant gap between the fundamental and clinical knowledge and public health interventions. This article provides a review of the progress made in the last decade by gastroenterologists in understanding the carcinogenic effects of H. pylori. The authors also summarize the evidence demonstrating the beneficial effects of eradication of H. pylori on gastric precancerous lesions and GC, and outline current strategies for H. pylori management. Notably, a family-based approach to H. pylori management represents a novel strategy for future GC prevention and control, boasting numerous advantages and having the potential to play a crucial role in future policymaking. 

Prevention and Screening of Gastric Cancer by Helicobacter pylori Management: Synthesis of Existing Data

ABSTRACT Background Patient adherence status to the newly introduced family‐based Helicobacter pylori ( H. pylori ) infection control and management strategy remains unclear, so are its influencing factors. We aim to investigate family members' adherence and its influencing factors during the family‐based H. pylori infection management practice for related disease prevention. Materials and Methods Based on our previously family‐based H. pylori survey in 2021, 282 families including 772 individuals were followed up 2 years after the initial survey to compare if the investigation and education might improve family member's adherence. The participant's adherence to H. pylori infection awareness, retest, treatment, publicity, gastroscopy, and hygiene habits were followed up, and their influencing factors were also analyzed. Results The overall participant's adherence to recommendations on H. pylori awareness, retest, treatment, publicity, gastroscopy, and hygiene habits were 77% (187/243), 67.3% (138/205), 60.1% (211/351), 46.5% (107/230), 45.6% (159/349), and 39.1% (213/545), respectively; and all showed improvements compared with their prior survey stages. The top reasons for rejection to treatment, retest, and gastroscopy were forgetting or unaware of H. pylori infection (30.3%), busy (32.8%), and asymptomatic (67.9%), respectively. Independent risk factor for low adherence to treatment was occupation (e.g., staff: OR 4.49, 95% CI 1.34–15.10). Independent favorable factors for treatment adherence were individuals at the ages of 18–44 years (OR 0.19, 95% CI 0.04–0.89) and had a large family size (e.g., four family members: OR 0.15, 95% CI 0.06–0.41); for retest adherence, it was individuals at the ages of 60–69 years (OR 0.23, 95% CI 0.06–0.97); for gastroscopy adherence, it was individuals at the age of 60–69 years (OR 0.46, 95% CI 0.28–0.75), and with gastrointestinal symptoms (OR 0.57, 95% CI 0.36–0.90). Conclusions Family‐based H. pylori management increases individual adherence to treatment, retest, and awareness, and there are also improved adherence to gastroscopy, publicity, and personal hygiene recommendations; further efforts are required to enhance the individual adherence rate for related disease prevention. 

Improved Patient Adherence to Family‐Based Helicobacter pylori Infection Control and Management Strategy in Central China and Its Influencing Factors

Abstract Background The overall benefits of the newly introduced family‐based Helicobacter pylori ( H. pylori ) infection control and management (FBCM) and screen‐and‐treat strategies in preventing multiple upper gastrointestinal diseases at national level in China have not been explored. We investigate the cost‐effectiveness of these strategies in the whole Chinese population. Materials and Methods Decision trees and Markov models of H. pylori infection‐related non‐ulcer dyspepsia (NUD), peptic ulcer disease (PUD), and gastric cancer (GC) were developed to simulate the cost‐effectiveness of these strategies in the whole 494 million households in China. The main outcomes include cost‐effectiveness, life years (LY), quality‐adjusted life year (QALY), and incremental cost‐effectiveness ratio (ICER). Results When compared with no‐screen strategy, both FBCM and screen‐and‐treat strategies reduced the number of new cases of NUD, PUD, PUD‐related deaths, and the prevalence of GC, and cancer‐related deaths. The costs saved by these two strategies were $1467 million and $879 million, quality‐adjusted life years gained were 227 million and 267 million, and life years gained were 59 million and 69 million, respectively. Cost‐effectiveness analysis showed that FBCM strategy costs −$6.46/QALY and −$24.75/LY, and screen‐and‐treat strategy costs −$3.3/QALY and −$12.71/LY when compared with no‐screen strategy. Compared to the FBCM strategy, the screen‐and‐treat strategy reduced the incidence of H. pylori ‐related diseases, added 40 million QALYs, and saved 10 million LYs, but at the increased cost of $588 million. Cost‐effectiveness analysis showed that screen‐and‐treat strategy costs $14.88/QALY and $59.5/LY when compared with FBCM strategy. The robustness of the results was also verified. Conclusions Both FBCM and screen‐and‐treat strategies are highly cost‐effective in preventing NUD, PUD, and GC than the no‐screen strategy in Chinese families at national level. As FBCM strategy is more practical and efficient, it is expected to play a more important role in preventing familial H. pylori infection and also serves as an excellent reference for other highly infected societies. 

Family‐based Helicobacter pylori infection control and management strategy and screen‐and‐treat strategy are highly cost‐effective in preventing multiple upper gastrointestinal diseases in Chinese population at national level

Enhanced efficiency of the 'family index-case method': why and when?

We read with utmost interest the study by Zhou et al, which was the first familybased investigation of Helicobacter pylori (Hp) infection in China. The authors provided valuable insights into the occurrence of familial cluster effect on Hp infection and the superiority of the ‘familybased strategy’. However, their work failed to compare the screening efficiency of various established Hp management methods, leaving us curious about whether the ‘familybased strategy’ could identify more Hpinfected participants with equal number of tests conducted as compared with the widely used ‘test and treat strategy’. Fortunately, the familyunit data in Zhou’s study offers the possibility for such exploration. To address this gap, we built a database consisting of over one million households, based on the infection status of households and individuals from 29 provinces reported by Zhou, in order to simulate realworld scenarios. The screening protocols were simulated in national database and subdataset by province, and were defined as follows (figure 1A): The ‘testandtreat strategy’ involved randomly selecting participants for Hp testing until all participants were tested. The ‘familybased strategy’ involved participants selecting, as well as Hp testing of family members only if the selected individual tested positive for Hp. If the selected individual tested negative, no further testing of family members was required and a new participant was selected at random; it is noteworthy that each individual was tested only once at most. The main difference between the two strategies was the order in which participants underwent Hp testing. The testing and sampling processes were simulated using Python. Our study found that, on average, the ‘familybased strategy’ exhibited an improvement of 4.02% in the ability to detect Hp infections throughout the screening process (table 1), despite the final number of Hppositive individuals identified was the same after both methods were applied to all participants. We used the xaxis to represent Letter

/pdf/family-based-strategy-for-helicobacter-pylori-infection-200a9h0s.pdf

‘Family-based’ strategy for Helicobacter pylori infection screening: an efficient alternative to ‘test and treat’ strategy

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‘Family-based’ strategy for Helicobacter pylori infection screening: an efficient alternative to ‘test and treat’ strategy