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Secondary prevention of gastric cancer

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A matter of definitions

When I was young(er), my mentor, Pelayo Correa, who taught a generation of researchers orbiting around gastric oncology, encouraged me to spend some sabbatical time at the European Cancer Agency in Lyon “...to gain, among other things, a better perception of the crucial clinical impact that epidemiological data really have in clinical practice”. I did not follow this good piece of advice... and it was a mistake! This was the first thought that came to me as I read the manuscript produced by de Vries et al in this issue of Gut (page 1665)—a well conducted study that will be mentioned by every paper addressing gastric precancerous lesions.1

The paper provides valuable insight on the declining prevalence of gastric precancerous lesions (that is, atrophic gastritis and gastric non-invasive neoplasia) in the Netherlands between 1991 and 2005: 15 years is a long enough time to give us a historical perception of how fast our world is changing. The abundance of data presented by the authors prompts a few general considerations on our current strategies for dealing with gastric precancerous lesions/conditions, making us look to the near future in the light of a critical review of our recent past.

Let us start from the conclusions: the Dutch data confirm that gastric cancer usually arises in the second half of life and its incidence is declining in the western world—a victory without a battle. Less optimistically, however, we could argue that gastric epithelial malignancies still have a major oncological impact in both Asian and South-American countries. Even in large areas of southern and eastern Europe, gastric cancer is still a leading oncological problem and surgeons are still faced with advanced gastric tumours in their daily practice (just to give an example, the incidence of gastric cancer in the …

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