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Gastric cancer is the fifth most common cancer and third leading cause of cancer-related death worldwide.1 In 2013, 841 000 people worldwide died due to gastric cancer.2 Eastern Asia, Eastern Europe and some regions in Central and South America have the highest incidence of stomach cancer, whereas Western Europe and North America have lower rates. The majority of gastric malignancies are intestinal type adenocarcinomas.3 These cancers develop according to a multistep process, in strong association with Helicobacter pylori infection. This bacterium causes chronic gastritis, which can slowly progress via atrophy, intestinal metaplasia and dysplasia to gastric adenocarcinoma.4 This process takes decades3 and provides an excellent window of opportunity for early detection and prevention of gastric cancer.
Several strategies have been proposed for gastric cancer screening. These include H. pylori screening and treatment, endoscopy with random or targeted biopsy sampling, serological testing for pepsinogens, gastrin and H. pylori antibodies and breath testing for volatile organic compounds.5 A test-and-treat approach for H. pylori has been proposed as the preferred strategy for population screening in high gastric cancer-risk populations in the Asia–Pacific region.6 ,7 This test-and-treat approach benefits from availability of non-invasive tests (serology, breath and stool tests) and is a single screen and treat strategy without the need for further surveillance. This is based on the low risk of recurrent H. pylori infection after successful eradication, and the low risk of gastric cancer in H. pylori negatives without premalignant lesions. Disadvantages include the risk of increased antibiotic resistance in the …
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