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Eradication of gastric cancer and more efficient gastric cancer surveillance in Japan: two peas in a pod

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Abstract

We provide a historical review and update on current thinking regarding the possibility of elimination of gastric cancer from Japan. Because Helicobacter pylori infection is the cause gastric cancer, its elimination forms the cornerstone of eradication of gastric cancer. However, simply eradicating H. pylori from the entire population will not immediately solve the problem because many patients with H. pylori infections have already developed the precursor lesion, atrophic gastritis. Cure of H. pylori in these high risk patients will only reduce the risk of subsequent cancer. In contrast, treatment of low risk patients will prevent cancer. Thus, to eliminate gastric cancer it is necessary to identify and treat all infected individuals. In addition, those at increased risk for gastric cancer (i.e., atrophic gastritis irrespective of age) should be considered for endoscopic surveillance to identify those cancers that develop at an early stage. We propose that severity and extent of atrophy be used to separate those expected to benefit from endoscopy and annual surveillance from those with little or no potential benefit. We suggest an algorithm for eradicating gastric cancer that incorporates H. pylori and atrophic gastritis testing, H. pylori therapy, and surveillance to institute a program of surveillance restricted to those who could benefit most (i.e., those with moderate or severe atrophy). This will also allow a much closer matching of surveillance capacity and surveillance need making surveillance more clinically- and cost-effective.

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Acknowledgments

This material is based upon work supported in part by the Office of Research and Development Medical Research Service Department of Veterans Affairs and by Public Health Service grant DK56338 which funds the Texas Gulf Coast Digestive Diseases Center.

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Authors and Affiliations

  1. Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, RM 3A-320 (111D), 2002 Holcombe Boulevard, Houston, TX, 77030, USA

    David Y. Graham

  2. Hokkaido University School of Medicine, Sapporo, Japan

    Masahiro Asaka

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Correspondence to David Y. Graham.

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Graham, D.Y., Asaka, M. Eradication of gastric cancer and more efficient gastric cancer surveillance in Japan: two peas in a pod. J Gastroenterol 45, 1–8 (2010). https://doi.org/10.1007/s00535-009-0117-8

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  • DOI: https://doi.org/10.1007/s00535-009-0117-8

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