WHO Encourages H Pylori Screening for Stomach Cancer

According to a recent report from the International Agency for Research on Cancer (IARC), the specialized cancer agency of the World Health Organization, evaluating the possibility of large population-based programs of Helicobacter pylori (H Pylori) screening and treatment should be a global priority to reduce the burden of gastric cancer.

The new recommendations are based on the work of an international panel of 19 gastric cancer experts and IARC staff who reviewed evidence and evaluated strategies for the prevention of stomach cancer based on H pylori eradication.

Their review examined the status of regional gastric cancer prevention efforts, the effectiveness and potential risks (bacterial resistance) of population-based H pylori treatment, and the feasibility and cost-effectiveness of H pylori screening and treatment programs.

The gastric cancer programs of Chile, China, Japan, Korea (which has the highest gastric cancer rate in the world), and Taiwan were among those reviewed. The report also addresses ongoing and planned studies of H pylori eradication.

“There is an acute need to commit more public health resources to gastric cancer control," according to a summary section of the IARC report. "This working group recommends that all countries consider including gastric cancer in their national cancer control programs and that they conduct detailed assessments of its current and future human and economic impacts and of the potential value of prevention strategies.”

“H pylori treatment lowers gastric cancer incidence by 30% to 40%,” the report noted, but the results might not be generalizable across all populations and do not account for possible adverse consequences, such as a possible increase in resistance to antibiotics needed to treat serious infections.

The IARC working group recommended a 7- to 10-day treatment regimen that included 2 or 3 inexpensive generic antibiotics and a proton pump inhibitor, which can be 80% successful in eliminating H pylori. They group cautioned that effectiveness “will vary according to the profile of antibiotic resistance in the target population.” There are clinical trials underway around the world.

Gastric cancer is the third leading cause of cancer deaths worldwide, and 80% of the 1 million new cases annually are caused by a treatable infection, according to the IARC report.

However, public health programs to prevent gastric cancer are almost nonexistent, according to Christopher P. Wild, PhD, director, IARC, Lyon, France, and the other members of the working group. “Unless effective control measures are established, thousands of unnecessary deaths will continue to occur each year. Ignoring stomach cancer in the hope that it will soon disappear on its own is not a tenable health policy,” Dr. Wild said in a statement. Screening and treatment provide “the potential means of preventing deaths from this lethal cancer,” he added.—Kerri Fitzgerald