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World J Gastroenterol. Oct 14, 2014; 20(38): 13681-13691
Published online Oct 14, 2014. doi: 10.3748/wjg.v20.i38.13681
Screening for and surveillance of gastric cancer
Debora Compare, Alba Rocco, Gerardo Nardone
Debora Compare, Alba Rocco, Gerardo Nardone, Department of Clinical Medicine and Surgery, Gastroenterology Unit, University Federico II of Naples, 80131 Napoli, Italy
Author contributions: Compare D contributed to data acquisition, screening search results and drafting this work and She approved the final version of the paper to be published; Rocco A contributed to appraising quality of retrieved papers and drafting this work and approved the final version of the paper to be published; Nardone G contributed to conceiving, drafting and revising critically for important intellectual content this paper and approved the final version of the paper to be published.
Correspondence to: Gerardo Nardone, MD, Department of Clinical Medicine and Surgery, Gastroenterology Unit, University Federico II of Naples, Via Pansini 5, 80131 Napoli, Italy. nardone@unina.it
Telephone: +39-81-7462158  Fax: +39-81-7464293
Received: November 28, 2013
Revised: March 6, 2014
Accepted: May 19, 2014
Published online: October 14, 2014
Abstract

Although the prevalence of gastric cancer (GC) progressively decreased during the last decades, due to improved dietary habit, introduction of food refrigeration and recovered socio-economic level, it still accounts for 10% of the total cancer-related deaths. The best strategy to reduce the mortality for GC is to schedule appropriate screening and surveillance programs, that rises many relevant concerns taking into account its worldwide variability, natural history, diagnostic tools, therapeutic strategies, and cost-effectiveness. Intestinal-type, the most frequent GC histotype, develops through a multistep process triggered by Helicobacter pylori (H. pylori) and progressing from gastritis to atrophy, intestinal metaplasia (IM), and dysplasia. However, the majority of patients infected with H. pylori and carrying premalignant lesions do not develop GC. Therefore, it remains unclear who should be screened, when the screening should be started and how the screening should be performed. It seems reasonable that screening programs should target the general population in eastern countries, at high prevalence of GC and the high-risk subjects in western countries, at low prevalence of GC. As far as concern surveillance, currently, we are lacking of standardized international recommendations and many features have to be defined regarding the optimal diagnostic approach, the patients at higher risk, the best timing and the cost-effectiveness. Anyway, patients with corpus atrophic gastritis, extensive incomplete IM and dysplasia should enter a surveillance program. At present, screening and surveillance programs need further studies to draw worldwide reliable recommendations and evaluate the impact on mortality for GC.

Keywords: Screening, Surveillance, Helicobacter pylori, Gastric cancer, Preneoplastic lesions, Gastric atrophy, Intestinal metaplasia, Gastric dysplasia

Core tip: Because of expansion and aging of the world population, gastric cancer incidence is still increasing. The primary objective of World Health Organization is to arrange screening and surveillance programs for cancer prevention. However, although we know the main etiological agent and the natural history, a gastric cancer elimination project, combining appropriate screening and surveillance programs, has yet to be defined because of the lack of standardized recommendations. This review addresses the most relevant literature focusing on this topic and tries to design the hypothetical screening and surveillance programs.