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State-of-the-Art : Strategy For Prevention Of Gastric Cancer
( Shiu Kum Lam ) 대한소화기학회 2007 SIDDS Vol.9 No.-
Gastric cancer remains a curse of Asia. Its aetiology is multifactorial, and includes in particular H. pylori infection and high salt. Surveillance in high risk populations with early treatment is effective to reduce mortality. Evidence has become available to adopt a bold prevention strategy by ridding H. pylori from the soil of Asia. In Asia, the risk for gastric cancer varies among various countries and populations. High risk areas include East Asian countries such as China, Japan and Korea, where the age standardized incidence rate (ASR) is greater than 20 per 100,000. Intermediate risk countries (ASR 11∼19/100,000) include Malaysia, Singapore and Taiwan, while low risk areas (ASR<10/100,000) include countries such as Australia, India, New Zealand and Thailand.1 There are two approaches to reduce the mortality of gastric cancer: (i) early detection and treatment, and (ii) prevention by addressing modifiable environmental risk factors such as diet and H. pylori infection. Currently a strategy of population screening for gastric cancer is being adopted in Japan,2 Korea3 and Matsu Island in Taiwan.4 A consensus conference was convened in Bangkok in November 2006 to assess the evidence for current and potential intervention strategies and to decide whether it was timely to adopt a bold proactive approach towards gastric cancer prevention by recommending H. pylori screening and eradication.5 A total of 38 statements were made at the consensus conference, and the following ten represent the consensus highlights. It is concluded that there is a definite causal link between H. pylori infection and gastric cancer. Current evidence suggests that H. pylori eradication can prevent the progression of precancerous gastric lesions, and in those without advanced precancerous lesions, H. pylori eradication reduces the incidence of gastric cancer. The time has come to intervene and prevent this cancer at the population level by ridding H. pylori from the soil of Asia.