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Clin Gastroenterol Hepatol. 2017 Dec;15(12):1833-1843. doi: 10.1016/j.cgh.2017.05.023. Epub 2017 May 19.

Gastric Cancer as Preventable Disease.

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Department of Medicine (DIMED), University of Padua, Padua, Italy; Veneto Tumor Registry, Veneto Region, Padua, Italy. Electronic address:
Miraca Life Sciences Research Institute, Irving, and Departments of Pathology and Medicine, Baylor College of Medicine, Houston, Texas.
Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
St George and Sutherland Clinical School, University of New South Wales, Sydney, Australia.
Department of Medicine, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, Texas.
Department of Medicine (DIMED), University of Padua, Padua, Italy.
Division of Gastroenterology, Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Canada.
Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Department of Gastroenterology, University of Magdeburg, Magdeburg, Germany.
Department of Medicine, Jichi Medical University, Tochigi, Japan.


Gastric cancer, 1 of the 5 most common causes of cancer death, is associated with a 5-year overall survival rate less than 30%. A minority of cancers occurs as part of syndromic diseases; more than 90% of adenocarcinomas are considered as the ultimate consequence of a longstanding mucosal inflammation. Helicobacter pylori infection is the leading etiology of non-self-limiting gastritis, which may result in atrophy of the gastric mucosa and impaired acid secretion. Gastric atrophy establishes a field of cancerization prone to further molecular and phenotypic changes, possibly resulting in cancer growth. This well-understood natural history provides the clinicopathologic rationale for primary and secondary cancer prevention strategies. A large body of evidence demonstrates that combined primary (H pylori eradication) and secondary (mainly endoscopy) prevention efforts may prevent or limit the progression of gastric oncogenesis. This approach, which is tailored to different country-specific gastric cancer incidence, socioeconomic, and cultural factors, requires that the complementary competences of gastroenterologists, oncologists, and pathologists be amalgamated into a common strategy of health policy.


Gastric Cancer; Gastritis; Helicobacter pylori; Primary Prevention; Secondary Prevention

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