Exploring the value of biomarkers in gastric cancer screening
Professor Tamara Matysiak-Budnik – Professor of Gastroenterology and Digestive Oncology at the Institute of Digestive Diseases (IMAD), Nantes University Hospital, France
Our gastric cancer blog series has so far investigated reasons for late diagnosis and explored successful screening programmes in high incidence countries. To round off the series, Professor Tamara Matysiak-Budnik – Professor of Gastroenterology and Digestive Oncology at the Institute of Digestive Diseases (IMAD), Nantes University Hospital, France – delves deeper into various European research projects, describing an ideal screening strategy, and elaborating on the integration of GastroPanel® into care pathways to detect precancerous conditions.
Can you tell us about yourself, and your role?
I oversee the digestive oncology unit at Nantes University Hospital, while also actively participating in research with a strong focus on gastric cancer and gastric precancerous lesions. Our patients come through different channels, including primary care referrals, self-referrals for second opinions, emergency cases with complications, and a dedicated pathway for the early diagnosis of digestive cancers. The latter offers a quicker route for patients considered at increased risk of different digestive cancers, including gastric cancer. We’re seeing more and more patients seeking our services as awareness of digestive cancers – and in particular gastric cancer – continues to rise, and our main goal is to provide comprehensive care and improve outcomes.
Do you see a need for screening patients at risk of developing gastric cancer?
Yes. Too many of the patients we see already have significant disease and this late diagnosis limits how effectively we can treat them. This is a common problem across the continent and that is why there are currently three European projects that aim to evaluate the possibility of implementing population-based screening for gastric cancer by identifying patients at increased risk of developing this disease. Among various strategies, the use of non-invasive serology (blood pepsinogen testing) – which is recognized by all the guidelines as a valuable test – is being evaluated.
What role does serological testing play in these projects?
Serological testing for pepsinogen is likely to play an important role in the above projects as it provides fast analysis of the gastric mucosa with a single, minimally invasive blood test. It is a valuable, cost-effective tool for detecting atrophic gastritis (AG), a precancerous condition in the stomach. Catching AG early is vital for preventing gastric cancer and this is why these studies are exploring whether test panels could be used to effectively streamline screening.
Have you conducted any similar studies in France?
Yes, we evaluated the performance of GastroPanel for detecting AG in a French cohort of patients, even though France has a relatively low incidence of gastric cancer.1 It was a comprehensive study that involved multiple centres and followed 344 patients, comprising 148 cases diagnosed with AG and 196 controls without AG. Our inclusion criteria targeted patients at a higher risk of gastric cancer who were scheduled to undergo an upper endoscopy with gastric biopsies. Blood samples were collected from the patients and analysed using GastroPanel, with the accuracy of the assay measured by comparing the results to those obtained from histology, which serves as the gold standard for diagnosing AG.
What were the main findings of this study, and what are the implications for the future?
Our study revealed that GastroPanel is highly effective in detecting severe AG in the corpus region of the stomach – particularly in cases of gastritis with autoimmune origin – among the French population.1,2 These findings have exciting implications for detecting AG, especially in patients with a heightened risk of gastric cancer. GastroPanel shows real promise as a valuable and efficient tool to screen for gastric precancerous conditions, and its non-invasive nature makes it more patient-friendly compared to the traditional approach of upper endoscopy with gastric biopsies. This ease of testing could improve patient adherence to screening programmes, helping to target individuals at risk of gastric cancer earlier and more effectively.
Are there any limitations to the study that should be considered?
We need to conduct more studies to confirm the effectiveness of GastroPanel across different cohorts and diverse situations. Our study focused on a region with lower incidence of gastric cancer, so the results might not be directly comparable to higher incidence countries. We also focused on patients who already had an increased risk of gastric cancer, meaning that the findings may not be representative of the entire population.
Based on the results of this study, what future research or developments do you think are needed in this field?
To truly grasp the long-term benefits of using non-invasive tests like GastroPanel, we need to dig deeper with longitudinal studies to reveal how well these tests can track disease progression over time and perhaps even help to make treatment decisions. We also need to explore the economic impact and feasibility of implementing these assays into real-world clinical practice to truly assess their cost-effectiveness.
Are there any other factors to consider?
Effective communication is absolutely crucial to raise awareness in the general population – and especially in policymakers – about the severity of gastric cancer, including integrating education on disease prevention and lifestyle factors into school curricula. Conducting more studies in all countries will also help to drive progress but early indications certainly suggest that GastroPanel offers hope for the development of affordable and practical screening programmes that will identify patients requiring regular endoscopy and surveillance, and lead to earlier detection and better outcomes.
The first in the series Why is gastric cancer often diagnosed too late? can be found here, while the second in the series Stomaching the lack of gastric cancer screening in Europe is available here.
To find out more about GastroPanel, visit https://biohithealthcare.co.uk/biohit-product/gastropanel-pepsinogen-i-pepsinogen-ii-h-pylori-igg-and-gastrin-17-elisas/
References
- Chapelle N, Petryszyn P, Blin J, et al. A panel of stomach-specific biomarkers (GastroPanel®) for the diagnosis of atrophic gastritis: A prospective, multicenter study in a low gastric cancer incidence area. Helicobacter. 2020;25(5). doi:10.1111/HEL.12727
- Chapelle N, Martin J, Osmola M, et al. Serum pepsinogens can help to discriminate between H. pylori-induced and auto-immune atrophic gastritis: Results from a prospective multicenter study. Digestive and Liver Disease. 2023;0(0). doi:10.1016/j.dld.2023.03.015
