Stomaching the lack of gastric cancer screening in Europe

Professor Tamara Matysiak-Budnik – Professor of Gastroenterology and Digestive Oncology at the Institute of Digestive Diseases (IMAD), Nantes University Hospital, France

In the second blog of the gastric cancer series, Professor Tamara Matysiak-Budnik – Professor of Gastroenterology and Digestive Oncology at the Institute of Digestive Diseases (IMAD), Nantes University Hospital, France – continues her discussion around the challenges of diagnosing gastric cancer by exploring the option of national screening programmes and examining successful examples from high incidence countries.

Gastric cancer is aggressive and frequently sneaks up on people, only showing symptoms when it’s already at an advanced stage, which is why it is often too late to treat effectively by the time it’s detected. Currently, it is estimated that less than 10 % of gastric cancers in Europe are diagnosed at an early stage when they are more manageable – an improvement from the 5 % reported in some European countries 10 years ago, but still not satisfactory.¹ In the UK, the figures are arguably more positive, with about 60 % of cases diagnosed when the disease is already in a late stage,² but the mortality rate is still significantly high, despite it being less common than, for example, bowel cancer (Figure 1).

Figure 1: Graph and table demonstrating stomach and bowel cancer statistics in the UK from 2016-2019 data²

Disparities in screening programmes

Taking these figures into account, it is perhaps surprising that there is no national screening programme for gastric cancer in the UK, especially considering the success of similar initiatives for other malignancies.³ The same is true across most of Europe,² however, a number of Asian countries like the Republic of Korea – where gastric cancer is more common – have successfully implemented screening that has resulted in the detection of a significant number of cases at early, more treatable stages.⁴ The programme in Korea relies mainly on endoscopy – enabling the identification and removal of even tiny lesions before they progress to advanced disease – and screening the general population over the age of 40. This resulted in a 41 % decrease in the risk of death from gastric cancer, better prognosis and lower medical costs between 2004 and 2013.⁵

Balancing health and wealth

The main stumbling block preventing European countries from following suit seems to be the perceived cost and impracticality of using endoscopy – an expensive and invasive tool – to screen large populations for a disease that has a relatively low incidence. Implementing screening protocols can certainly be challenging in terms of logistics and finances, but the cost of treating advanced-stage disease can also represent a huge economic burden. Detecting cancer earlier through a nationwide programme could potentially cut healthcare costs, at the very least by reducing the need for aggressive and expensive treatments.^6,7 However, it even goes beyond that; these initiatives can lead to better allocation of healthcare resources, improving the overall health of the population and ensuring that those at risk have better access to healthcare.^7,8

Screening strategies for an overlooked disease

One factor that could have a positive impact on the cost of a screening protocol is the adoption of a rule-out ‘first sweep’ of risk groups measuring different biomarkers in blood, stool or saliva. While this is common for other malignancies, it is yet to gain traction for gastric cancer, despite the availability of suitable assays such as pepsinogen and Helicobacter pylori. The choice of biomarkers is, of course, key and the main aims would be to detect early signs of gastric cancer, as well as flagging precancerous lesions – especially atrophic gastritis or gastric intestinal metaplasia – so that targeted preventative measures could be taken.⁹ For example, GastroPanel^® is a non-invasive serological test from BIOHIT HealthCare – encompassing Pepsinogen I, Pepsinogen II, Gastrin-17 and H. pylori IgG – that has been shown to be very effective as a pre-screening panel.¹⁰ The advantage of this test is that it allows users to not only evaluate the state of the gastric mucosa and identify gastric atrophy with pepsinogen testing, but also detect the presence of a H. pylori infection (current or past), which is important both for determining the cause of pathology and proposing the first treatment measure, which is eradication of the bacteria. The vast majority of patients would not need follow-up but any positive results would lead to patients being offered upper endoscopies for a confirmatory diagnosis. This approach would be far more economically feasible in lower incidence countries like the UK, enhancing the efficiency of healthcare resources, improving access to screening for at-risk individuals, and ultimately contributing to the early detection and prevention of gastric cancer.

Read the next blog in this series to see the promising results of a research study that evaluated the diagnostic performance of GastroPanel in detecting atrophic gastritis, and the potential implications for improving the early detection and management of gastric disorders.

The first in the series Why is gastric cancer often diagnosed too late? can be found here.

To find out more, visit https://biohithealthcare.co.uk/biohit-product/gastropanel-pepsinogen-i-pepsinogen-ii-h-pylori-igg-and-gastrin-17-elisas/

References

1. Chapelle N, Bouvier AM, Manfredi S, Drouillard A, Lepage C, Faivre J, Jooste V. Early gastric cancer: trends in incidence, management, and survival in a well-defined French population. Annals of surgical oncology. 2016;23:3677-83.
2. Statistics by cancer type | Cancer Research UK. Accessed May 23, 2023. https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type
3. Results of the 2019 National Bowel Cancer Audit | Bowel Cancer UK. Accessed June 7, 2023. https://www.bowelcanceruk.org.uk/news-and-blogs/research-blog/results-of-the-2019-national-bowel-cancer-audit/
4. Ryu JE, Choi E, Lee K, et al. Trends in the Performance of the Korean National Cancer Screening Program for Gastric Cancer from 2007 to 2016. Cancer Res Treat. 2021;54(3):842-849. doi:10.4143/CRT.2021.482
5. Suh YS, Lee J, Woo H, et al. National cancer screening program for gastric cancer in Korea: Nationwide treatment benefit and cost. Cancer. 2020;126(9):1929-1939. doi:10.1002/CNCR.32753
6. Cho E, Kang MH, Choi KS, Suh MN, Jun JK, Park EC. Cost-effectiveness outcomes of the national gastric cancer screening program in South Korea. Asian Pac J Cancer Prev. 2013;14(4):2533-2540. doi:10.7314/APJCP.2013.14.5.2533
7. Schreuders EH, Ruco A, Rabeneck L, et al. Colorectal cancer screening: a global overview of existing programmes. Gut. 2015;64(10):1637-1649. doi:10.1136/GUTJNL-2014-309086
8. You WC, Li JY, Blot WJ, et al. Evolution of precancerous lesions in a rural Chinese population at high risk of gastric cancer. J Cancer. 1999;83:615-619. doi:10.1002/(SICI)1097-0215(19991126)83:5
9. Choi KS, Jun JK, Suh M, et al. Effect of endoscopy screening on stage at gastric cancer diagnosis: results of the National Cancer Screening Programme in Korea. British Journal of Cancer 2015 112:3. 2014;112(3):608-612. doi:10.1038/bjc.2014.608
10. Loor A, Dumitraşcu DL. Helicobacter pylori Infection, Gastric Cancer and GastroPanel. Romanian Journal Of Internal Medicine. 2016;54(3):151-156. doi:10.1515/rjim-2016-0025