Prevention and Implementation Group, Early Detection and Prevention Section, International Agency for Research on Cancer, 150 Cours Albert-Thomas, 69372, Lyon Cedex 08, France,
Curr Oncol Rep. 2013 Dec;15(6):517-25. doi: 10.1007/s11912-013-0341-5.
The incidence of gastric cancer has decreased in much of the world, but gastric cancer remains the second leading cause of cancer death globally, and the burden is growing in many countries in East Asia and Latin America. Chronic infection with Helicobacter pylori is the dominant cause of gastric cancer, and two recent randomized trials showed that H. pylori eradication significantly decreased gastric cancer risk. Population screening and treating individuals for H. pylori also appears to be cost-effective. Nevertheless, current clinical guidelines differ as to whether asymptomatic adults should be screened and treated for H. pylori, and no countries have yet implemented eradication programs. Some of this inaction may reflect lingering doubts about the effectiveness of H. pylori eradication in preventing gastric cancer, but there is also uncertainty about possible risks of mass antibiotic treatment and its impact on gut flora. Appropriately designed studies will help address these issues and hasten the implementation of population-wide prevention programs.
在世界上的许多地方，胃癌的发病率已经下降，但胃癌仍然是全球癌症死亡的第二大主要原因，在东亚和拉丁美洲的许多国家，这一负担正在增加。慢性感染幽门螺杆菌是胃癌的主要病因，最近两项随机试验表明，幽门螺杆菌的根除显著降低了胃癌的风险。人群筛查和针对幽门螺杆菌的个体治疗似乎也具有成本效益。然而，目前的临床指南对于无症状成年人是否应该进行幽门螺杆菌筛查和治疗存在分歧，而且没有任何国家实施过根除计划。这种不作为的部分原因可能反映了人们对幽门螺杆菌根除预防胃癌的有效性仍存在疑虑，但大规模抗生素治疗的潜在风险及其对肠道菌群的影响也存在不确定性。适当设计的研究将有助于解决这些问题，并加速实施全人群预防计划。
