Inoue Manami
AXA Department of Health and Human Security, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Prevention Division, Center for Public Health Sciences, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
Gastric Cancer. 2017 Mar;20(Suppl 1):3-7. doi: 10.1007/s10120-016-0658-5. Epub 2016 Oct 18.
Helicobacter pylori (H. Pylori) is known as the most important cause of gastric cancer. The prevalence of H. pylori infection varies widely by geographic area, age, and socioeconomic status. In Japan, H. pylori infection has been highly correlated with the incidence rate of gastric cancer, and a reduction in H. pylori infection is therefore crucial for decreasing the incidence of gastric cancer, especially at the population level. Infection occurs during childhood, commonly before 5 years of age. In Japan, where gastric cancer has ranked as the most common cancer by incidence and mortality for the last several decades, the prevalence of H. pylori infection has dramatically declined by birth cohort effect, mainly due to improvements in the general hygiene environment in childhood. Older generations born before around 1950 show a high prevalence of around 80-90 %, decreasing with age to reach around 10 % or less in those born around the 1990s, and less than 2 % for children born after the year 2000. This change will have generational effects on gastric cancer prevention strategies, both primary and secondary. The risk-stratified approach to gastric cancer prevention should be considered in Japan and other countries which have similarly experienced rapid economic development.
幽门螺杆菌（H. Pylori）被认为是胃癌最重要的病因。幽门螺杆菌感染的患病率因地理区域、年龄和社会经济地位的不同而有很大差异。在日本，幽门螺杆菌感染与胃癌发病率高度相关，因此降低幽门螺杆菌感染对于降低胃癌发病率至关重要，尤其是在人群层面。感染发生在儿童期，通常在5岁之前。在日本，过去几十年来胃癌的发病率和死亡率一直位居最常见癌症之首，由于儿童时期总体卫生环境的改善，幽门螺杆菌感染的患病率因出生队列效应而大幅下降。1950年左右以前出生的老一辈感染率高达80% - 90%左右，随着年龄增长而下降，到20世纪90年代左右出生的人感染率降至10%左右或更低，2000年以后出生的儿童感染率不到2%。这种变化将对胃癌一级和二级预防策略产生代际影响。在日本以及其他经历了类似快速经济发展的国家，应考虑采用风险分层的胃癌预防方法。
