Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University, Stanford, California.
Department of Population Health Sciences, Duke University, and Cancer Risk, Detection, and Interception Program, Duke Cancer Institute, Durham, North Carolina.
Clin Gastroenterol Hepatol. 2022 Oct;20(10):2218-2228.e2. doi: 10.1016/j.cgh.2021.09.039. Epub 2021 Oct 6.
BACKGROUND & AIMS: Gastric cancer (GC) remains a leading cause of mortality among certain racial, ethnic, and immigrant groups in the United States (US). The majority of GCs are diagnosed at advanced stages, and overall survival remains poor. There exist no structured national strategies for GC prevention in the US.
On March 5-6, 2020 a summit of researchers, policy makers, public funders, and advocacy leaders was convened at Stanford University to address this critical healthcare disparity. After this summit, a writing group was formed to critically evaluate the effectiveness, potential benefits, and potential harms of methods of primary and secondary prevention through structured literature review. This article represents a consensus statement prepared by the writing group.
The burden of GC is highly inequitably distributed in the US and disproportionately falls on Asian, African American, Hispanic, and American Indian/Alaskan Native populations. In randomized controlled trials, strategies of Helicobacter pylori testing and treatment have been demonstrated to reduce GC-specific mortality. In well-conducted observational and ecologic studies, strategies of endoscopic screening have been associated with reduced GC-specific mortality. Notably however, all randomized controlled trial data (for primary prevention) and the majority of observational data (for secondary prevention) are derived from non-US sources.
There exist substantial, high-quality data supporting GC prevention derived from international studies. There is an urgent need for cancer prevention trials focused on high-risk immigrant and minority populations in the US. The authors offer recommendations on how strategies of primary and secondary prevention can be applied to the heterogeneous US population.
在美国（US），某些种族、族裔和移民群体的胃癌（GC）仍然是导致死亡的主要原因。大多数 GC 被诊断为晚期，整体存活率仍然很差。美国没有针对 GC 预防的结构化国家策略。
2020 年 3 月 5 日至 6 日，斯坦福大学召开了一次研究人员、政策制定者、公共资助者和倡导领袖的峰会，以解决这一关键的医疗保健差距。峰会结束后，成立了一个写作小组，通过结构化文献综述，批判性地评估初级和二级预防方法的有效性、潜在益处和潜在危害。本文代表写作小组编写的共识声明。
GC 的负担在美国高度不均衡，不成比例地落在亚洲、非裔美国人、西班牙裔和美洲印第安人/阿拉斯加原住民人群中。在随机对照试验中，幽门螺杆菌检测和治疗策略已被证明可降低 GC 特异性死亡率。在精心设计的观察性和生态学研究中，内镜筛查策略与降低 GC 特异性死亡率相关。然而，所有随机对照试验数据（用于初级预防）和大多数观察性数据（用于二级预防）均来自非美国来源。
有大量高质量的国际研究支持 GC 预防。迫切需要针对美国高风险移民和少数民族人群开展癌症预防试验。作者就如何将初级和二级预防策略应用于美国多样化的人群提出了建议。
