Stomach cancer primary prevention

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2] Mohammed Abdelwahed M.D[3]

Overview[edit | edit source]

Effective measures for the primary prevention of stomach cancer include smoking cessation, eradication of Helicobacter pylori infection, and having a balanced diet rich in fruits and vegetables. In areas of low gastric cancer, incidence and screening for gastric cancer with upper endoscopy should be reserved for specific high-risk subgroups. Individuals at increased risk for gastric cancer include gastric adenomas, pernicious anemia, gastric intestinal metaplasia, familial adenomatous polyposis, Lynch syndrome, Peutz-Jeghers syndrome, Juvenile polyposis syndrome.

Primary prevention[edit | edit source]

Lifestyle modifications[edit | edit source]

Lifestyle modifications include following:^[1]

• Dietary modification is an important approach to control gastric cancer. There is a link between physical inactivity and obesity to many types of cancer.
• Diet with low consumption of red meat, high in fruits and vegetables may have a protective effect against many cancers.
• The World Health Assembly adopted the WHO Global Strategy on Diet, Physical Activity, and Health, in May 2004 to reduce deaths and diseases.

H.pylori eradication[edit | edit source]

• The incidence of metachronous gastric cancer following the endoscopic resection of a gastric neoplasm is known to be reduced by the eradication of H. pylori infection. ^[1][2]

Prevention Through Screening[edit | edit source]

• In countries with a high incidence of gastric cancer such as east Asia countries, universal screening is recommended
• Japan has a high incidence of gastric cancer; therefore annual screening via double contrast barium radiography and photofluorography every year or upper endoscopy every two to three years ^[3]
• Screening interval is recommended to be every two years but may be extended to a three-year interval without significant difference in effect^[3]

Prevention of Hereditary Cancer[edit | edit source]

Prevention[edit | edit source]

•  Asymptomatic patients with a family history of HDGC and CDH1 mutations have a high probability of developing signet ring cell adenocarcinoma of the stomach. Prophylactic total gastrectomy is recommended for patients with family history of HDGC and CDH1 mutations.^[4][5]

• For patients with a CDH1 mutation but who are not from an HDGC family, individualized evaluation at an experienced center before prophylactic total gastrectomy is recomended.^[6]

• Prophylactic gastrectomy is often advised between age 20 and 30.
• Some suggest timing total gastrectomy in CDH1 mutation carriers at an age that is five years younger than the youngest family member who developed gastric cancer.^[7]
• Older patients are less likely to benefit from a prophylactic gastrectomy than younger patients because of a shorter life-expectancy and a higher perioperative risk.^[5]

• Patients who are older than 75 years should not undergo such a procedure, as their mortality from the procedure outweighs their mortality from gastric cancer.
• Decisions should be individualized based upon their comorbidities and the age of gastric cancer onset in their respective kindred.^[8]

References[edit | edit source]

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