In the UK and Europe, too many cases of gastric cancer are still coming to light at a later, less treatable stage. In contrast, high-risk Asian countries have shown real progress in significantly improving outcomes by screening populations for early signs of the disease. Tamara Matysiak-Budnik discusses how we can learn from the progress that has been made in high-incidence countries, and explores a multi-step testing approach.
Gastric cancer is the fifth most common malignancy globally and it is responsible for a third of all cancer-related deaths.1 In Europe, the severity of the threat to public health from this disease has been somewhat overlooked because the incidence is relatively low across most of the continent, with some exceptions including Portugal, Slovenia and some Eastern European countries.2,3 There have also been very few advances made in the last 30 years compared to other digestive neoplasms, leaving clinicians to rely on limited treatment options and an outdated diagnostic pathway. This means that only 10 to 15% of cases are diagnosed in the early stages4 – when treatment is most likely to be effective – which is a marginal improvement from the 4% reported 10 years ago in some European countries, but still far from satisfactory.5 As a result, despite the relatively low incidence, patients face an abysmal 25% five-year survival rate, amounting to a disproportionately high number of more than 100,000 deaths in Europe every year.6
In the UK, there are around 6,500 newly diagnosed cases every year, relatively low not only compared to other parts of the world, but also to figures for other cancers – such as bowel – in the region.7 However, gastric cancer is aggressive in nature and it frequently progresses silently until it reaches an advanced stage, making it one of the deadliest malignancies. To put this into perspective, the 10-year survival rate for bowel cancer – which is considered a common killer – is 53% in the UK, but just 17% for gastric cancer.8 Most concerningly, more than half of gastric cancer related deaths are thought to be completely preventable9 through early intervention and identification of risk factors, such as Helicobacter pylori infection for distal (non-cardia) gastric cancer or acid reflux for cardia cancer. This is supported by the fact that most non-cardia cases – particularly adenocarcinomas – develop from a cascade of premalignant morphological alterations that manifest into atrophic gastritis (AG) and gastric intestinal metaplasia (GIM), providing clear early warning signs. Unfortunately, the absence of a well-defined and consistent diagnostic pathway or screening programme means that these stages are often missed, resulting in the progression towards malignancy.
Why is gastric cancer often diagnosed too late?
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