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Implementation of Mass Screening Projects for Eradication of Gastric Cancer

Implementation of Mass Screening Projects for Eradication of Gastric Cancer

20 Aug 2021 10:20 10:32
(12 mins)
Lee Yi-Chia Speaker
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Gastric cancer is the third leading cause of cancer death worldwide, accounting for more than 800,000 deaths every year. Most cases are a consequence of infection with Helicobacter pylori, which can survive in the stomach's acidic environment, lead to stomach inflammation, and increase the risk of developing stomach cancer. Eradication of H. pylori can result in healing of inflammation and halt the progression of the H. pylori-associated mucosal and genetic damages. However, such a policy has been rarely realized on the population level. Obstacles include difficulties in integrating policy into the national healthcare priorities and a lack of infrastructure to support these services. In this presentation, three approaches utilized in Taiwan will be described, including the: (1) mass eradication method; (2) the two-in-one method; and (3) the index case method. The first method has been implemented in a high-risk population living in a relatively isolated community (Matsu Islands). After long-term follow-up, mass eradication has reduced 53% of gastric cancer incidence in this population. The second method has been implemented in an intermediate risk population. Since the Taiwanese government has already offered asymptomatic, middle-aged adults a biennial service screening for colorectal cancer with the fecal immunochemical test. We used this platform to offer the screening and eradication of H. pylori using the stool antigen testing. The benefits included the higher participation rate to screening and the higher colorectal adenoma detection rate, in addition to the treatment for H. pylori infection. The third method has been implemented in the high-risk Indigenous communities, which were mostly in the mountain area. This approach first identified the index case with a positive test result for H. pylori and then outreached his/her family members for screening. It can help identify the families with the highest rate for H. pylori infection. Using the family as the basis for treatment can also improve their compliance and reduce their risk of re-infection.

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