Screening for Gastric Cancer

Gastric cancer remains one of the most lethal types of cancer. When examining the global distribution of gastric cancer, the highest incidences are observed in South-East Asia, as well as in China and Japan [1]. Histologically, most gastric cancers are adenocarcinomas. Known risk factors are H. pylori infection, chronic gastritis, tobacco use and heavy alcohol consumption. A small percentage of gastric cancers occur hereditary. The TNM-classification is used for gastric cancer staging. Imaging methods, blood tests with tumor markers, and gastroscopy with biopsies are employed for detection, diagnosis, grading and staging. Treatment options include operation, chemotherapy, immunotherapy and radiotherapy. There are non-invasive methods (such as H. pylori serology and plasminogen tests), invasive methods (endoscopy), and radiological methods (upper gastrointestinal series with barium, photofluorography) to screen for gastric cancer. Screening programs are most useful for countries with high incidence of gastric cancer, where the technical and economic conditions exist at the same time. That applies to most countries in East Asia, for instance for South Korea, and of course also for Japan and increasingly for China, where the overall costs are in a favorable relationship to the benefits [2]. In countries with lower incidence of gastric cancer, non–invasive screening programs are discussed controversially, although endoscopy is readily available almost everywhere, has few complications and is affordable for most health systems. In Europe and the United States gastric cancer screening programs and recommendations regarding screening are in place in some but by far not in all countries [3].