Fecal Immunochemical Test and Helicobacter pylori Stool Antigen Co-Testing: A Potential Approach for Gastric Cancer Screening
Mené à Taïwan sur 240 000 adultes (âge moyen : 58,1 ans ; 46,8 % de femmes), cet essai randomisé évalue l'intérêt, du point de vue de l'incidence des cancers gastriques et de la mortalité associée, d'ajouter à un test FIT un test de recherche de l'antigène de la bactérie Helicobacter Pylori dans les selles
Gastric cancer is a leading cause of cancer death globally. Although endoscopy-based screening has led to a decrease in gastric cancer mortality in Eastern Asian countries with populations at high risk, lack of risk stratification and the cost of health care infrastructure and trained personnel limit its use in most of the world. Availability of noninvasive biomarkers for the identification of high-risk individuals could optimize endoscopy-based screening programs for a more general application, including in regions where gastric cancer rates in the general population are low.Chronic Helicobacter pylori infection is responsible for at least 80% of gastric cancers globally, including approximately 90% of noncardia (ie, distal) tumors and at least 50% of cardia tumors. H pylori infection is also etiologically linked to peptic ulcer and extragastric conditions, including iron deficiency anemia. According to the US Surveillance, Epidemiology, and End Results (SEER) Program, the estimated number of new cases of gastric cancer that will be diagnosed in the US population in 2024 is 26 890. There are racial and ethnic disparities in gastric cancer in the US; incidence rates are 2- to 3-fold higher in self-identified African American, Asian, and Hispanic/Latino populations compared with non-Hispanic White populations. Unfortunately, most US patients with gastric cancer are diagnosed at advanced stages, when curative resection is not possible. The 5-year relative survival in the US SEER dataset for the 2014-2020 period is only 36.4%, much lower than in Japan or the Republic of Korea.
JAMA , éditorial, 2023