Do I Need Gastric Cancer Screening?
- While the U.S. has not implemented gastric cancer screening for people of average risk, there are several countries, such as Japan, Korea, and Chile, that do population-wide screening due to the high incidence of this disease.
- In certain populations where gastric cancer is more common, screening may be recommended.
- This includes those with a family history of gastric or stomach cancer, those with certain genetic conditions, and those who come from Asian or South American countries where the disease is more common.
- If you or a relative are considered high-risk, you should schedule an appointment with your primary care physician to discuss further screening possibilities.
There are several countries, though, such as Japan, Korea, and Chile, where population-based screening for gastric cancer has been implemented due to the high incidence of this disease.
Read MoreDr. Pintova adds that screening depends on some environmental and genetic factors as well as “high risk features.”
“One such high risk feature is what we call genetic syndrome. So something that you are potentially born with and that affects all the cells in your body, but certain genetic syndromes can increase the risk of gastric or stomach cancer,” she explains.
How Do I know if I Have a Higher Risk?
In certain populations where gastric cancer is more common, screening may be recommended.
Individuals at increased risk for gastric cancer include:
- Older people with chronic gastric atrophy or pernicious anemia
- People who have had partial gastrectomy or a family history of stomach cancer
- People who have specific genetic syndromes, including Hereditary Diffuse Gastric Cancer, Familial Adenomatous Polyposis, Lynch syndrome, Peutz-Jeghers syndrome, and Juvenile polyposis syndrome
- People from countries where stomach cancer is more common
“One example of that is Lynch syndrome,” Dr. Pintova explains. “It’s a genetic syndrome that one is born with. It increases the risk of several number of cancers, including gastric or stomach cancer. So if someone has Lynch syndrome, they should absolutely be followed more closely and these are patients that will have or at least be recommended to have more frequent endoscopies for monitoring for stomach or gastric cancer.”
The intensity of screening should be based upon an appraisal of the magnitude of risk in each patient, their suitability for treatment should a lesion be detected, and their willingness to accept the uncertain benefits and risks of a screening program. Whether eradication of H. pylori — or Helicobacter pylori, an infection of the stomach — can reverse or reduce the risk that precursor lesions will progress to cancer is unclear.
If you or a relative are considered a high-risk patient, you should schedule an appointment with your primary care physician to discuss further screening possibilities. Additionally, some patients, such as those with hereditary diffuse gastric cancer, should be counseled about prophylactic (preventative) surgery instead of screening.
To assess risk, “one important thing that you can do is ask your family members about your own family history of cancers,” Dr. Pintova explains. “If you have a number of relatives with a history of cancers — it may be stomach cancer, it may be other types of cancers — then it is probably a good idea to meet with a genetic counselor and review your family history and your risk of potentially having a genetic syndrome so you could get tested for it.”
It is important to note that some misunderstandings regarding the difference between screening and diagnosis methods are common in clinical practice. When medical professionals talk about screening, it means the patient has no symptoms or signs of the disease — the goal is to detect the disease before it presents physically. However, if there are any clinical manifestations, such as nausea, vomiting, and/or weight loss, the approach is to diagnose the disease and not screen for it.
Current Screening Modalities
By defining your individual risk of gastric cancer with a medical doctor, together you will be able to plan how, when, and what would be the best frequency of the screening exams. The screening is performed with upper endoscopy and/or less common, contrasted radiography.
Upper endoscopy allows for direct visualization of the gastric mucosa and for biopsies to be obtained for diagnosing precancerous lesions such as gastric atrophy, a condition marked by thinning of the inner lining of the stomach wall and the loss of gland cells in the lining that release substances that help with digestion, intestinal metaplasia, a transformation of the cells in the lining of your upper digestive tract, often the stomach or the esophagus (food pipe), or gastric dysplasia which occurs when the cells of the stomach lining (called the mucosa) change and become abnormal, in addition to gastric cancer. Although invasive and more expensive than other diagnostic tests, upper endoscopy is the gold standard for diagnosing and identifying lesions within the stomach.
Unfortunately, to date, there are no blood tests nor non-invasive exams to consider as a feasible screening modality for gastric cancer.
Gastric Cancer Prevention
Patients at high risk of gastric cancer development might be suitable for Helicobacter pylori infection screening and treatment.
In areas of low gastric cancer incidence, there is no role for routine screening of asymptomatic, average-risk, healthy individuals for H. pylori in order to decrease the risk of gastric cancer. There may be a future role for screening selected asymptomatic individuals for H. pylori, although further research needs to prove its benefit.
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