Strategy for Eliminating Gastric Cancer in Japan
Strategy for Eliminating Gastric Cancer in Japan
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DOI：
10.1111/j.1523-5378.2010.00799.x
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发表时间：
2010-12-01
期刊：
影响因子：
4.4
通讯作者：
Graham, David Y.
中科院分区：
文献类型：
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作者：
Asaka, Masahiro;Kato, Mototsugu;Graham, David Y.
日本胃研究小组进行的一项研究表明，根除幽门螺杆菌可使胃癌风险降低约三分之一。然而，它并没有完全预防高危人群中潜伏性胃癌的发生（即，萎缩性胃炎）。为了预防胃癌死亡，有必要根除H。幽门感染我们提出了一个基于H.幽门螺杆菌感染伴或不伴萎缩性胃炎，随后进行针对性干预。那些没有胃癌风险的人（没有H。pylori，无萎缩性胃炎）不需要治疗或随访。低风险（H。pylori感染、非萎缩性胃炎）仅需要H.幽门螺杆菌根除治疗。处于高风险或非常高风险的较小群体需要根除和癌症监测。我们估计了这种策略的成本和收益。同时测定血清胃蛋白酶原和幽门螺杆菌对胃癌的筛查作用。pylori抗体联合根除H.幽门螺旋杆菌在所有高危人群中的传播最初会增加国家卫生保健支出，但这将被显著降低治疗胃癌的费用所抵消。拟议的战略将在其通过后的5年内防止约15万人死于胃癌。如果将这些死亡造成的损失也考虑在内，这一战略的经济影响就变得巨大。十年内，胃癌发病率可能降低80-90%以上。日本政府应尽快主动实施这一战略。
A study conducted by the Japan Gast Study Group showed that eradication of Helicobacter pylori reduced the risk of gastric cancer by about one-third. However, it did not completely prevent the onset of latent gastric cancer among those at high risk (i.e., with atrophic gastritis). To prevent deaths from gastric cancer, it is necessary to eradicate H. pylori infection. We propose a program of risk stratification based on the presence of H. pylori infection with or without atrophic gastritis followed by targeted interventions. Those at no risk for gastric cancer (no H. pylori, no atrophic gastritis) need no therapy or follow-up. Those at low risk (H. pylori infected, nonatrophic gastritis) need only H. pylori eradication therapy. The smaller groups at high or very high risk need eradication and cancer surveillance. We estimated the costs and the benefits of this strategy. Gastric cancer screening by simultaneous measurement of serum pepsinogen and H. pylori antibody combined with eradication of H. pylori in all individuals at risk would initially increase national healthcare expenditure, but this would be offset by markedly reducing the cost of treating gastric cancer. The proposed strategy should prevent about 150,000 deaths from gastric cancer during the 5 years after its adoption. If the loss caused by these deaths is also taken into account, the economic effect of this strategy becomes enormous. It would probably reduce the incidence of gastric cancer by more than 80-90% within 10 years. The Japanese government should take the initiative to implement this strategy as soon as possible.