Stomach cancer: extended screening possible with an innovative breath test
A public health plan targeting healthy sections of the population, designed to detect Helicobacter, is needed: the role of new technologies
by Alberto Vannelli*
Key points
Every year in Italia, over 14,000 people are diagnosed with stomach cancer; although we are among the European countries with the best survival rates, when it comes to cancer prevention, this disease seems to have almost disappeared from the radar.
This contradiction gave rise to the discussion at the heart of the conference ‘Prevention of Gastric Cancer’, organised under the patronage of Erone Onlus and the Lombardy Region at the Meet-Med Centre in Como, which brought together specialists, general practitioners, representatives of public bodies and experts in new diagnostic technologies
The role of Helicobacter pylori
Throughout my professional career, I have treated a great many patients diagnosed with stomach cancer; today we have immunotherapy, biologic drugs and increasingly effective treatment regimens, but in fewer than 20 per cent of cases is the disease detected at an early stage. The paradox is that, unlike many other cancers, the cause of gastric cancer is very well understood: 80 per cent of gastric carcinomas are directly or indirectly linked to infection with Helicobacter pylori. Thirteen per cent of all cancer cases worldwide are caused by untreated chronic infections. Cervical cancer is probably the best-known example: in Australia, the identification of the role of HPV, the introduction of screening programmes and the widespread vaccination of the population have profoundly altered the natural history of the disease. Similarly, vaccination against hepatitis B and C is helping to reduce the number of primary liver cancers. We estimate that over 20% of Italians are infected with Helicobacter, a bacterium which, in 22% of cases, contributes to the development of precancerous lesions. Fortunately, only between 1% and 3% will develop stomach cancer over a period of 10–20 years, hence the need for a public health programme targeting healthy sections of the population, designed to detect Helicobacter and prevent the development of this cancer.
Estimated costs of up to 18,500 euros per patient
According to a recent Italian analysis, healthcare costs are estimated at around 12,800 euros per citizen with localised disease, 18,500 euros for locally advanced disease and over 15,000 euros for metastatic disease. Over 88 per cent of expenditure is linked to hospital admissions. Unfortunately, these figures were collected before the widespread adoption of the latest innovative therapies, such as immunotherapy and new molecularly targeted drugs. Added to this are the costs of follow-up care, relapses, nutritional complications, loss of productivity at work, disability and the often invisible but vital role of carers.
Stomach cancer screening in Italia would make it possible to increase the five-year survival rate (currently standing at around 32 per cent) to over 60 per cent.
