[Strategies for extermination of gastric cancer from Japan]

To prevent deaths from gastric cancer, it is important to combine H. pylori eradication for primary prevention with endoscopic follow-up for secondary prevention. We estimated the cost 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 would eventually archive great savings by markedly reducing the cost of treating gastric cancer. The proposed strategy would 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.