Population-Based Helicobacter pylori Screening for Gastric Cancer Prevention: Opportunities and Challenges in Asia

Gastric cancer remains a major public health concern, particularly in Asia, where both incidence and mortality rates are among the highest worldwide. While endoscopic screening enables early detection and improves prognosis, it requires substantial healthcare resources and specialized manpower. Growing evidence supports population-based Helicobacter pylori screening and eradication as an effective and cost-efficient primary prevention strategy, enabling elimination of the etiological factor while directing endoscopic resources toward individuals at the highest risk. Randomized controlled trials and cohort studies, predominantly from Asian countries, have demonstrated significant reductions in gastric cancer incidence following successful H. pylori treatment. To maximize the impact of this strategy, implementation should follow the principles of an organized screening program, with clearly structured pathways for invitation, testing, treatment, and outcome monitoring. Test selection must be tailored to local prevalence and healthcare capacity, and eradication regimens should be guided by regional antibiotic resistance patterns to achieve high cure rates while upholding antibiotic stewardship. Integrating H. pylori screening into existing preventive services can further enhance cost-effectiveness and population coverage. Ongoing challenges include managing antibiotic resistance, stratifying the residual risk of gastric cancer after eradication to inform endoscopic surveillance, and ensuring consistent quality and equity of screen-and-treat programs across different healthcare systems.