Advancing Gastric Cancer Prevention in Korea: Current Strategies and Future Directions

Area of Science:

• Epidemiology
• Oncology
• Public Health

Background:

• Korea has historically faced a high gastric cancer burden, but incidence and mortality have declined significantly.
• Gastric cancer dropped from the most common cancer to fifth, with 5-year survival rates now over 75%.
• Helicobacter pylori (H. pylori) seroprevalence shows a decreasing trend, particularly in younger Korean generations.

Purpose of the Study:

• To evaluate H. pylori eradication as a primary prevention strategy for gastric cancer in the general Korean population.
• To assess the role of H. pylori eradication alongside existing secondary prevention measures.
• To inform future gastric cancer screening and surveillance strategies in Korea.

Main Methods:

• The HELPER study is a randomized controlled trial evaluating H. pylori eradication in average-risk Korean participants.
• Participants are randomized to receive bismuth quadruple therapy or placebo, with follow-up via the Korean National Cancer Screening Program (KNCSP).
• The KNCSP provides biennial endoscopic screening for individuals aged 40 and older, serving as a platform for participant follow-up.

Main Results:

• Over 12,000 participants were screened for H. pylori status within the KNCSP framework.
• The KNCSP has demonstrated high participation rates and is linked to reduced gastric cancer mortality and earlier disease detection.
• Secondary prevention via KNCSP has increased the use of endoscopic treatments for gastric cancer.

Conclusions:

• Current uniform gastric cancer screening in Korea is costly and lacks individual risk stratification.
• Integrating H. pylori eradication and gastric atrophy assessment into risk-adapted screening could enhance effectiveness.
• Future strategies focusing on risk stratification may optimize gastric cancer prevention, reduce healthcare costs, and lessen the disease burden in Korea.