Prevention of Gastric Cancer

Gastric cancer (GC) is the fifth most common malignancy worldwide, with 968,784 new cases reported in 2022. Since 1975, when stomach cancer was the most common cancer, its incidence has declined in many regions. This decline can be attributed to improved food preservation and recognition of Helicobacter pylori (H. pylori) as a group 1 carcinogen in intestinal-type GC. The aim of this review was to summarize current strategies for primary and secondary prevention of GC, with an emphasis on H. pylori management, dietary factors, novel biomarkers, and screening approaches relevant in Europe. Papers from large databases, namely Web of Science, Scopus, and PubMed/MEDLINE, were selected (reviews, guidelines, and peer-reviewed studies) from about the last 1-5 years. The research was conducted using the keywords gastric cancer, prevention, primary prevention, secondary prevention, and endoscopy guidelines on prevention of gastric cancer. Primary prevention of GC is directed at screening for H. pylori and dietary changes. Secondary prevention is supported by traditional tumor markers, pepsinogen-based serological biopsy, newer blood-based markers, and major technological progress in endoscopy. High-definition endoscopy, magnification, virtual chromoendoscopy, and artificial intelligence have improved the detection of preneoplastic lesions and early cancer, while advanced therapeutic techniques such as endoscopic mucosal resection and endoscopic submucosal dissection permit organ-sparing treatment. Large projects, including GISTAR, EUROHELICAN, TOGAS, and EUCanScreen, are expected to clarify optimal screening strategies. Although GC incidence has declined, it remains a common and significant malignancy. Understanding the facets of primary and secondary prevention of GC will lead to a reduction in the burden of this disease.