No reduction in gastric cancer incidence, mortality by adding H. pylori screening to FIT
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Key takeaways:
- Incidence rates of gastric cancer were 0.032% in the H. pylori with FIT screening group vs. 0.037% in the FIT-alone group.
- Gastric cancer mortality rates were 0.015% vs. 0.013%, respectively.
An invitation to screen for Helicobacter pylori along with fecal immunochemical testing did not significantly reduce gastric cancer incidence or mortality over approximately 5 years vs. FIT alone, according to a study conducted in Taiwan.
“Helicobacter pylori is a contributing factor to the development of gastric cancer, and bacterial eradication treatment may prevent its occurrence,” Yi-Chia Lee, MD, PhD, of the department of internal medicine at the National Taiwan University College of Medicine, and colleagues wrote in JAMA. “However, whether community screening for H. pylori can reduce rates of gastric cancer or gastric cancer mortality remains unknown.”
To investigate this, Lee and colleagues randomly assigned residents aged 50 to 69 years in Changhua County, Taiwan, to H. pylori stool antigen (HPSA) screening combined with FIT or FIT alone.
The researchers invited 63,508 individuals to participate in HPSA with FIT and 88,995 to FIT alone between January 2014 and September 2018. Of these, 49.6% and 35.7%, respectively, underwent screening, with median follow-up times of 5.7 and 5.4 years.
Positive HPSA results were reported among 38.5% of participants, of whom 71.4% received antibiotics and 91.9% (95% CI, 91.3-92.5) achieved eradication after one or two courses. FIT results were positive among 7.1% of 31,497 individuals in the combined screening group and 7% of 31,777 in the FIT-alone group.
Further, results demonstrated gastric cancer incidence rates of 0.032% in the combined screening group vs. 0.037% in the FIT-alone group (mean difference = –0.005%; 95% CI, –0.013 to 0.003), which corresponded with an unadjusted RR of 0.86 (95% CI, 0.68-1.1). Mortality rates were 0.015% vs. 0.013%, respectively, (mean difference = –0.002%; 95% CI, –0.004 to 0.007), with an unadjusted RR of 1.12 (95% CI, 0.77-1.62).
Compared with FIT alone, an invitation for combined HPSA and FIT was associated with a lower incidence of gastric cancer (0.79; 95% CI, 0.63-0.98) but not mortality (1.02; 95% CI, 0.73-1.4), according to post-hoc analyses.
“Among residents of Taiwan, an invitation to test for HPSA combined with FIT did not reduce rates of gastric cancer or gastric cancer mortality, compared with an invitation for FIT alone,” Lee and colleagues wrote. “However, when differences in screening participation and length of follow-up were accounted for, gastric cancer incidence, but not gastric cancer mortality, was lower in the HSPA with FIT group, compared with FIT alone.”
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