Perspectives

Screening for the risk of gastric cancer

Prof. Francesco Di Mario

 

GastroPanel® has emerged as a promising tool for screening individuals at risk of gastric cancer (1-3), particularly in regions with high incidence rates such as China and Chile. Recent studies have shown that GastroPanel® biomarkers, including pepsinogen I (PGI), pepsinogen II (PGII), and gastrin-17 (G-17) and IgG against Hp can effectively identify individuals with atrophic gastritis, a known precursor to gastric cancer (4, 5). By measuring these biomarkers in serum or plasma samples, GastroPanel® offers a non-invasive and cost-effective method for identifying individuals at increased risk of developing gastric cancer, allowing for early intervention and improved patient outcomes (6, 7). Moreover, advancements in technology have enhanced the accuracy and reliability of GastroPanel® testing, making it a valuable tool for population-based screening programs aimed at reducing the burden of gastric cancer.

GastroPanel® can diagnose non-invasively (a simple blood sample) a precancerous condition for gastric cancer, i.e. Chronic Atrophic Gastritis (CAG).

This is especially due to the high negative predictive value of PGI, above 90%, and the role of G17, which increases significantly when low or absent acidity (6), . This concept has been confirmed and underlined in numerous international consensuses in recent years (8-10).

A comparison study (11) between different diagnostic methods for diagnosing diseases of the upper digestive tract concluded that GastroPanel® represents the gold standard for optimising results in identifying patients at risk of developing gastric cancer.

Read also: Bowel cancer screening is resource-intensive – GastroPanel® serves as a tool for endoscopy resource allocation

 

References:

  1. Correa P, Piazuelo MB. The gastric precancerous cascade. J Dig Dis. 2012 Feb;13(1):2-9. doi: 10.1111/j.1751-2980.2011.00556.x. PMID: 22212485; PMCID: PMC3291127.
  2. Miki K. Gastric cancer screening using the serum pepsinogen test method. Gastric Cancer. 2006;9(4):245-253. doi:10.1007/s10120-006-0387-3.
  3. Miki K, Morita M, Sasajima M, et al. Usefulness of gastric cancer screening using the serum pepsinogen test method. Am J Gastroenterol. 2003;98(4):735-739. doi:10.1111/j.1572-0241.2003.07331.x.
  4. Storskrubb T, Aro P, Ronkainen J, et al. Serum biomarkers provide an accurate method for diagnosis of atrophic gastritis in a general population: The Kalixanda study. Scand J Gastroenterol. 2008;43(12):1448-1455. doi:10.1080/00365520802308083.
  5. Crafa P, Franceschi M, Rodriguez Castro KI, Barchi A, Russo M, Franzoni L, Antico A, Baldassarre G, Panozzo MP, Di Mario F. Functional Dyspesia. Acta Biomed. 2020 Jul 9;91(3):e2020069. doi: 10.23750/abm.v91i3.10150. PMID: 32921764; PMCID: PMC7716988.
  6. Zagari RM, Rabitti S, Greenwood DC, Eusebi LH, Vestito A, Bazzoli F. Systematic review with meta-analysis: diagnostic performance of the combination of pepsinogen, gastrin-17 and anti-Helicobacter pylori antibodies serum assays for the diagnosis of atrophic gastritis. Aliment Pharmacol Ther. 2017 Oct;46(7):657-667. doi: 10.1111/ apt.14248. Epub 2017 Aug 7. PMID: 28782119.
  7. Pimentel-Nunes P, Libânio D, Marcos-Pinto R, Areia M, Leja M, Esposito G, Garrido M, Kikuste I, Megraud F, Matysiak-Budnik T, Annibale B, Dumonceau JM, Barros R, Fléjou JF, Carneiro F, van Hooft JE, Kuipers EJ, Dinis-Ribeiro M. Management of epithelial precancerous conditions and lesions in the stomach (MAPS II): European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter and Microbiota Study Group (EHMSG), European Society of Pathology (ESP), and Sociedade Portuguesa de Endoscopia Digestiva (SPED) guideline update 2019. Endoscopy. 2019 Apr;51(4):365-388. doi: 10.1055/a-0859-1883. Epub 2019 Mar 6. PMID: 30841008.
  8. Sugano K, Tack J, Kuipers EJ, Graham DY, El-Omar EM, Miura S, Haruma K, Asaka M, Uemura N, Malfertheiner P; faculty members of Kyoto Global Consensus Conference. Kyoto global consensus report on Helicobacter pylori gastritis. Gut. 2015 Sep;64(9):1353-67. doi: 10.1136/gutjnl-2015-309252. Epub 2015 Jul 17. PMID: 26187502; PMCID: PMC4552923.
  9. Malfertheiner P, Megraud F, Rokkas T, Gisbert JP, Liou JM, Schulz C, Gasbarrini A, Hunt RH, Leja M, O’Morain C, Rugge M, Suerbaum S, Tilg H, Sugano K, El-Omar EM; European Helicobacter and Microbiota Study group. Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report. Gut. 2022 Aug 8:gut jnl-2022-327745. doi: 10.1136/gutjnl-2022-327745. Epub ahead of print. PMID: 35944925.
  10. Rugge M, Genta RM, Malfertheiner P, Dinis-Ribeiro M, El-Serag H, Graham DY, Kuipers EJ, Leung WK, Park JY, Rokkas T, Schulz C, El-Omar EM; RE.GA.IN; RE GA IN. RE.GA.IN.: the Real-world Gastritis Initiative-updating the updates. Gut. 2024 Feb 23;73(3):407-441. doi: 10.1136/gut jnl-2023-331164. PMID: 38383142..
  11. Di Mario F, Cavallaro LG. Non-invasive tests in gastric diseases. Dig Liver Dis. 2008 Jul;40(7):523-30. doi: 10.1016/j.dld.2008.02.028. Epub 2008 Apr 24. PMID: 18439884.