Fast Five Quiz: Gastric Cancer Diagnosis

Daniel Catenacci, MD


August 24, 2022

Screening for gastric cancer is controversial, and recommendations are based on the regional incidence of gastric cancer. In regions with low gastric cancer incidence, screening with upper endoscopy is typically reserved for high-risk individuals, such as those with a family history of a first-degree relative with gastric cancer and immigrants from regions with a high incidence of gastric cancer, such as Southeast Asia. Studies have suggested that gastric cancer has been observed to have a familial aggregation rate of up to 10%. According to the National Cancer Institute, no evidence suggests that routine screening will reduce gastric cancer-related mortality in areas with low incidence. In areas with high incidence, such as Japan and Korea, population-based screening is recommended for individuals > 50 years and 40 years, respectively. Analyses have shown that endoscopic screening may identify early gastric cancer and reduce mortality.

H pylori is an established carcinogen for gastric cancer. Evidence supports that eradication therapy should be offered to individuals with H pylori infection as primary prevention for gastric cancer. However, the AGA Clinical Practice Guidelines recommend against repeat endoscopic surveillance in patients with gastric intestinal metaplasia and no additional risk factors.

Low serum pepsinogen levels are associated with atrophic gastritis, a precursor for intestinal-type gastric cancer. However, levels of pepsinogen are altered with medications used to treat H pylori and with proton pump inhibitors, making it an unreliable screening tool.

Learn more about gastric cancer.


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