Epidemiology and Risk Stratification in Gastric Cancer

With over one million new cases (n = 1,033,701) and 782,685 deaths in 2018, gastric cancer (GC) ranks fifth for incidence and third for mortality among cancers worldwide. Most cancers have sporadic origin (90%) while a small proportion (10%) show a family component or hereditary syndromes. GC arises, in most cases, from the interaction of genetic and environmental components and 89% of cases worldwide are caused by chronic infections with Helicobacter pylori. Screening strategies aimed at reducing the mortality of GC are standardized in Asian countries, but there are currently no well-defined screening programs in the West. Consequently, in those countries without national guidelines for screening programs, an adequate prevention strategy could be developed by stratifying the population for relevant risk factors and directing the most appropriate diagnostic tests to high-risk individuals. Here we propose a risk stratification model for GC development, analysing the main risk factors and suggesting a screening strategy that could be effective in Western countries. In conclusion, a strategy that combines adequate risk stratification with gastroscopy on pre-selected individuals and gastric pre-cancer surveillance could lead to an increase in early diagnosis and hopefully in patient survival and quality of life.