Gastric corpus atrophy in gastric cancer screenings: Benefits and drawbacks

* Corresponding Author: Dariush Nasrollahzadeh, M.D Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden Telefax:+46 852482369 Email: [email protected] Recieved: 1 Jul. 2011 Accepted: 30 Jul. 2011 Gastric cancer (GC) is one the major health burden in the world. In Iran GC is the most common malignancy among men and second to breast cancer among women and the first cause of cancer mortality.1 Age-standardized rate of GC follows a particular geographic pattern and it tends to be higher in Northern provinces (Ardabil:49.,Golestan: 26.8 among males) than Southern ones (Fars:3.8 among males).2-4 The overall 5-year survival of 14-24% among operable patients shows poor prognosis of this malignancy.5 This pattern of prognosis highlights the importance of early GC detection. In this editorial our main focus is on the most prevalent type of gastric cancer which is non-cardia GC. Among a few established risk factors for GC, Infection with Helicobacter pylori (H.pylori) infection happens long time before GC occurrence which results a prolonged latency period for 4-5 decades. This arrangement of exposure and outcome raises opportunity for H.pylori-based preventive programs to be appeared promising. H.pylori has been suggested as a necessary cause for development of GC. The magnitude of association between H.pylori and GC is sensitive to the design of study. While a prospective study reported that strength of H.pylori association with GC exceeded 40 times more than non-infected individual6, retrospective studies or cohorts with recruitment age of more than 40 years old were not able to detect this strength. Meanwhile this prolonged latency period has a drawback for diagnosis. In other words, serologic methods for H.pylori diagnosis are prone to immunologic amnesia therefore old infections could be always falsely ignored. Detection of durable cagA antigen was one of the advances in this field to overcome the problem of false negative serology results. Recently developed multiplex serology method with ability of detecting multiple antigens confirmed the cagA association with GC risk and additionally suggested new antigens such as GroEL to be as potent as cagA.7 Yet, the epidemiologic design of study plays a major role in detection of magnitude between H.pylori and GC. Gastric corpus atrophy as a consequence of long-lasting H.pylori infection attracted the attention of screening programmers because of two main reasons; firstly it was assumed for