Gastric cancer is a serious threat to people’s health in China. According to the National Cancer Registry, the incidence of gastric cancer in 2015 was second only to that of lung cancer, ranking second among all malignant tumors, with a total of 679,000 new cases and 498,000 deaths. On average, one person dies of gastric cancer in almost one minute.
Compared with our neighbor Japan, both the morbidity and mortality rates are much higher than theirs.
The detection rate and 5-year survival rate of early cancer are far lower than them.
This has a great relationship with their emphasis on the first and second level prevention of gastric cancer.
Comparison of the incidence and mortality of gastric cancer in China, the United States and Japan
What is the tertiary prevention of gastric cancer?
Tertiary prevention is:
Namely, etiological prevention, removing the possible causes of gastric cancer in advance, preventing the occurrence of gastric cancer from the source, that is, preventing the disease from being treated; This is the cornerstone of the prevention of gastric cancer, is the most important means of prevention.
It is what we often say “3 early” prevention, namely early discovery, early diagnosis, early treatment.
Before the occurrence of gastric cancer, but the occurrence of precancerous diseases or precancerous lesions, should be found in advance, diagnosis and treatment in advance, so as to improve the survival rate and cure rate.
For example, in the atypical hyperplasia stage of atrophic gastritis, timely detection can effectively intervene to prevent the evolution of gastric cancer;
Refers to the confirmed gastric cancer patients, in fact, can not be counted as prevention, just the use of the existing gastric cancer treatment, in order to improve the quality of life of patients, prolong life, belongs to the “better late than never” medical behavior.
Let’s focus today on primary and secondary prevention.
Let’s take a look at gastric cancer prevention in Japan
As a country with a high incidence of gastric cancer, Japan had been ranked first in the incidence and mortality of gastric cancer in the world.
They started screening for stomach cancer more than 30 years ago, and have continued to improve their methods.
Subsequently, Japan proposed a new gastric cancer prevention strategy combining primary prevention (eradication of Hp positive patients) with secondary prevention (screening and follow-up of people at high risk of gastric cancer).
The specific measures of gastric cancer prevention strategies in Japan are summarized as follows:
- Primary prevention
It is national basically detect and treat helicobacter pylori. Because 98% of stomach cancer in Japan is associated with HP.
So all middle and high school adolescents should be tested for Hp, and if they test positive, they should be treated for eradication immediately.
The Japan Hp Research Association recommends that all people infected with Hp receive Hp eradication treatment;
Residents are also advised to eat less high-salt food, less fresh food and more fruits and vegetables.
- Secondary prevention:
It was mainly to promote gastroscopy. In 1963, Japan called for universal gastric cancer screening.
400,000 people were screened in 1964, 4 million in 1970, and about 6 million people were screened for stomach cancer every year since 1990;
In 1994, Japan increased the rate of early diagnosis through a wide range of gastroscopy screening, provided annual gastric cancer screening for residents over 40 years of age, and incorporated gastric cancer screening into the national cancer screening program.
Gastroscope report issued by a Japanese doctor
Today, the Japanese are as familiar with doing gastroscopes as we are with doing color doppler ultrasound. No one refuses a gastroscope out of fear;
Japan’s population is reported to be about 127 million, with a total of about 15 million gastroscopy performed each year. That’s 12.5 percent of people who go for gastroscopes every year. That translates to five years, and nearly all of those over 40 who are at high risk have undergone a gastroscopy.
Therefore, the diagnosis and treatment rate of early gastric cancer in Japan (80%) is much higher than that in China (30%).
How should we prevent gastric cancer?
To draw lessons from Japan’s successful experience, in fact, can be attributed to the yellow Emperor’s Neijing: “Prevention before disease, prevention after disease”.
- Prevent before you get sick
It’s to get rid of the cause.
Although the occurrence of gastric cancer is affected by a variety of factors, such as genetics, environment, dietary habits, and so on, the most important factors, and we can completely control the two factors, one is helicobacter pylori, one is nitrite.
Nitrite mainly exists in pickled food, high-salt food, overnight vegetables, eat less of these things can be;
Helicobacter pylori infection is the main cause of gastric cancer in China. About 75% of gastric cancer is caused by Hp infection, and about 90% of gastric cancer from non-cardiac stomach is closely related to Hp infection. As early as in 1994, the WHO’s international agency for research on cancer (IARC) has put Hp as human gastric cancer Ⅰ carcinogens, Hp infection in stomach cancer risk increased by 2.3 ~ 6.2 times.
A Japanese study suggested that the eradication of Helicobacter pylori at the age of 12-20 could prevent gastric cancer to the greatest extent.
According to Chinese expert Liu Wenzhong, before the atrophy of gastric mucosa occurs, the benefit is the greatest and almost 100% can prevent intestinal gastric cancer.
The best age to recommend eradication is between 18 and 40.
At present, about half of the people in China are infected with HP, and treatment only reduces one source of infection. Treatment is recommended regardless of whether there are symptoms or not and whether it is a high-risk group, as long as there are no checks and balances.
- Prevent disease from changing
The development pattern of gastric cancer is: superficial gastritis – atrophic gastritis – intestinal metaplasia – gastric cancer.
Once atrophic gastritis occurs, as well as the subsequent stage, it belongs to pre-cancer disease and belongs to the category of existing disease, which requires early detection, early diagnosis and early treatment.
This stage is the key point to stop the carcinogenesis; Therefore, the high-risk population must pay attention to gastroscopy. The following groups are included:
Helicobacter pylori infection
Age 40 or older, male or female, with or without symptoms;
Family history of gastric cancer;
Pregastric diseases/lesions: atrophic gastritis, intestinal metaplasia, atypical hyperplasia, gastric ulcer, adenomatous polyp, vertical-like gastritis, hypertrophic gastritis, etc.
Postoperative gastric stump;
Long-term bad living habits: drinking, smoking, staying up late, anxiety, etc
- The eradication of Helicobacter pylori is the most important means to prevent gastric cancer; Testing and eradication are recommended for adults with or without symptoms; The optimal age for treatment is 18 to 40 years; Elimination in the stage of superficial gastritis can prevent 100% intestinal gastric cancer.
- It is recommended to have a gastroscopy if you are over 40 years of age and have no symptoms;
- High-risk groups should regularly review gastroscopy and helicobacter pylori testing.
- Improve living habits, refuse high-salt, spicy, processed meat, tobacco and alcohol; Promote public chopsticks.