The research is one of eight suggestions published in the book “Proposals for Chile 2022”, from the UC Public Policy Center, recently launched at the UC Extension Center. The proposed policy includes the implementation of a screening program through a blood sample in people under 45 years of age, for the identification and treatment of infection by Helicobacter pylori, the main factor associated with the development of gastric cancer. On the other hand, in subjects 45 years of age or older, the use of blood tests is being considered to prioritize access to upper digestive endoscopy, the test of choice for the diagnosis of gastric cancer.
Andrea Riquelme, Journalist.- Three academics and researchers from the UC School of Medicine have just published a public health policy proposal for the prevention of gastric cancer, one of the most frequent and deadly cancers in the Chilean population. The policy suggested by the doctors Arnoldo Riquelme, Manuel Espinoza and Eduardo Fuentes, academics and researchers from the UC School of Medicine, Center for Cancer Prevention and Control (CECAN)consists of a screening program to detect infection by Helicobacter pylori, one of the factors that trigger the development of this cancer.
Gastric cancer leads the causes of death from cancer in Chile, with a mortality rate of 14.6 per 100,000 inhabitants for both sexes between 2009-2018, which rises to 22.8 per 100,000 inhabitants in men, during the same period (Chilean Ministry of Health, 2020). This type of cancer is also the first cause of years of potential life lost in the period 2009-2018, for both sexes.
The proposal for this innovative public health policy is one of the eight projects featured in the book “Proposals for Chile 2022 and It was financed by a competitive fund from the UC Public Policy Center and articulated with a FONIS and CECAN-FONDAP. The launch of the publication included the participation of the dean of the Catholic University, Guillermo Marshall, as well as Ignacio Irarrázaval, director of the UC Public Policy Center; Javiera Ascencio, head of the Studies Division of the Ministry of the General Secretariat of the Presidency; Cristián Monckeberg, former minister and former deputy; and Carolina Goic, executive director of the Center for Cancer Prevention and Control (CECAN).
He Gastric cancer leads the causes of oncological death in Chile, which is strongly determined by the diagnosis in advanced stages of the disease. In addition, the distribution of this is concentrated in the quartiles of lower socioeconomic level, given the inequities in access to timely diagnosis that affect more socioeconomically disadvantaged patients.
The main risk factor for gastric cancer is infection by Helicobacter pylori. Several studies have shown that its elimination with antibiotic treatment manages to reduce the number of new cases of this type of cancer and, also, of peptic ulcer, another disease caused by this infection. In Chile, the Explicit Health Guarantees Regime (GES) guarantees the treatment of Helicobacter pylori, However, since there is no screening program for the asymptomatic population, only those patients who have consulted for symptoms access diagnosis and treatment.
“This public health policy proposal was generated from the review of the specialized literature and from a recent cost-effectiveness analysis project that studied screening alternatives to Helicobacter pylori and gastric cancer, in addition to the opinion of national experts collected through work sessions and a consensus survey on-line carried out with representatives of scientific societies and the public and private health sector. During the process, multiple diagnostic strategies for different age groups were identified and analyzed, from which the consensus that supports this proposal emerges”, said Dr. Arnoldo Riquelme, leader of the research and proposal.
It is proposed to implement a screening program for Helicobacter pylori for diagnosis and treatment (primary prevention), based on non-invasive studies, following the test and treat strategy in children under 45 years of age, favoring the age group between 35-44 years and a combined screening strategy for Helicobacter pylori and universal gastric cancer in the population ≥45 years (primary and secondary prevention). Screening is done by taking a blood sample for a serological study of IgG antibodies. H pylori and the biological marker pepsinogen I and II for gastric cancer. In those cases with IgG H pylori greater than 14 Immuno-Enzymatic Units (EUI), diagnostic confirmation with the antigen test is proposed. H pylori in stools.
In confirmed cases, it is proposed that the GES regime operate according to current conditions. This screening scheme is the one that applies to the population between 35 and 44 years of age. On the other hand, in populations ≥45 years old, serology will also be performed to H pylori and determination of pepsinogen I and II, which will be evaluated together with other characteristics of the subject to estimate their risk of gastric cancer. In high-risk patients, the proposal suggests performing upper GI endoscopy with gastric biopsies. Patients with gastric cancer will be referred to their health centers for activation of the corresponding GES and patients with gastric premalignant lesions will undergo endoscopic follow-up as a secondary prevention strategy. Finally, it is proposed that the screening strategies be incorporated into the adult preventive medicine exam (EMPA), within the GES and with its corresponding financing.
