Journal of the American Academy of Physician Associates (JAAPA)Reducing Gastric Cancer Mortality in the United States: Practical Strategies

This comprehensive review, accredited for continuing medical education, examines evidence-based strategies for reducing gastric cancer mortality in the United States, focusing on H. pylori eradication and targeted screening approaches. The authors synthesize current guidelines and international screening models to propose practical implementation strategies for high-risk populations.

⚕️ Key Clinical Considerations ⚕️

• H. pylori infection causes 89% of noncardia gastric adenocarcinomas, with eradication reducing incidence by 47% across all age groups and geographic regions.
• Updated 2024 ACG guidelines recommend optimized bismuth quadruple therapy as first-line treatment, replacing clarithromycin-based triple therapy due to resistance patterns.
• Targeted endoscopic screening at age 50 for high-risk groups (Asian American/Pacific Islander, Black, Hispanic, American Indian/Alaska Native) demonstrates cost-effectiveness compared to population-based approaches.
• Noncardia gastric cancer disproportionately affects racial and ethnic minorities, with threefold to fourfold higher age-adjusted incidence in high-risk populations versus non-Hispanic whites.
• Early-stage detection improves 5-year survival from less than 30% to 95-99%, emphasizing the critical importance of screening implementation in appropriate populations.

🎯 Clinical Practice Impact 🎯

• Patient Communication: Engage high-risk patients in shared decision-making regarding H. pylori testing and endoscopic screening, emphasizing the substantial mortality reduction potential and addressing cultural considerations for immigrant populations.
• Practice Integration: Implement systematic H. pylori testing protocols for asymptomatic patients from high-risk racial/ethnic groups and immigrants from endemic regions, with standardized eradication confirmation testing at 4 weeks.
• Risk Management: Utilize bismuth quadruple therapy as first-line treatment while monitoring for antibiotic resistance patterns and ensuring appropriate follow-up for eradication confirmation.
• Action Items: Develop risk stratification tools incorporating H. pylori status, family history, race/ethnicity, and immigration history to identify patients most likely to benefit from endoscopic screening.

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