From the Guidelines
Surveillance for familial stomach cancer should be performed using high-quality upper endoscopy with image enhancement, gastric mucosal cleansing, and insufflation, and should include a systematic biopsy protocol for mucosal staging, as recommended by the most recent guidelines 1.
Key Recommendations
- Endoscopy is the best test for screening or surveillance in individuals at increased risk for gastric cancer, and should be performed by an experienced endoscopist 1.
- High-risk groups for gastric cancer include first-generation immigrants from high-incidence regions, individuals with a family history of gastric cancer, and those with certain hereditary gastrointestinal polyposis or hereditary cancer syndromes 1.
- H. pylori eradication is essential and serves as an adjunct to endoscopic screening and surveillance for primary and secondary prevention of gastric cancer 1.
- Gastric biopsies should be obtained according to a systematic protocol, such as the updated Sydney System, to enable histologic confirmation and staging 1.
- Endoscopists should work with their local pathologists to achieve consensus for consistent documentation of histologic risk-stratification parameters when atrophic gastritis with or without metaplasia is diagnosed 1.
Surveillance Intervals
- The optimal screening intervals for individuals at increased risk for gastric cancer are not well defined, but should be based on the individual's risk factors and preferences 1.
- For those with hereditary diffuse gastric cancer (HDGC) due to CDH1 mutations, screening should begin at age 18-20 with upper endoscopy every 6-12 months 1.
- For individuals with other high-risk syndromes, endoscopic surveillance should begin at age 25-30 and continue every 1-3 years 1.
Additional Considerations
- Genetic counseling is recommended for all patients with suspected familial gastric cancer to identify appropriate candidates for genetic testing and determine the optimal surveillance strategy 1.
- Artificial intelligence tools may be useful for the detection of early gastric neoplasia, but data are too preliminary to recommend routine use 1.
From the Research
Familial Stomach Cancer Surveillance
- Familial stomach cancer is a significant concern, with approximately 10% of patients showing familial clustering, and 3% showing autosomal dominance and high penetrance 2.
- Individuals with a family history of gastric cancer are at increased risk, and surveillance strategies are crucial for early detection and prevention.
Risk Factors and Surveillance
- Having first-degree relatives diagnosed with gastric cancer is a strong and consistent risk factor for gastric cancer 3.
- Current or past Helicobacter pylori infection, having two or more first-degree affected relatives, or female gender are associated with an increased risk of developing gastric cancer in individuals with a family history 3.
- Helicobacter pylori eradication is recommended for individuals with a family history of gastric cancer, particularly those in their 20s and 30s, to prevent the progression to intestinal metaplasia and reduce the synergistic effect on gastric carcinogenesis 4, 3.
- Endoscopic surveillance is expected to benefit individuals with a family history, with a recommended surveillance interval of 2 years instead of 3 years to detect early gastric cancer in those who have already developed precancerous gastric lesions 4.
Hereditary Diffuse Gastric Cancer (HDGC)
- HDGC is an autosomal-dominant, inherited cancer syndrome in which affected individuals develop diffuse-type gastric cancer at a young age, with a 70% lifetime risk of developing diffuse gastric cancer for CDH1 mutation carriers 2.
- Prophylactic total gastrectomy is recommended for CDH1 mutation carriers, as endoscopic surveillance is ineffective in identifying early HDGC 5, 2, 6.
- Gene-directed prophylactic total gastrectomy is offered for CDH1 mutation carriers, with consideration of total gastrectomy at an age 5 years younger than the youngest family member who developed gastric cancer 2.