Biohit Oyj Press Release April 1, 2015 at 12:30 p.m. local time (EET)
Gastric cancer, being detected in 600-700 patients in Finland each year, is suitable for population-based screening, because the disease is sufficiently common, its precursors are well established and by detecting them, the development of cancer can be prevented.
The most significant risk factors of gastric cancer are Helicobacter pylori (HP) and atrophic gastritis induced by HP or autoimmune disease. An untreated HP infection can lead to stomach cancer or atrophic gastritis, graded into three degrees of severity: mild, moderate and severe. These are the risk conditions, of which gastric cancer may develop through precursors, called dysplasia by the most recent WHO classification (1).
Recognition of the risk conditions and gastric cancer precursors is important
The diagnostics of gastric cancer risk factors and cancer precursors, their follow-up and management practice have been varied. For this reason, four European scientific organizations* arranged an assembly to create unified recommendations for the recognition and follow-up of these conditions.
*the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and Sociedade Portuguesa de Endoscopia Digestiva (SPED).
Altogether, 63 leading experts from 24 European countries gathered in Porto, Portugal, in June 2011, to decide on the European recommendations for recognizing gastric cancer risk factors and precursors (2).
The key recommendations of these European guidelines deviate from the Finnish Current Care recommendations (”Ylävatsavaivaisen potilaan tutkiminen ja hoito”), published in 2012, which are inevitably outdated (3). These Finnish Current Care recommendations have completely neglected to exploit the diagnostic use of biomarkers for over a decade. Because of this, it is possible that atrophic gastritis, caused by HP- infection or autoimmune disease, or related risk conditions such as stomach cancer, B12 vitamin and calcium deficiency, have remained undiagnosed (4,5).
The following are quotations from the European recommendations, from which the Finnish Current Care recommendations differ most markedly or are entirely missing (a-d).
Risk conditions are identified using non-invasive diagnostic biomarker tests, but the follow-up requires gastroscopy
a) Levels of Pepsinogen I and II in plasma reliably predict severe atrophic gastritis.
b) In patients with low pepsinogen levels, the definition of Helicobacter pylori antibodies helps identify the high risk patients.
c) All patients diagnosed with extensive (antrum and corpus) atrophic gastritis or intestinal metaplasia, should be scheduled for regular follow-up by gastric endoscopy (gastroscopy).
d) The follow-up of these patients should be conducted every three years by gastroscopy, starting from the time of diagnosis.
In the screening of symptomatic (dyspeptic) and even asymptomatic subjects, GastroPanel biomarkers (pepsinogen I and II, gastrin-17 and H.pylori antibodies) allow for the diagnosis of HP- infection and atrophic gastritis, as well as the risk conditions associated with them, including gastric and esophageal cancer (4,5)
CEO Semi Korpela, Biohit Oyj: “Mass screening of stomach cancer risk conditions with gastroscopy is not feasible, due to high unit costs and lack of capacity. An early detection of stomach cancer using blood tests could prevent disease burden and healthcare costs. According to the cost-effectiveness model developed by the Nordic Healthcare Group, systematic GastroPanel screening of one single age group in Finland (50-year-old) for stomach cancer risk could save the life-time healthcare costs of these people up to 60 million euros.”
1. Lauwers, GY.; Carneiro, F.; Graham, DY., et al. Gastric carcinoma.. In: Bosman, FT.; Carneiro, F.; Hruban, RH.; Theise, ND., editors. WHO Classification of tumours of the digestive system. 4: edn.. IARC Press; Lyon: 2010. p. 48-58.
2.Dinis-Ribeiro M, Areia M, de Vries AC, Marcos-Pinto R, Monteiro-Soares M, O’Connor A, Pereira C, Pimentel-Nunes P, Correia R, A. Ensari A, Dumonceau M, Machado JC, Macedo G, Malfertheiner P, Matysiak-Budnik T, Megraud F, Miki K, O’Morain C, Peek RM. Ponchon T, Ristimaki A, Rembacken B, Carneiro F, Kuipers EJ, and behalf of MAPS Participants. Management of precancerous conditions and lesions in the stomach (MAPS): guideline from the European Society of Gastrointestinal Endoscopy (ESGE), European Helicobacter Study Group (EHSG), European Society of Pathology (ESP), and the Sociedade Portuguesa de Endoscopia Digestiva (SPED). Endoscopy 2012; 44:74–94.
3. Ylävatsavaivaisen potilaan tutkiminen ja hoito. http://www.kaypahoito.fi/web/kh/suositukset/suositus?id=hoi50093.
4. Agréus L, Kuipers EJ, Kupcinskas L, Malfertheiner P, Di Mario F, Leja M, Mahachai V, Yaron N, van Oijen M, Perez Perez G, Rugge M, Ronkainen J, Salaspuro M, Sipponen P, Sugano K, Sung J. Rationale in diagnosis and screening of atrophic gastritis with stomach-specific plasma biomarkers. Scand J Gastroenterol 2012;47:136-147.
5. http://www.biohithealthcare.com/investors/stock-exchange-releases: 12/12/2014, Biohit and Doctagon to co-operation, Additional information.pdf
