13 Sep H.pylori Treatment Linked to Decreased Gastric Cancer Mortality
MedicalResearch.com Interview with:
Prof. Kai-feng Pan
Director. Department of Cancer Epidemiology
Peking University School of Oncology
Beijing Cancer Hospital & Institute
Peking University Cancer Hospital
MedicalResearch.com: What is the background for this study?
Response: Based on a high-risk population in China, we have conducted a large randomized factorial-designed intervention trial (Shandong Intervention Trial) to examine the effect of short-term Helicobacter pylori (H. pylori) treatment and 7.3-year vitamin and garlic supplementation on gastric cancer. During 14.7-years’ follow-up in the trial, 2-week treatment for H. pylori resulted in statistically significant reduction in gastric cancer incidence. Results for gastric cancer mortality and for the effects of garlic and vitamin supplementation, though promising, were not statistically significant. Longer follow-up was needed to determine whether the reductions in gastric cancer incidence from H. pylori treatment would persist and lead to a demonstrable reduction in gastric cancer mortality. It also remained unknown whether vitamin and garlic supplementation would yield a statistically significant reduction in gastric cancer incidence and mortality with additionally extended follow-up. In addition, the entire spectrum of effects of these interventions needs to be understood.
MedicalResearch.com: What are the main findings?
Response: Based on a total follow-up of 22.3 years in the Shandong Intervention Trial, the preventive effect of short-term H. pylori treatment on risk of developing gastric cancer continued 22 years post-treatment and resulted in significantly lower gastric cancer mortality. We also found significantly decreased long-term risk of developing gastric cancer associated with vitamin supplementation and reduced gastric cancer mortality for those taking vitamin or garlic supplements. We did not find significantly altered risk of other major cancer-specific deaths.
MedicalResearch.com: What should readers take away from your report?
Response: This study found statistically significantly decreased risk of gastric cancer incidence and mortality with short-term H. pylori treatment during 22.3 years after active treatment, demonstrating the longest durable beneficial effect among the major randomized trials of H. pylori treatment. Multiyear vitamin supplementation yielded statistically significant reductions in gastric cancer incidence and mortality. Garlic supplementation also yielded a statistically significant decrease in gastric cancer mortality and a promising, but not statistically significant, decrease in gastric cancer incidence. These findings suggest many potential strategies for gastric cancer prevention. H.pylori treatment represents a promising approach to gastric cancer prevention. Even though nutritional and garlic supplements may take years to impact gastric cancer incidence and mortality, they may prove less expensive, safe, or robust interventions in the long run.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Our findings suggest many potential strategies for gastric cancer prevention. However, before major public health campaigns for gastric cancer prevention are launched utilizing antibiotic-based H. pylori therapy or nutritional regimens, further large-scale intervention trials are needed to delineate the full range of beneficial and adverse effects of H. pylori treatment with adequate statistical power, to confirm the preventive effects of vitamin and garlic supplementation, and to identify possible risks from nutritional regimens. In addition, although the findings may have implications for populations worldwide, the extrapolation to a well-nourished population or a population with low incidence of gastric cancer should be approached with caution. Further studies on other well-nourished or low-risk populations would be needed.
The authors do not have conflicts of interest to disclose.
Wen-Qing Li, Jing-Yu Zhang, Jun-Ling Ma, Zhe-Xuan Li, Lian Zhang,Yang Zhang, Yang Guo,1 Tong Zhou, Ji-You Li, Lin Shen, Wei-Dong Liu, Zhong-Xiang Han, William J Blot, Mitchell H Gail, Kai-Feng Pan, Wei-Cheng You
BMJ 2019;366:l5016 | doi: 10.1136/bmj.l5016
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