TBA (25W159)

A Primary Preventative Gastric Cancer Screening Approach in a Western European Country: Interim Results of The Irish Experience

Author(s)

C. Deane 1, 2, A. Mc Kiernan 2, O Casey 1, 2, O. Kelly 1, 3, C. O'Morain 2, 4, B. Tepes 5, T. kofol 6, M. Leja 7

Department(s)/Institutions

1Connolly Hospital, Gastroenterology, Dublin, Ireland, 2Beacon Hospital Research Institute, Dublin, Ireland, 3Royal College of Surgeons Ireland, Dublin, Ireland, 4Trinity College Dublin - Faculty of Health Sciences, Dublin, Ireland, 5DC ROGASKA d.o.o., Gastroenterology, Rogaska Slatina, Slovenia, 6National Institute of Public Health, Ljubljana, Slovenia, 7University of Latvia, Digestive Diseases centre GASTRO, Riga, Latvia

Introduction

Europe’s Beating Cancer Plan identified the urgent need for a gastric cancer screening strategy. In response, the TOGAS consortium (TOwards GAstric cancer Screening in the European Union) was established to evaluate different methods for gastric cancer prevention and detection within Europe(1). One such approach involves population-based screening of young adults for Helicobacter pylori (H.pylori) as a primary preventative strategy.

Aims/Background

The pilot study aimed to assess the feasibility of screening asymptomatic 30-34 year olds for H.pylori. Key outcome measures included: 1) Response rate 2) Seropositivity 3) Treatment acceptance rate 4) Treatment effectiveness

Method

Methods: Individuals aged 30-34 years were invited to participate in free screening via GP practices or occupational-based screening programmes in the period January 2024- March 2025. Invitations were distributed through email or text message at the discretion of the recruitment stream. Exclusion criteria included prior history of treatment of H. pylori or gastrectomy. Those who tested positive on serology (BIOHIT H. pylori IgG antibody, antibody titer >30 IU/ml) were offered confirmatory 13-C urea breath testing (Richen IR Force 200). Positive participants were offered treatment with a 10-day regimen of single capsule combination therapy (Bismuth subcitrate 140mg/Metronidazole 125mg/Tetracycline 125mg, three tablets, QDS; PYLERA, Juvise pharmaceuticals) + Esomeprazole 40mg BD. Eradication confirmation was offered a minimum of 6 weeks post-treatment. Demographics, risk factors, and treatment effectiveness were recorded. The calculated sample size for statistical significance at a 95% confidence interval with a presumed prevalence rate of 30% was 323. The Mann-Whitney U-test was used for comparison of continuous variables, and the Chi² test for categorical variables (significance set at p<0.05).

Results

3030 invites were distributed (80% GP practices, 20% occupation-based). 20%(n=604) of recipients expressed interest in participating. Among these; 5%(n=31) were excluded and 18%(n=109) refused or ceased responding. 464 consented to and completed the study. The median age of participants was 32, 48%(n=223) were male. 15% (n=75) of those who underwent serology testing were seropositive. 97% agreed to have a confirmatory 13-C UBT, of which 50/73 (66%) tested positive. The median titre in this dual positivity group was 109 IU/mL [range 40-142], compared to 37 IU/mL [range 32-148 IU/ml] in the 13-C UT negative group. Overall, the true ‘positivity’ rate among those who agreed to screening was 11%. 96%(48/50) of positive participants agreed to treatment, a further 2 were excluded due to pregnancy. Among those treated, 96% (44/46) reported >90% adherence. 1st line eradication rates, confirmed by a 13-C UBT, were 97%(36/37) in the per-protocol group and 89%(33/37) in the intention-to-treat group. Side effects were reported by 24%, the majority of which were GI. 4 patients required 2nd line therapy due to early discontinuation or poor compliance, 1 failed 2nd line therapy on follow-up eradication confirmation.

Conclusions

These interim results indicate that a population-based H.pylori screening approach is feasible within an Irish population. Despite a decreasing worldwide prevalence, infection remains a persistent issue. Although initial response rates to screening are modest, this is a novel pilot programme and reflects trends seen in the early phases of other national screening programmes, such as the colorectal cancer screening. As public awareness increases, higher engagement rates are anticipated.