National Taiwan University Hospital has pioneered the world’s first integrated screening model for both gastric and colorectal cancers. The research, published on October 1st, 2024 in the prestigious Journal of the American Medical Association (JAMA), introduces a groundbreaking public health strategy centered on integrated screening. This innovation not only improves screening efficiency and reduces demands on healthcare personnel but also enhances convenience for participants and significantly contributes to disease prevention. Since 2012, this large-scale community screening project has been led by National Taiwan University Hospital in partnership with the College of Public Health (National Taiwan University), the Changhua County Public Health Bureau, and 51 other collaborators, including hospitals, clinics, and health centers in Changhua County. After 10 years of dedicated effort, the findings show that this two-in-one, integrated screening model effectively prevents both gastric and colorectal cancers. This international recognition represents a major achievement in the medical field.
Helicobacter pylori (H. pylori) is the primary cause of gastric cancer and peptic ulcers, both of which are prevalent in Taiwan. Although H. pylori eradication can improve gastric health, many carriers remain asymptomatic, resulting in delayed medical consultations and missed opportunities for early treatment. To address this, National Taiwan University Hospital, in partnership with the Changhua County Public Health Bureau, launched a pilot dual fecal sample-based screening program in 2012. Built on the national colorectal cancer screening platform, which utilizes the fecal immunochemical test (FIT), the program introduced an H. pylori fecal antigen test to create an integrated H. pylori screening and eradication initiative. In 2014, the program secured funding from the Ministry of Health and Welfare’s National Cancer Program, enabling its expansion. Collaborating with hospitals, clinics, and public health centers across Changhua County, a large-scale pragmatic randomized clinical trial was conducted. After 10 years of dedicated work, the findings were published in October 2024 in the prestigious Journal of the American Medical Association (JAMA), marking a significant societal contribution and demonstrating considerable international influence. The journal JAMA invited Dr. M. Constanza Camargo from the U.S. National Cancer Institute to write a special commentary. Dr. Camargo also participated in an online discussion with JAMA Deputy Editor, Professor John M. Inadomi.
Despite the World Health Organization (WHO) classifying H. pylori as a Group 1 carcinogen, countries worldwide continue to search for the most effective way to incorporate H. pylori screening into national cancer prevention policies. This study provides a practical solution by leveraging the existing colorectal cancer screening platform to include an additional fecal test for H. pylori. With a single fecal sample collection, individuals can be simultaneously tested for H. pylori stool antigens and fecal occult blood, reducing the time and effort associated with specimen collection and improving screening efficiency. Compared to traditional single fecal occult blood testing, the dual test boosted participation rates by 14%, attracting individuals who had not previously participated in colorectal cancer screening programs. Those who tested positive for H. pylori were referred for eradication treatment, with a success rate of up to 97% and low subsequent reinfection rates. Meanwhile, individuals with positive fecal occult blood results underwent colonoscopy, leading to increased detection rates of colorectal neoplasms. This integrated screening approach effectively achieves the dual objective of preventing both gastric and colorectal cancers in a single process.
The integrated two-in-one testing approach allows individuals to benefit from H. pylori eradication treatment, providing preventive effects against gastric cancer (primary prevention). In a comparison between approximately 63,000 individuals invited to dual fecal screening and around 89,000 invited to single fecal occult blood testing, after adjusting for participation rates and confounding factors, the dual screening approach demonstrated a 21% reduction in gastric cancer incidence. Among roughly 31,000 actual participants from each group, gastric cancer incidence was reduced by 32%. Additionally, individuals who participated in fecal occult blood screening also benefited from early detection of colorectal cancer (secondary prevention). This initiative illustrates the concept of achieving two goals with a single action: “One effort, two benefits.”
First author's email address: [email protected]
Corresponding author’s email address: [email protected]
Link to the full text of the paper:
https://jamanetwork.com/journals/jama/fullarticle/2824276
Editorial, M. Constanza Camargo, PhD, of the National Cancer Institute, USA:
https://jamanetwork.com/journals/jama/fullarticle/2824280
Audio, M. Constanza Camargo, PhD, of the National Cancer Institute, USA, and JAMA Associated Editor John M. Inadomi, MD:
https://edhub.ama-assn.org/jn-learning/audio-player/18915757
