Früherkennung und prävention des magenkarzinoms - "Screen and treat" ist in Deutschland noch in weiter ferne

Gastric cancer at the first clinical presentation and diagnosis is often in advanced and uncurable stage. This underscores the need for effective means of early diagnosis and prevention. Although being the most effective technique for early diagnosis of gastric cancer, endoscopy is not recommended in Europe for a general mass-screening due to a poor cost-effectiveness. Cheap and easy applicable techniques are needed, e.g. serological tests, to preselect patients at high risk who would be candidates for a targeted endoscopic screening. Helicobacter pylori infection is the most relevant risk factor for the development of gastric cancer, which is underscored by a clear causal relationship. H. pylori eradication as strategy for an effective prevention has so far only be applied selectively for defined risk groups. COX-inhibitors and modulators of gastrin-dependent pathways are under evaluation of their potential to inhibit gastric carcinogenesis. Moreover, dietary and - more than that - host factors like mutations of the e-cadherin-gene have to be considered to generate an individual risk profile for each patient.