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Gastric cancer screening in low incidence populations: Position statement of AEG, SEED and SEAP. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 44:67-86. [PMID: 33252332 DOI: 10.1016/j.gastrohep.2020.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/06/2020] [Accepted: 08/31/2020] [Indexed: 02/06/2023]
Abstract
This positioning document, sponsored by the Asociación Española de Gastroenterología, the Sociedad Española de Endoscopia Digestiva and the Sociedad Española de Anatomía Patológica, aims to establish recommendations for the screening of gastric cancer (GC) in low incidence populations, such as the Spanish. To establish the quality of the evidence and the levels of recommendation, we used the methodology based on the GRADE system (Grading of Recommendations Assessment, Development and Evaluation). We obtained a consensus among experts using a Delphi method. The document evaluates screening in the general population, individuals with relatives with GC and subjects with GC precursor lesions (GCPL). The goal of the interventions should be to reduce GC related mortality. We recommend the use of the OLGIM classification and determine the intestinal metaplasia (IM) subtype in the evaluation of GCPL. We do not recommend to establish endoscopic mass screening for GC or Helicobacter pylori. However, the document strongly recommends to treat H.pylori if the infection is detected, and the investigation and treatment in individuals with a family history of GC or with GCPL. Instead, we recommend against the use of serological tests to detect GCPL. Endoscopic screening is suggested only in individuals that meet familial GC criteria. As for individuals with GCPL, endoscopic surveillance is only suggested in extensive IM associated with additional risk factors (incomplete IM and/or a family history of GC), after resection of dysplastic lesions or in patients with dysplasia without visible lesion after a high quality gastroscopy with chromoendoscopy.
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Llach J, Moreno L, Sánchez A, Herrera-Pariente C, Ocaña T, Cuatrecasas M, Rivero-Sánchez L, Moreira R, Díaz M, Jung G, Pellisé M, Castells A, Balaguer F, Carballal S, Moreira L. Genetic Counseling for Hereditary Gastric and Pancreatic Cancer in High-Risk Gastrointestinal Cancer Clinics: An Effective Strategy. Cancers (Basel) 2020; 12:cancers12092386. [PMID: 32842532 PMCID: PMC7564434 DOI: 10.3390/cancers12092386] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 02/06/2023] Open
Abstract
The identification of high-risk groups of gastric (GC) and pancreatic adenocarcinoma (PC) due to a hereditary basis could imply a benefit in the affected families by establishing personalized preventive strategies. We aimed at assessing the diagnostic yield of GC/PC hereditary syndromes in individuals evaluated based on specific clinical criteria. In total, 77 unrelated individuals (45 from GC group/32 from PC group) were recruited: 51 (66.2%) cancer diagnosis ≤60 years, 3 (4%) with personal history of GC/PC and other cancer and 23 (29.8%) due to family history. Immunohistochemical analysis of DNA mismatch repair proteins was performed in 38 (49.3%) available tumors, being pathological in one (2%) GC. A genetic analysis was performed if clinical criteria of hereditary syndrome were fulfilled, identifying a mutation in 10/22 (45.5%) families [7/16 (43.7%) with GC and 3/6 (50%) with PC] and 19 (24.7%) fulfilled criteria of familial cancer. Diagnosis of cancer <40 years and personal history of other cancers were independent risk factors of a hereditary syndrome [OR:11.3 (95%IC 1.9–67); p = 0.007 and OR:17.4 (95% IC 2.5–119.9); p = 0.004; respectively]. The selection of patients based on clinical criteria leads to high diagnostic yield, detecting a causative germline mutation in almost half of the cases; therefore, both meticulous genetic counseling and use of multi-gen panels is crucial.
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Affiliation(s)
- Joan Llach
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomediques August Pi i Sunyer, 08036 Barcelona, Spain; (J.L.); (L.M.); (A.S.); (C.H.-P.); (T.O.); (L.R.-S.); (R.M.); (M.D.); (G.J.); (M.P.); (A.C.); (F.B.); (S.C.)
| | - Lorena Moreno
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomediques August Pi i Sunyer, 08036 Barcelona, Spain; (J.L.); (L.M.); (A.S.); (C.H.-P.); (T.O.); (L.R.-S.); (R.M.); (M.D.); (G.J.); (M.P.); (A.C.); (F.B.); (S.C.)
| | - Ariadna Sánchez
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomediques August Pi i Sunyer, 08036 Barcelona, Spain; (J.L.); (L.M.); (A.S.); (C.H.-P.); (T.O.); (L.R.-S.); (R.M.); (M.D.); (G.J.); (M.P.); (A.C.); (F.B.); (S.C.)
| | - Cristina Herrera-Pariente
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomediques August Pi i Sunyer, 08036 Barcelona, Spain; (J.L.); (L.M.); (A.S.); (C.H.-P.); (T.O.); (L.R.-S.); (R.M.); (M.D.); (G.J.); (M.P.); (A.C.); (F.B.); (S.C.)
| | - Teresa Ocaña
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomediques August Pi i Sunyer, 08036 Barcelona, Spain; (J.L.); (L.M.); (A.S.); (C.H.-P.); (T.O.); (L.R.-S.); (R.M.); (M.D.); (G.J.); (M.P.); (A.C.); (F.B.); (S.C.)
| | - Miriam Cuatrecasas
- Pathology Department, Centre for Biomedical Diagnosis, Hospital Clínic, 08036 Barcelona, Spain;
| | - Liseth Rivero-Sánchez
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomediques August Pi i Sunyer, 08036 Barcelona, Spain; (J.L.); (L.M.); (A.S.); (C.H.-P.); (T.O.); (L.R.-S.); (R.M.); (M.D.); (G.J.); (M.P.); (A.C.); (F.B.); (S.C.)
| | - Rebeca Moreira
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomediques August Pi i Sunyer, 08036 Barcelona, Spain; (J.L.); (L.M.); (A.S.); (C.H.-P.); (T.O.); (L.R.-S.); (R.M.); (M.D.); (G.J.); (M.P.); (A.C.); (F.B.); (S.C.)
| | - Mireia Díaz
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomediques August Pi i Sunyer, 08036 Barcelona, Spain; (J.L.); (L.M.); (A.S.); (C.H.-P.); (T.O.); (L.R.-S.); (R.M.); (M.D.); (G.J.); (M.P.); (A.C.); (F.B.); (S.C.)
| | - Gerhard Jung
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomediques August Pi i Sunyer, 08036 Barcelona, Spain; (J.L.); (L.M.); (A.S.); (C.H.-P.); (T.O.); (L.R.-S.); (R.M.); (M.D.); (G.J.); (M.P.); (A.C.); (F.B.); (S.C.)
| | - Maria Pellisé
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomediques August Pi i Sunyer, 08036 Barcelona, Spain; (J.L.); (L.M.); (A.S.); (C.H.-P.); (T.O.); (L.R.-S.); (R.M.); (M.D.); (G.J.); (M.P.); (A.C.); (F.B.); (S.C.)
| | - Antoni Castells
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomediques August Pi i Sunyer, 08036 Barcelona, Spain; (J.L.); (L.M.); (A.S.); (C.H.-P.); (T.O.); (L.R.-S.); (R.M.); (M.D.); (G.J.); (M.P.); (A.C.); (F.B.); (S.C.)
| | - Francesc Balaguer
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomediques August Pi i Sunyer, 08036 Barcelona, Spain; (J.L.); (L.M.); (A.S.); (C.H.-P.); (T.O.); (L.R.-S.); (R.M.); (M.D.); (G.J.); (M.P.); (A.C.); (F.B.); (S.C.)
| | - Sabela Carballal
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomediques August Pi i Sunyer, 08036 Barcelona, Spain; (J.L.); (L.M.); (A.S.); (C.H.-P.); (T.O.); (L.R.-S.); (R.M.); (M.D.); (G.J.); (M.P.); (A.C.); (F.B.); (S.C.)
| | - Leticia Moreira
- Gastroenterology Department, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Institut d’Investigacions Biomediques August Pi i Sunyer, 08036 Barcelona, Spain; (J.L.); (L.M.); (A.S.); (C.H.-P.); (T.O.); (L.R.-S.); (R.M.); (M.D.); (G.J.); (M.P.); (A.C.); (F.B.); (S.C.)
- Correspondence: ; Tel.: +34-93-227-5739; Fax: +34-93-227-5589
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