What If We Could Eliminate a Major Gastric Cancer Risk Factor?

Shria Kumar, MD

When Shria Kumar, MD, sees patients with gastric cancer, she is struck by how sick they are. Her patients often first present with advanced stages of disease, when treatments are less effective than if the cancer had been caught earlier.

Dr. Kumar, an assistant professor in the Division of Digestive Health and Liver Diseases and member of the Cancer Control Program at Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine, is determined to find ways to prevent disease in the first place. She studies how to screen for and eliminate a key risk factor for gastric cancer: infection with the bacterium Helicobacter pylori.

“In high-risk areas, can you use H. pylori eradication as an avenue toward primary prevention of gastric cancer?” Dr. Shria asked.

Screening for Gastric Cancer-Related Infections

Dr. Kumar and her Sylvester colleagues now report data from a study focused on vulnerable populations in South Florida. The researchers found they could successfully identify and eradicate H. pylori infections in a community setting, though not for all affected individuals.

The ongoing study should yield data about how to screen and treat more people for H. pylori. Dr. Kumar said the approach could inform future, scaled-up efforts in Miami and beyond.

Dr. Kumar, who has a master’s degree in clinical epidemiology, led the study published in Clinical Gastroenterology and Hepatology. David Goldberg, MD, is the senior author. Damian Cohen, MD, is lead research coordinator. Both are assistant professors in the Miller School Division of Digestive Health and Liver Diseases.

Sylvester and a P50 Pilot award from the National Institutes of Health funded the study.

H. pylori infection is known to cause inflammation in the gut and increase the risk of ulcers. The bacterium also has “one of the strongest” links to cancer risk known in medicine, said Dr. Kumar.

In an earlier study, Dr. Kumar and her colleagues found that patients treated for H. pylori had a 74% reduced risk of later developing gastric cancer. Those findings align with numerous studies showing that eliminating H. pylori prevents disease development.

Eradicating the Cancer Source

In Japan and other East Asian countries with a high prevalence of the bacterium, people are routinely screened for H. pylori when they visit their doctor.

However, in the U.S., the bacterium is not as prevalent. People are generally only tested for H. pylori when they show symptoms, such as an upset stomach, or related secondary complications like ulcers. That approach ends up overlooking vulnerable populations in the U.S. that have relatively high incidences of H. pylori, including Asian Americans, Latinos and African Americans, said Dr. Kumar.

She said the Miami area is the “perfect enclave” to test community-based strategies to eliminate H. pylori. It’s home to large communities of ethnic and racial minorities who have a high incidence of H. pylori, as well as immigrants from highly affected countries.

“We recognize how unique and special this community is,” stated Dr. Kumar. “We truly want to serve it and make it better.”

Going into the Community

For the study, Dr. Kumar and her colleagues visited health fairs and community centers. The team also used Sylvester’s “Game Changer Vehicles,” which bring cancer screening and health information to underserved communities.

“We leave the clinical confines,” said Dr. Kumar. “We don’t only test people who are symptomatic and we also test people who don’t have typical access to health care.”

Study participants were tested for H. pylori using a breath test. If they tested positive, they received a free treatment regimen and were asked to return to a testing site several weeks later to determine whether the bacterium had been eradicated.

Dr. Kumar said she was “enthused by the reception” in the community. Many participants were familiar with gastric cancer because of its elevated prevalence in the region. One participant returned with her two sons the next day.

Study Validates Community Testing

The team tested 155 people. The 52 who tested positive were given drugs to eradicate H. pylori free of charge. Twenty-three made it to a clinic for re-testing after treatment, with 22 showing eradication.

The data showed that it’s feasible to identify and treat people for H. pylori in the community setting. However, the approach still left many people behind. Ten individuals did not complete treatment and the team lost contact with 19 others.

Potential barriers to greater uptake and adherence include the effort of making it to an appointment for retesting and the complexity of treatment, which requires taking pills several times a day, said Dr. Kumar. As the study continues, the researchers should be able to identify groups most likely to adhere and ways to reduce patient burden.

Dr. Goldberg is hopeful that widespread H. pylori testing in the U.S. may one day be routine. Advancements that simplify H. pylori testing and treatment may also play a role in the future.

“These things evolve over time,” he said.