Agustos 2013
Mide kanseri risk gruplarinin “serum biomarker” temelli taramasi
Serum biomarker-based screening of the risk groups of stomach cancer: Preliminary results of a feasibility study in Finland
- Ana Sayfa
- Sayılar
- Agustos 2013
- Mide kanseri risk gruplarinin “serum biomarker” temelli taramasi...
2 Chief Medical Director of Biohit Oyj, Helsinki, Finland
3 Director of Screening Programs, Health Care Finland Ltd, Finland
Özet
Giris ve Amaç:Atrofik gastritis ve gastrik anasidite gastrik kanser için en belirgin ve temel risk faktörüdür. Biz 2012 yilinda yaptigimiz pilot çalismada i) Bir biyolojik belirteç ile atrofik gastritis ve toplum tabanli taramanin fizibilitesini ve ii) Böyle bir tarama programinin en iyi nasil organize edilecegini degerlendirdik. Gereç ve Yöntem:2012 sonbaharinda Güney Bati Finlandiya’nin birbirine benzer dört küçük bölgesinden tüm orta yasli kadin ve erkekler (51-56 yas arasi) GastroPanel testi ile atrofik gastritis taramasi için davet edildiler. Tarama protokolü dizayn ve uygulamasi ulusal düzeyde faaliyet gösteren Health Care Finland Ltd.tarafindan yapildi. Tarama programi giderleri Fnlandiya’da idarenin sorumlulugunda olan birinci basamak için uygun bir tetkik gideri olarak görüldü ve karsilandi. Bulgular:Tarama yapilan kohort grubun %5’inde serum pepsinojen I düzeyi düsük (25 μg/l) bulundu. Tarama yapilanlarin %20’sinde Helicobacter pylori (+)’ti ve tarama yapilan grubun %29’u ileri tibbi tetkikler için yönlendirildi. Düsük pepsinojen saptanan gruba diagnostik gastroskopi yapildi (%3,6). Bu hastalar tibbi takip için yerel hastanelere sevk edildi. Tarama programinin etkinligi; taranan ve tarama yapilmayanlardaki mide kanserine bagli ölüm oranlari ve gastrik kanser için takip edilenlerin potansiyel yasam yili kaybi ve oranlari ile karsilastirilarak degerlendirilecektir. Sonuç:Gastroskopi yapilan hastalarin yillik gözetimi; gastrik kanser insidansini %60, gastrik kansere bagli mortaliteyi %50 ve mide kanserine bagli (erken ölümlerde) potansiyel yasam yili kaybini %70 azaltacaktir. Yapilan taramada Helicobacter pylori enfeksiyonu beklenenden yüksek bulunmustur. GastroPanel ile taramanin endoskopi ile takibi mide kanseri mortalitesinin belirgin sekilde azalmasini saglar ve bu test ömür boyu bir kez yapildigindan maliyet etkin kabul edilmektedir
Abstract
Background and Aims:Atrophic gastritis and acid-free stomach are the single most significant risk conditions for gastric cancer. In a pilot study (2012), we assessed i) the feasibility of a population-based screening for atrophic gastritis by a biomarker test (GastroPanel; Biohit Oyj, Helsinki), and ii) how to best organize this type of screening. Materials and Methods:In autumn 2012, all middle-aged men and women (aged 51–65 years) from four relatively small municipalities in South-Western Finland were invited for atrophic gastritis screening with the GastroPanel assay. The screening protocol was designed and implemented by a nationally operating large private supplier of medical and screening services (Health Care Finland, Ltd). The costs of the screening were included among the regular costs of the primary health care, which in Finland are the responsibility of the municipalities. Results: In the screened cohort, low (25 μg/l ) pepsinogen I; levels were detected in 5% of the participating men, Helicobacter pylori infection was present in about 20%, and 29% of the screened subjects were referred for further medical examinations. A diagnostic gastroscopy was performed for 3.6% of screened subjects, with low pepsinogen I. These patients were referred for medical surveillance in local hospitals. In the final analysis, the effectiveness of this pilot screening program will be assessed by standardized mortality rate of gastric cancer,comparing the screened and not screened population, and by potential years of life lost and the rate of potential years of life lost for gastric cancer during several years of follow-up. Conclusions: In the short-term, the number of subjects with low pepsinogen I turned out to correspond the a priori assumptions of their frequency. The on-going annual surveillance of these patients by gatsrocopies should reduce the incidence of gastric cancer by 60%, standardized mortality rate due to gastric cancer by 50%, and the potential years of life lost -rates (premature deaths) due to stomach cancer by 70%. The number of individuals with Helicobacter pylori - infections was higher than expected. Taken together, this type of screening by serum biomarker test (GastroPanel) followed by endoscopy should result in a remarkable decrease in gastric cancer mortality and its cost-effectiveness is assumed to be high, since this is a once in the life-time screening by a biomarker.
