Low risk, high cost: challenging the role of gastric cancer screening in low-prevalence countries

Gastric cancer is the second commonest gastrointestinal (GI) neoplasm, with a high mortality rate and highly variable regional incidence data associated with factors such as diet, genetics, and infection with Helicobacter pylori. In high-risk countries as Japan and South Korea endoscopic screening has shown its potential to reduce this cancer's mortality. However, in low-risk countries such as Spain, where population screening is not cost-effective, a selective approach is advised focused on high-risk groups, including patients with a family history of gastric cancer, or in the form of opportunistic screening during gastroscopy for other clinical indications. High-quality gastroscopy is key for the identification of early lesions. This includes using high-definition endoscopes with chromoendoscopy, pursuing optimal mucosal visibility with washes or premedication, systematically inspecting all of the mucosa, investing adequate observation times, and using risk stratification tools such as EGGIM or OLGIM. Endoscopic surveillance is particularly advisable for high-risk precursor lesions, with intervals adjusted for patient profile. Further research is crucial for optimizing these interventions and reducing the condition's mortality rate.