Eradicating Helicobacter pylori infection significantly reduces both gastric cancer incidence and mortality in adults of nearly all ages, including those over 80, according to a population-based study from South Korea.
The findings challenge previous assumptions that treatment is only worthwhile when given at younger ages.
“These findings suggest that eradication benefits not only younger adults but also older adults. Eradication treatment is preferable at a younger age, but older age may not be a limiting factor for the treatment,” wrote the authors, led by Yoon Suk Jung, Division of Gastroenterology, Kangbuk Samsung Hospital, Seoul, South Korea.
Gastric cancer remains one of the deadliest cancers worldwide, ranking fifth in incidence and mortality in 2022 with nearly 1 million new cases and more than 650,000 deaths.
H pylori infection, acquired most often in childhood, is a primary driver of the disease, fueling chronic inflammation that progresses over decades to cancer.
Although prior research established that eradication lowers risk, uncertainty remained about its impact on older populations who may already have precancerous changes in the stomach.
To address this uncertainty, researchers analysed data from South Korea’s National Health Insurance Service covering 916,438 adults aged 20 or older who received H pylori eradication therapy between 2009 and 2011.
Participants were followed for an average of 12 years, and their cancer outcomes were compared with those of the general population matched by age and sex, with standardised incidence ratios (SIRs) and standardised mortality ratios (SMRs) calculated.
The results were striking. In every age group from 30 years upward, individuals treated with H pylori eradication therapy had significantly lower rates of gastric cancer.
For example, the SIR was 0.72 for those aged 30-39, 0.65 for those aged 40-59, and 0.60 for those aged 60-69. Even in adults over age 70, incidence was cut almost in half (SIR, 0.52).
Mortality patterns were similar. The SMRs in the 30-39, 40-49, 50-59, 60-69, and 70+ age groups receiving eradication therapy were 0.64, 0.31, 0.29, 0.28, and 0.34, respectively (all P < .001).
“Notably,” wrote the researchers, even when eradication therapy was administered to individuals older than 80 years, the incidence and mortality rates of gastric cancer remained lower than those in the general population.
Therefore, there may be no need to impose an age limit on H pylori eradication treatment, noting that even individuals aged 80 or older could benefit from active treatment if they can tolerate antibiotics, they said.
“However, our results should not be misinterpreted to mean that delaying eradication until older age could be beneficial. Although H pylori eradication treatment may remain effective in older adults, administering treatment at a younger age is preferable,” they noted.
“Given the limited data on elderly populations, this study provides comprehensive real-world evidence to support that age alone should not preclude H pylori eradication if individuals are otherwise suitable candidates for this therapy,” wrote Zong-Chao Liu and Wen-Qing Li, from Peking University Cancer Hospital & Institute, Beijing, China, in a linked editorial.
“As the feasibility of population-level H pylori eradication for gastric cancer prevention becomes increasingly evident, future screen-and-treat efforts should prioritise scalable implementation strategies with context-specific adaptation,” they said.
“Before implementing H pylori screen-and-treat strategies, it is essential to consider the local health care system’s capacity and population-specific priorities, as well as the regional gastric cancer incidence and H pylori prevalence,” they added.
The study had no commercial funding. The authors and editorial writers reported no relevant disclosures.
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