ideasIdea

Family-based H. pylori test-and-treat to prevent stomach cancer

Stomach cancer is largely caused by a bacterium that spreads in households. Testing and treating whole families, not individuals, would stop reinfection and prevent cancer.

Mass eradication in Linqu County and the Matsu Islands reduced gastric cancer incidence, and the Chinese family-based consensus recommends household testing. Propose family-unit test-and-treat with stool antigen testing and tailored therapy, evaluated in a cluster-randomised design in high-incidence regions.

Hypothesis

Family-based eradication reduces reinfection to under 2% per year and gastric cancer incidence by at least 30% over 15 years versus individual-based treatment.

Rationale

Household transmission drives reinfection; eradication reduces cancer most in those without established pre-malignant lesions.

What would test it

Cluster RCT in 50,000 households with ten-year incidence follow-up.

Maturity

being tested at scale

Who has to act

policy

Cost to try

Large (over $50M)

Years to first evidence

Bottlenecks it attacks

Prevention we already have is not deployed · Around four in ten cancers are preventable with tools we already own: vaccines, tobacco control, weight, alcohol, sun and infection control.

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Family-based H. pylori test-and-treat to prevent stomach cancer

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