Cancer Care: Calls to target gastric cancer, which disproportionately affects Māori and Pacific populations

Gastric cancer prevention in Aotearoa New Zealand requires significant improvements in controlling H. pylori.

• Health professionals urge targeted strategies to manage Helicobacter pylori to prevent gastric cancer and improve equity.
• The infection increases gastric cancer risk three-fold, disproportionately affecting Māori and Pacific populations.
• The paper calls for Aotearoa-specific guidelines, including PCR-based testing and a population-based test-and-treat programme.

Addressing poor management of a preventable cause of gastric cancer will lead to better outcomes and improve equity and justice in healthcare, a group of health professionals argues.

Published today in the Journal of the Royal Society of New Zealand, a group paper calls for the implementation of targeted, evidence-based strategies to manage Helicobacter pylori infection.

Senior author Dr Stephen Inns, of the University of Otago, Wellington Department of Medicine, says gastric cancer prevention in Aotearoa New Zealand requires significant improvements in controlling H. pylori.

The most common bacterial infection in the world, it is associated with a threefold increased risk of gastric cancer.

Dr Stephen Inns, of the University of Otago, Wellington Department of Medicine.

“Gastric cancer is a significant public health challenge in Aotearoa and disproportionately affects Māori and Pacific populations. This disparity is driven largely by Helicobacter pylori infection.”

The paper presents a roadmap of actionable strategies to reduce these disparities.

“Key challenges to managing H. pylori include inconsistent testing guidelines, rising antibiotic resistance, and inequitable access to treatment. Our article highlights the need for early intervention and the potential for meaningful improvements in health equity,” Inns says.

Firstly, the group says, it is imperative Aotearoa-specific guidelines for H. pylori management are developed and implemented.

It says the guidelines should encompass recommendations for PCR-based antibiotic resistance testing, which will enable more precise, individualised treatments. They should also include systematic retesting to confirm eradication and advocate for a 14-day treatment regimen. The guidelines must also recommend testing of high-risk populations, even if asymptomatic, to ensure comprehensive coverage.

Secondly, the group highlights the critical need to immediately establish a population-based test-and-treat approach, or screening programme, tailored to Aotearoa.

“Implementation of these initiatives — alongside early and sustained engagement with Māori and Pacific health leaders — will lead to better health outcomes and improve equity and justice in healthcare delivery, with the ultimate goal of eradication of the infection.

“Policymakers need to urgently allocate resources and prioritise equity-focused interventions to improve outcomes for at-risk populations,” Inns says.