TOGAS

Official website: (ENG): https://www.togas.lu.lv/

Project Description:

Despite the fact that the incidence of gastric cancer is decreasing worldwide, including in Europe, the burden of this disease is still high and will not disappear in the near future unless effective preventive measures are implemented. Stomach cancer is the fourth most common cause of cancer death in the world and the fifth most commonly diagnosed cancer. It causes more than 1 million new cases and nearly 800,000 deaths per year worldwide. In Europe, 136,000 new cases were diagnosed in 2020, representing 12.8% of all cases worldwide. Given that the population is aging both globally and in Europe, it is expected that the absolute number of new cases will continue to increase.

A key problem is the lack of established programs for early detection and prevention of the disease in Western countries. Thus, stomach cancer is usually only discovered at an advanced stage when patients undergo tests to investigate associated symptoms. This results in a poor prognosis and low survival rate.

In Europe, there is no effective method of screening for H. pylori infection, nor are there any endoscopic programs for secondary prevention or detection of gastric cancer at an early stage.  Timely detection of H. pylori infection and treatment of the infection would reduce the incidence of gastric cancer by up to 63%. Searching for pre-cancer and early gastric cancer would only be possible with gastroscopic controls after the age of 40, which is not done in Europe.

The goal of the TOGAS project is to contribute to the improvement and strengthening of health in the European Union by reducing the burden caused by gastric cancer by proposing an EU Screening Program for the detection and treatment of H. pylori infection as the main cause of gastric cancer and by proposing screening for precancerous changes in the gastric mucosa and endoscopic follow-up of these patients (this program is currently not included in the Recommendations of the European Council of the EU BEeating Cancer Plan).

Phases of the project and their implementation:

The work will be conducted in 7 work packages (WP).

WP 1 – Project management and coordination:  To ensure the successful implementation of the project in time with planned human and financial resources so that the project delivers all the outputs and meets all necessary reporting requirements. More specifically, this assures proper functioning of the TOGAS project management structure. Workpackage is led by University of Latvia (LU).

WP 2 – Communication and dissemination: To keep the project target audiences and stakeholders informed on the progress made within the project, to share TOGAS activities, results and added value to relevant target audiences; to promote TOGAS outputs and results. Workpackage is led by DiCE.

WP 3 – Evaluation: The assessment of the progress, outputs and results of the projects in line with the initial plan, the defined indicators and ethics principles, more specifically:

• Assessment of the study protocols for the pilot studies to be conducted within WP 4
• Assessment of the progress of the pilot studies, including personal data safety-related aspects; therefore providing status update at interim, and discussion of possible problems, proposal of solutions
• Final evaluation of the results with respect to the initial objectives, practical implementation, further perspectives
• Assessment of the ethical aspects of the project progress to ensure ethically sound implementation of the project and to contribute to development of ethics recommendations for planning and implementation of gastric cancer screening.

Workpackage is led by CHU- Nantes University Hospital.

WP 4 – Pilot studies: The objectives of this WP are defined as follows:

• Generation of comprehensive data on distinct strategies for gastric cancer screening and prevention in Europe
• Evaluation of the acceptance and feasibility of screen and treat strategy for H.pylori in the young and average age populations
• Comparison of invasive and non-invasive upper gastrointestinal screening in a population undergoing colorectal cancer screening.
• Analysis of the impact of a H.pylori screen and treat strategy in view of adverse events and short – and long-term side effects.

Three pilot studies will be conducted and splih between Natonal institute of Public Health – NIJZ (Pilot 1), Otto-von-Guericke University in Magdeburg – OVGU (Pilot 2) and LU (Pilot 3).

WP 5 – Comprehensive analysis of the implementation possibilities of various gastric cancer screening modalities: comprehensive assessment of the current status and implementation possibilities of (various) gastric cancer screening modalities for the EU Member States. Workpackage led by Thomas More (TM).

WP 6 – Cost-effectiveness modelling: To provide a comprehensive cost-effectiveness estimate of various gastric cancer screening and early detection strategies potentially to be implemented in the EU Member States. This includes expected cost implications of potential adverse events, such as the potential burden of increasing bacterial resistome due to broad antibiotic use, as well as possible positive effects. Workpackage let by Erasmus University Medical Center – EMC, the global leader in the field.

WP7 – Coordination of the methodological approaches:  Coordination of the methodological work within TOGAS with the Knowledge Centre at the JRC for assuring compliance to the EU screening quality assurance schemes. Coordination of the TOGAS recommendations with the developers of international and national guidelines in the field for assuring common understanding and complementarity. Coordination of the TOGAS methodological work with the relevant bodies in the Member States to assure that the project outputs are in the format the potential implementers require. Coordination of the methodological aspects to ethics standards and guidelines. Workpackage led by Instituto Portugues de Oncologia do Porto Francisco Gentil (IPORTO).

Added value

The results, which include cost-effectiveness modeling and address medical ethics aspects, will be further used to plan and implement appropriate gastric cancer prevention across the EU. The results of this project will help policy makers integrate gastric cancer screening into their health care priorities, balancing its effectiveness, feasibility and acceptability with potential long-term adverse effects.

Expected Results and Material:

The TOGAS project has 3 specific goals:

1. Assessment of the current status and needs of Member States and target populations in the field of gastric cancer prevention, including information on “opportunistic” screening initiatives organized in public and private settings.
2. Assessment of the appropriateness of different gastric cancer screening methods for use in the EU.
3. Ensuring the sustainability of results through an effective dissemination strategy and aligning the methodology with approaches used in the EU, including European guidelines and Quality Assurance Systems.

The results and different approaches will be used in modeling possible programs and their cost-effectiveness in different EU countries.

The overall aim of the project “Towards gastric cancer screening in the European Union”, abbreviated as TOGAS, is to provide evidence-based knowledge missing by conducting three pilot studies, each aimed at addressing specific aspects of gastric cancer screening and early detection . This includes the evaluation of different strategies that are expected to be effective in preventing gastric cancer mortality in EU countries with different burden of gastric cancer and different prevalence of H. pylori infection.

Project Duration: 1st of March 2023 – 28th of February 2026.

Supporting Organisation: Institute of Clinical and Preventive Medicine, University of Latvia (UL ICPM)

Project partners: International Agency for Research on Cancer (IARC); European Society of Gastrointestinal Oncology (ESDO); Association of Digestive Cancers Europe (DiCE); European Helicobacter and Microbiota Study Group (EHMSG); European Organization Against Cancer (E.C.O); National Institute of Public Health, Slovenia (NIJZ); Nantes University Hospital, France; Erasmus University Medical Center, The Netherlands; Portuguese Institute of Oncology (I.P.O.); Madrid Health Service, Spain; Biomedical Research Foundation, Spain; Lithuanian University of Health Sciences; Iuliu Hațieganu University of Medicine and Pharmacy, Romania; Wroclaw Medical University, Poland; University Hospital Center Zagreb, Croatia; University Hospital Center Rijeka, Croatia; Thomas More University, Belgium; Beacon Sandyford Hospital Limited, Ireland; Otto-von-Guericke University in Magdeburg, Germany; Maria Skłodowska-Curie Institute of Oncology, Poland.

Funding: The project is co-financed with EU funds through the EU4Health program within the framework of the Cooperation Agreement, no. 101101252.

Disclaimer:  Funded by the European Union. The views and opinions expressed are those of the authors and do not necessarily reflect the views and opinions of the European Union or the European Health and Digital Executive Agency (HaDEA). Neither the European Union nor the body that co-finances the campaign can be held responsible for them.

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