Final Conference of the EU-funded project EUROHELICAN – Accelerating gastric cancer reduction in Europe through Helicobacter pylori eradication

The conference has showcased the results of research conducted in Slovenia and Latvia, as well as the recommendations of the IARC/WHO expert group for the implementation and organization of a primary prevention program for gastric cancer through screening and treatment of Helicobacter pylori infection.

The EUROHELICAN project – Prevention of gastric cancer through the detection and treatment of Helicobacter pylori infection – has been co-funded by the EU in the framework of the the EU4Health program (HaDEA). We have demonstrated how the “screen and treat” strategy should be implemented as a new preventive screening program to reduce the incidence of gastric cancer. The project commenced in November 2022 and will run until the end of April 2025. The coordinator is the National Institute of Public Health (NIJZ). Partner institutions include the Community Health Centre dr. Adolf Drolc Maribor (ZD MB), the Institute of Clinical and Preventive Medicine at the University of Latvia (LU), the International Agency for Research on Cancer of the World Health Organization (IARC/WHO), and the University Hospital Nantes (NANTES).

Gastric cancer remains a major public health challenge worldwide. In Europe, there are significant geographical differences in the incidence of gastric cancer.  Noncardia gastric cancer is in 89% of cases attributed to Helicobacter pylori (H. pylori) infection. The highest burden is observed in the regions of Eastern and Southern Europe. According to data from the European Cancer Inequalities Registry, Slovenia had the eighth highest gastric cancer incidence in the EU in 2020. Gastric cancer is expected to account for 4% of new cancer cases in men and 3% in women, with an age-standardized incidence rate exceeding 20 per 100,000 inhabitants, which is higher than the EU average of 15.8 per 100,000. In Europe, gastric cancer has a poor prognosis, with a 5-year relative survival rate ranging between 19% and 30%. Despite recent therapeutic advancements, 5-year survival rates have not significantly improved in most European countries over the past decades.

Given the absolute burden of gastric cancer, H. pylori infection is a logical target for urgent action in gastric cancer prevention. The exploration of implementing organized population-based screening using the H. pylori “screen-and-treat” strategy as part of primary prevention is supported by the latest international recommendations and European Commission policy documents on cancer prevention.

So far, no European country has adopted a gastric cancer prevention strategy or implemented organized screening for H. pylori or gastric cancer. The delay in action is partly due to longstanding doubts about the feasibility and acceptability of H. pylori  “screen-and-treat” strategy at the population level, as well as uncertainties regarding the potential adverse effects of mass antibiotic treatment, which have been refuted by recent research. The project’s goal is to bridge these gaps and enhance health promotion within the European Union by implementing the objectives of the Europe’s Beating Cancer Plan, with a focus on preventing gastric cancer caused by H. pylori infection.

The overall objective of the EUROHELICAN project is to assess the feasibility of a population-based screen and treat strategy for H. pylori infections to prevent gastric cancer in Europe.

Pilot Study on Screen-and-Treat Strategy in Slovenia

A pilot implementation of a population-based screen-and-treat program for H. pylori infection among young adults in Slovenia aimed to assess the acceptability of the proposed screening procedures, their feasibility within the healthcare system, and their acceptability to the target population. Initially, individuals aged 30–34 (5,500 insured persons) with a designated family physician at the Community Health Centre dr. Adolf Drolc Maribor were invited for H. pylori testing. The study was then expanded to a broader region, including other interested young adults aged 30–34. Participants completed a questionnaire and underwent H. pylori testing using IgG serology. Those with positive antibody results underwent a confirmatory urea breath test (UBT). All individuals with confirmed H. pylori infection received a 14-day antibiotic treatment. Treatment success was evaluated with a follow-up UBT one month after the completion of therapy. The study was led by the National Institute of Public Health (NIJZ) and conducted by the Community Health Centre dr. Adolf Drolc Maribor.

At today’s event, Prof. Dr. Bojan Tepeš, MD, Scientific Coordinator of the EUROHELICAN project, and Assoc. Prof. Dr. Prim. Jernej Završnik, Director of the Community Health Centre dr. Adolf Drolc Maribor, presented the results of the pilot study conducted in Maribor. The response rate among invited participants was 24%. Serology testing was performed on blood samples from 1,919 patients, of whom 269 tested positive and 1,650 tested negative, resulting in a 14% positivity rate. Among those who underwent confirmatory testing for active infection using the urea breath test (UBT), 83.1% tested positive, while 14.1% tested negative. Patients with a positive UBT received antibiotic therapy. Follow-up UBT conducted one month after treatment showed an eradication rate of 95,7% among those treated.

Long-term Effects Study in Latvia

Danute Ražuka-Ebela from the University of Latvia presented a study entitled “Long-term Assessment of Potential Adverse Effects of the Screen-and-Treat H. pylori Strategy in Latvia.” The study followed participants from the GISTAR study across five different research centers in Latvia. Recruitment began in autumn 2023, and the target of 2,000 participants was reached by June 2024. The study includes individuals who have been part of the GISTAR study over the past 11 years. Approximately half of the participants were tested for H. pylori, and those who tested positive were offered treatment or follow-up within the GISTAR study. Data collection included various factors such as anthropometric measurements and blood sample analyses. Participants previously diagnosed with H. pylori infection underwent a follow-up breath test. Currently, blood samples taken at the time of initial inclusion in the GISTAR study and again during the follow-up phase are being analyzed. The study aims to compare metabolic, inflammatory, and other biomarkers over time among different study groups. Additionally, it will evaluate the incidence of serious cardiovascular and metabolic events, peptic ulcers, and gastroesophageal reflux disease, as well as changes in body mass index (BMI).

The aim of the study is to evaluate the long-term effects of the H. pylori eradication or noneradication strategy among middle-aged Latvian men and women within the framework of the GISTAR population study.

Development of guidance by the expert group under IARC/WHO “ Population-based Helicobacter pylori screen-and-treat strategies for gastric cancer prevention: guidance on implementation ” within the EUROHELICAN project.

Dr. Jin Young Park presented progress toward global guidelines for population-based screening and treatment of H. pylori infection. After nearly two years of preparation international experts gathered for a three-day meeting from February 17 to 19, 2025 at the Agency for Research on Cancer (IARC). The meeting brought together an international, interdisciplinary group of 33 experts from 21 countries to discuss current practices and finalize the development of guidelines for implementing H. pylori screen and treat strategies for gastric cancer prevention in the adult population. The meeting, led by Dr. Jin Young Park, head of the Gastric Cancer Prevention Group at IARC, was held within the framework of the EUROHELICAN project.

The findings will be published as a report from the IARC working group, which addresses population-based screen and treat strategies for H. pylori infections as specific measures for the primary prevention of gastric cancer. The guidance are not limited to Europe only but aim to ensure global applicability, covering all world regions while considering differences in human development index and disease burden.

The working group report will include chapters on the epidemiology of H. pylori and gastric cancer, the effects of strategies, a summary of existing guidelines from various regions, current global efforts to prevent gastric cancer, assessments of needs and readiness, choices of screening methods and treatment approaches, the use of antibiotics, procedures and results to improve quality and equity, and ways to optimize the cost-benefit ratio of strategies.

Project Results

The results will assist policymakers in incorporating population-based screening and H. pylori treatment strategies as a priority in healthcare efforts to prevent gastric cancer in areas and population groups where it represents a significant burden, while balancing effectiveness, feasibility, acceptability, and potential harmful effects. Consequently, this will contribute to reducing gastric cancer rates in Europe and prevent significant loss of life and productivity due to this preventable cancer. The eradication of the infection will also reduce the burden of other diseases H. pylori infection can cause, such as gastric and duodenal ulcers, dyspepsia, iron-deficiency anemia, and some cases of idiopathic thrombocytopenic purpura.

Since Slovenia is one of the European countries with a high incidence and mortality rate from gastric cancer, the results of this project will be directly applicable to planning new cancer prevention and screening programmes in Slovenia.

The findings from both studies will provide scientific evidence on the effects and feasibility of the H. pylori ‘screen and treat’ strategy.

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EUROHELICAN – Accelerating gastric cancer reduction in Europe through Helicobacter pylori eradication:

Lead partner: National Institute of Public Health Slovenia

Project partners: Community Health Centre dr. Adolf Drolc Maribor, Institute of Clinical and Preventive Medicine of the University of Latvia, International Agency for Research on Cancer of the World Health Organization, University Hospital Nantes.

EUROHELICAN has been funded by the European Union in the framework of the EU4Health Programme.

Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or the European Health and Digital Executive Agency (HaDEA). Neither the European Union nor HaDEA can be held responsible for them.”

Disclaimer

Where authors are identified as personnel of the International Agency for Research on Cancer/World Health Organization, the authors alone are responsible for the views expressed in this presentation and they do not necessarily represent the decisions, policy or views of the International Agency for Research on Cancer /World Health Organization.