Prevention of Upper Gastrointestinal Tract Cancers

Abstract

Key Points Prevention of both tobacco use and heavy alcohol consumption is a key factor in the primary prevention of upper gastrointestinal tract cancers. Infection with Helicobacter pylori is a gastric carcinogen. Only about 1-2% of persons infected with H. pylori ultimately are diagnosed with gastric cancer; therefore, an understanding of the cofactors in this process is an important area of research. Further, infection with CagA+ H. pylori has been associated with an apparent reduced risk of esophageal adenocarcinoma which may complicate treatment decisions. Barrett's esophagus is believed to be a premalignant lesion for esophageal adenocarcinoma. Obesity, as determined by elevated body mass index, is also associated with adenocarcinoma of the esophagus, rates of which are increasing in the United States. Maintaining body weight in the normal range throughout adult life is important for the prevention of many cancers, including esophageal adenocarcinoma. Consumption of fruits and vegetables is lower than optimal in the United States and increased consumption of these foods will have beneficial effects on the incidence of esophageal and stomach cancers as well as other major chronic diseases. Specific micronutrients or combinations of micronutrients may be effective in the prevention of upper gastrointestinal tract cancers, but this has not yet been consistently established in randomized controlled trials.