Cancer of the gastrointestinal tract: early detection or early prevention?

Gastrointestinal cancer is a major medical and economic burden worldwide. Oesophageal and gastric cancers are most common in the non-industrialized countries, while colorectal cancer is the predominant gastrointestinal malignancy in westernized countries. Their aetiology is mainly related to correctable and preventable lifestyle habits; namely diet (including obesity), physical activity, alcohol and tobacco intake, and sanitation. Prevention and/or treatment of Helicobacter pylori infection would significantly reduce the prevalence of gastric cancer. Screening for cancer, its early detection and treatment requires medical facilities, endoscopic expertise and a major investment of national financial resources. This is only feasible in affluent industrialized countries such as Japan for gastric cancer, some western countries for oesophageal and colorectal cancer. Only population screening for colorectal cancer has been proven feasible and cost-beneficial.