Chemoprevention of gastric cancer: role of COX-2 inhibitors and other agents.

Despite the decrease in incidence, gastric cancer remains the second leading cause of cancer-related death worldwide. Prevention is likely to be the most effective means of not only reducing the incidence but also mortality from this disease. The term 'chemoprevention' has been referred to the prevention of cancer using specific agents to suppress or reverse the carcinogenic process. In recent years, attention has been focused on the anticancer properties of non-steroidal anti-inflammatory drugs (NSAIDs), Helicobacter pylori eradication therapy and diet life-style. In vitro and in vivo studies show that widespread and long-term use of NSAIDs may be adopted in the healthy population for gastric chemoprevention. Albeit, enthusiasm has been thwarted by the potential toxic effects, i.e., risk of peptic ulcer disease. The new NSAIDs, selective cyclooxygenase-2 inhibitors, causing less injury to the mucosa of the upper gastrointestinal tract may be a valid alternative. However, fundamental questions such as safety, efficacy, mechanisms of actions, and optimal treatment regimens need to be defined. H. pylori triggers gastric carcinogenesis, however, cost-effect analyses suggest that only a subgroup of H. pylori-infected subjects present beneficial changes following eradication therapy. Diet plays an important role in the pathogenesis of gastric cancer either increasing the risks of or protecting against, cancer development. Thus, a reasonable suggestion for the general population is a natural chemoprevention based on life-style 'eat to live, not live to eat'. Copyright (c) 2004 S. Karger AG, Basel.