Markers for gastric cancer premalignant lesions: where do we go?

Only a small proportion of patients infected with Helicobacter pylori develop gastric cancer during their lifetime. At the same time, this type of cancer remains an important cause of mortality globally. The current interventional strategies have not been successful in decreasing the global burden of the disease; therefore, biomarkers for the identification of the individuals at high risk as well as those in the early stage of the disease is of high importance. In addition, predicting the point of no return for the development of the malignancy is of particular interest; whether atrophy, intestinal or spasmolytic polypeptide-expressing metaplasia, or some of their subtypes correspond to this point, still needs to be answered. The current review addresses the place of 'old markers', in particular pepsinogen tests for the identification of increased risk conditions. More data in Caucasian populations are required before these tests can be recommended for routine screening. Several of the host genetic factors are related to the development of sporadic gastric cancer; still their importance is probably not so high as initially thought, and at this stage host genetic factors cannot be used to identify high-risk groups. The detection of specific microRNAs could become a potential field in marker development, and several other new approaches for marker identification are emerging. To achieve the goal, a screening marker has to be not only accurate, but also available and cost-effective in the target populations, many of which are from low-income countries. This has to be considered when developing a marker or set of markers offered for gastric cancer screening programs.