Stomach Cancer Screening | How Asian and Latinx Patients Can Self-Advocate

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Stomach Cancer Screening | How Asian and Latinx Patients Can Self-Advocate from Patient Empowerment Network on Vimeo.

How can Asian and Latinx patients self-advocate for gastric cancer screening? Expert Dr. Joo Ha Hwang from Stanford Medicine shares advice for how patients can discuss gastric cancer screening with their provider and how providers should be engaging with patients for better care.

[ACT]IVATION TIP

“…especially if you come from Korea, Japan, where they actually have instituted national screening, with endoscopy, we actually have U.S. guidelines that state that if you come from a country whose guidelines state you should have endoscopy, then you should also have endoscopy, we should be following your home of origins guidelines for you and so, those patients should also have endoscopy.”

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Transcript:

Lisa Hatfield:

So in the United States, we do have many people from the Asian and Hispanic communities who may be at higher risk for gastric cancer, do you suggest that they talk to their provider about getting screened? And how might they phrase that question? Can I get screened for the H. pylorI? So if you had a patient who wanted to be screened or is interested in getting screened, how might they approach their provider in asking for the screening for gastric cancer or H. pylori?

Dr. Joo Ha Hwang:

I think the first step is to get tested for H. pylori, and pretty much, everyone who is, an immigrant to the U.S. is at much higher risk for having H. pylori, in the past, we used to say that the people from Asia, immigrants from Asia had an 80 percent risk of having H. pylori, from Mexico, it was more like around 60 percent, United States, it was in the 20 to 30 percent, it’s probably less than that now.

So worldwide, prevalence of H. pylori is certainly going down but again, providers should know this is something that is taught in medical school, is areas that are, endemic with H. pylori and providers should also know that, H. pylori is a carcinogen, and so if a patient just comes up in and says I’m worried about having H. pylori, I come from a high-risk population, it really shouldn’t be difficult to get tested for H. pylori, furthermore, if they have any symptoms, especially any epigastric pain what we call dyspepsia that should also trigger the provider to go ahead and test for H. pylori, because that’s part of the algorithm. So I think that all of these, it shouldn’t be difficult to engage a provider on that particular issue.

Lisa Hatfield:

So it is okay and appropriate for a patient to approach their provider and ask that question? So I appreciate that.

Dr. Joo Ha Hwang:

I think it’s important and I think that patients need to be their own advocates, because I have heard of instances where providers have been reluctant and in certain systems they’re discouraged from further testing, because it’s a capitated system. I think H. pylori testing is not that difficult, sometimes if patients want endoscopy, it can be, more challenging but again, especially if you come from Korea, Japan, where they actually have instituted national screening, with endoscopy, we actually have U.S. guidelines that state that if you come from a country whose guidelines state you should have endoscopy, then you should also have endoscopy, we should be following your home of origins guidelines for you and so, those patients should also have endoscopy.

But the challenge with that is that they’re going to end up paying for it, because it’s not typically covered by insurance or it’s not fully covered by insurance so you’d probably have to pay a copay, for something like that at this time.

Lisa Hatfield:

I have a friend who’s dealing with her father who lives in Korea, she’s from Korea, has been here about two, five years. He has stomach cancer. So we’ve been having this discussion, and that’s why I thought I’d ask that last question. She said she sometimes is afraid to approach her provider…

Dr. Joo Ha Hwang:

If you’re afraid to approach your provider, you need a different provider.

Lisa Hatfield:

Well, that’s a good suggestion too.

Dr. Joo Ha Hwang:

No, no. We’re supposed to work with you and listen to you and again, I go around and give a lot of talks to patient groups, and I like engaging in these types of activities, because I think the more information patients have, the more that they can talk with their physicians, and oftentimes patients know more than their physicians do, because they’ve done a lot more research. And hopefully you have a physician with some hubris who will listen to the patient and if they don’t know, they’ll kind of look things up, so yeah.

Lisa Hatfield:

Yeah. I appreciate that, thank you.

Dr. Joo Ha Hwang:

My pleasure.

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Potential Impact of Artificial Intelligence on Stomach Cancer Detection and Care

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Potential Impact of Artificial Intelligence on Stomach Cancer Detection and Care from Patient Empowerment Network on Vimeo.

What role might artificial intelligence take in stomach cancer detection and care? Expert Dr. Joo Ha Hwang from Stanford Medicine shares his perspective on how AI might be most impactful in stomach cancer detection and care, how the FDA will be involved in AI use, and protections that must be put in place to safeguard patient interests.

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 Stomach Cancer Screening | How Asian and Latinx Patients Can Self-Advocate

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Can Stomach Cancer Risk Be Reduced by Treatment and Lifestyle Changes?

Transcript:

Lisa Hatfield:

Dr. Hwang, what is the current role of artificial intelligence or AI in gastric cancer care? And how do you envision the role of AI in the future management of gastric cancer?

Dr. Joo Ha Hwang:

Yeah, it’s a great question, very early day for AI but AI is really the hot topic, in the field of medicine, and AI will definitely play a role in, the detection of gastric cancer on probably many fronts, obviously the most straightforward one is during endoscopy, we can use AI to help identify early gastric cancer, and one of the issues in the United States is, since gastric cancer is a relatively rare finding, and it can be very subtle on endoscopy, a lot of endoscopists can miss an early gastric cancer or a precancerous lesion, and so we’re hoping to use AI to better identify, these lesions, since they’re not super common, and we’re really not taught to look for these lesions, this is an area that AI can be helpful. But the other, probably easier implementations of AI would be through just medical records and just using AI to help identify people who are at high risk.

And then flagging these patients for physicians to say, “Hey, this patient should be considered for H. pylori testing, this patient should be considered for endoscopic screening.” So I think that’s actually a simpler implementation of AI. So I think that AI will definitely help, it should help with outcomes, the challenge really is, working with the FDA to allow AI to be implemented in the clinical setting, that’s not a really simple task, because AI can also potentially be used for nefarious reasons and so we certainly have to protect patients’ identities, we have to protect patients’ information.

And so, there’s a lot of steps and a lot of responsibility that comes with AI. But I would say stay tuned, it will definitely, you’ll see more and more AI implementation over the years to come, and overall it should be very positive for patients for all disease processes, including gastric cancer.

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What Stomach Cancer Care Obstacles Do Asian and Latinx Patients Face?

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What Stomach Cancer Care Obstacles Do Asian and Latinx Patients Face? from Patient Empowerment Network on Vimeo.

What kind of gastric cancer care barriers do some patient groups face? Expert Dr. Joo Ha Hwang from Stanford Medicine discusses key factors that impact gastric cancer care access, and recommendations for patients and providers to reduce disparities.

[ACT]IVATION TIP

“…if you have any influence with the members of Congress, kind of bring up the issues related to minority health and access to healthcare. I know there’s a, within the Department of Health and Human Services, there is a Department of Minority Health, this is something that I think that they’re working on, which is access to healthcare, but it’s a real problem.”

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 Can Stomach Cancer Risk Be Reduced by Treatment and Lifestyle Changes?
Can Stomach Cancer Risk Be Reduced by Treatment and Lifestyle Changes?

Transcript:

Lisa Hatfield:

Dr. Hwang, what are the challenges faced by the Asian and Hispanic populations in accessing timely and appropriate treatment for stomach cancer? And what strategies could be implemented to address these challenges?

Dr. Joo Ha Hwang:

There are several questions or several challenges. Number one, I think, is patient awareness is educating these communities that they actually are at higher risk of developing gastric cancer. Number two, their access to healthcare oftentimes, is difficult sometimes because of language barriers, sometimes due to cultural issues, sometimes just due to regional geographic issues, and access to healthcare also insurance. A lot of the immigrant population, they even if they’re very successful and work quite a bit, oftentimes they’re, small business owners and they have high deductible, insurance plans. I had a friend who was an immigrant from Asia, and I told him you’re at high risk for developing gastric cancer, and you should have an endoscopy, we did an endoscopy on him and this was at a county hospital in Seattle.

He got a bill for $6,000 for his endoscopy, and I was personally appalled at that, and that’s actually kind of what got me into this field, was because I felt that that was very unfair, that this person who worked very hard and had insurance, but had a high copay, because he had high deductible insurance, was being treated like this when someone with Medicare, we’re charging only $200 for an endoscopy. And then if we had screening guidelines from the USPSTF such as for colon cancer, breast cancer, it would be completely free. And so there’s a huge disparity, and it is the Hispanic, it’s the Asian population, it’s the immigrant population that are at higher risk for gastric cancer.

And this is completely uncovered, and so, these are all inequities, in the system that we’re trying to address, what I would say, is that, if my activation tip for this would be, if you have any influence with the members of Congress, kind of bring up the issues related to minority health and access to healthcare. I know there’s a, within the Department of Health and Human Services, there is a Department of Minority Health, this is something that I think that they’re working on, which is access to healthcare, but it’s a real problem. The other side of it also is the education side and the empowerment side, and I think that we have to do a better job in terms of educating the populations who are at high risk for gastric cancer to go see their primary care physician to talk to them about what they need to do.

The other challenge really, actually is on the physician side, because, and I’ve been working at this as well, physicians don’t know, we’re taught in medical school that gastric cancer is rare, and it’s almost like an afterthought and we spend very little time on gastric cancer, but gastric cancer isn’t rare, and there are high risk populations, and there is something that we can do about it. So we really have a long way to go, but the good news is there is progress to be made, so if we just put in the effort, we can make a huge dent in outcomes for gastric cancer.

Lisa Hatfield:

Are there any efforts underway right now to develop guidelines for those communities in the U.S. to do screening? Do you know?

Dr. Joo Ha Hwang:

Yeah. We’re actively involved on a national level to work with societies and working with societies to make guidelines. This helps educate providers and whatnot, the challenge really in terms of getting insurers to cover this. This is really cost-effective, but oftentimes when insurers look at something they need to see an immediate return, they want to say within one year, this is cost beneficial, where this is a long….Gastric cancer prevention, any cancer prevention is really a long-term, outlook and that’s why the USPSTF plays such an important role because their guidelines have immediate implications on insurers and what they need to pay for, and so really we need, guidelines from the USPSTF, to make a true impact on the outcomes of gastric cancer.

But this is proving to be challenging because, the population that’s affected is a relatively small population in the United States. But again, in this era of precision medicine and equitable medicine, my view is it shouldn’t matter, in terms of the size of the population, that’s at risk, it should be data that says these particular patients are at high risk, and this intervention should work to decrease the risk of gastric cancer, and so I think we need to start having dialogue and changing the way we think about, patient care and make this more personalized, precision individualized medicine as opposed to population-based medicine.

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Can Stomach Cancer Risk Be Reduced by Treatment and Lifestyle Changes?

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Can Stomach Cancer Risk Be Reduced by Treatment and Lifestyle Changes? from Patient Empowerment Network on Vimeo.

Are there treatments and lifestyle changes that can reduce stomach cancer risk? Expert Dr. Joo Ha Hwang from Stanford Medicine discusses key risk factors of gastric cancer, incidence rates in some population groups, and recommended diet modifications to reduce risk.

[ACT]IVATION TIP

“…for anybody, not just, if you’re Asian or Latinx, talk to your physician about a healthy diet, because what I basically talk to my patients about is I counsel them on minimizing salt intake increasing fiber, higher intake of fresh fruits and vegetables, a well-balanced diet. I don’t think you need to go to an extreme, there are no supplements that you need to take that will protect you from developing gastric cancer, probiotics really aren’t of benefit either.”

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What Stomach Cancer Care Obstacles Do Asian and Latinx Patients Face?

Transcript:

Lisa Hatfield:

So you mentioned there is a treatment for H. pylori, does that significantly reduce the risk of gastric cancer then, if that’s treated?

Dr. Joo Ha Hwang:

Yes. It really depends on when you catch it. So if you catch H. pylori before it’s done, its damage to the stomach, it essentially brings your risk of gastric cancer back down to the baseline population, which is very, very low. If you catch H. pylori infection after it’s caused problems, you still decrease the risk, you kind of flatten the curve but you’re still at increased risk, if the damage to the stomach has already been done and you’ve already progressed onto intestinal metaplasia.

Lisa Hatfield:

Dr. Hwang, how do diet and lifestyle contribute to the incidence of gastric cancer in Asian and Latinx populations?

Dr. Joo Ha Hwang:

The main reason the diet affects, the risk of gastric cancer, is the salt content, to the best, that we know, and so we know that high salt content, for some reason increases your risk of gastric cancer, we think that maybe salts, somehow interacts with the mucosal barrier in the stomach and allows for H. pylori to become more invasive, we don’t know the specific mechanism for that but there was a recent study that came out of England that showed that if you added salt to your diet on a regular basis, that you increased your risk of developing gastric cancer by about 40 percent. Now, to put that into context, compared to the baseline population, if you have H. pylori infection, you increase your risk of developing gastric cancer by 2 to 300 percent.

And if you come from Korea or Japan, your risk of developing gastric cancer is probably somewhere between 8 to 1200 percent higher than the baseline population. So a 40 percent increase because of diet alone is a modest increase, compared to H. pylori infection and to some degree, your ethnicity. So that’s really both diet and lifestyle. There’s some data also that suggests, processed meats also increase your risk of gastric cancer, it’s always hard to study diet and its role in developing any type of cancer, because getting that data, specific enough is very difficult, but it makes a lot of sense since your stomach is basically the first thing that that food sees and we know that food can be somewhat toxic. On the flip side, things that we know to be healthy are the common sense stuff like fresh fruits, fresh vegetables.

We know that that is somewhat protective. And so how I counsel my patients and my activation code for this would be that for anybody, not just, if you’re Asian or Latinx, talk to your physician about a healthy diet, because what I basically talk to my patients about is I counsel them on minimizing salt intake increasing fiber, higher intake of fresh fruits and vegetables, a well-balanced diet. I don’t think you need to go to an extreme, there are no supplements that you need to take that will protect you from developing gastric cancer, probiotics really aren’t of benefit either. So in terms of diet and lifestyle, I think that those are just the main take-home points.

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What Are Key Risk Factors for Stomach Cancer?

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What Are Key Risk Factors for Stomach Cancer? from Patient Empowerment Network on Vimeo.

What factors have strong links to stomach cancer? Expert Dr. Joo Ha Hwang from Stanford Medicine discusses key factors linked to diet, certain population groups, and proactive patient advice to reduce stomach cancer risk.

[ACT]IVATION TIP

“…if you do come from Asia, one, try and minimize the salt in your diet if at all possible, try not to add any additional salts, and try and stick to a lower sodium diet, lower sodium content diet, and then number two, get tested for H. pylori. I think that H. pylori really is the main driver, and we do see a declining incidence of gastric cancer in Asia and that’s largely attributed to better recognition of H. pylori and treatment of H. pylori.”

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 Can Stomach Cancer Risk Be Reduced by Treatment and Lifestyle Changes?

Can Stomach Cancer Risk Be Reduced by Treatment and Lifestyle Changes?

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What Stomach Cancer Care Obstacles Do Asian and Latinx Patients Face?

Transcript:

Lisa Hatfield:

Dr. Hwang, are there any specific risk factors for gastric cancer that are more prevalent in Asian communities compared to other ethnic groups? Are there any hereditary factors?

Dr. Joo Ha Hwang:

I think the biggest risk factor that’s prevalent in Asian communities and also prevalent in wherever you see high incidence of gastric cancer, really the number one risk factor is H. pylori infection. So Helicobacter pylori infection, which is a bacterial infection of the stomach that’s usually obtained at a very young age, and basically persists in the stomach over decades and over decades someone can develop chronic inflammation that then changes the lining of the stomach to something called atrophic gastritis and gastric intestinal metaplasia.

And these are the precursors, or this is the pathway that many gastric, not all gastric cancers, but many gastric cancers take in their development. The other thing about Asian communities compared to other communities would be environmental things such as diet. So, I would say the Asian diet is probably saltier. There’s a higher salt content in the Asian diet than maybe the Western diet. And there was a recent study that showed that increased salt intake does affect your risk of developing gastric cancer. And we’ve actually known this for many, many years. Gastric cancer used to be one of the top three cancers in the United States and Europe back in the early 1900s. And I don’t think a lot of people know that.

And the two reasons that it’s gone down and the number one reason being refrigeration, so prior to refrigeration in order to preserve foods we salted everything. So there was an enormous salt content in our foods and you see, especially in Scandinavia, and you see a lot of the original gastric cancer research coming out of Scandinavian journals, and that just had to do with the fact that there was a lot of gastric cancer back then and so I think the rapid decline in the Western world can largely be attributed to both refrigeration and lower salt content and also the decreasing prevalence or the type of H. pylori that exists in the West.

And so I think that those are kind of the two primary risk factors that might be different in Asian communities versus the rest of the world. And so, my activation tip for this is if you do come from Asia, one, try and minimize the salt in your diet if at all possible, try not to add any additional salts, and try and stick to a lower sodium diet, lower sodium content diet, and then number two, get tested for H. pylori. I think that H. pylori really is the main driver, and we do see a declining incidence of gastric cancer in Asia and that’s largely attributed to better recognition of H. pylori and treatment of H. pylori.

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How Biomarkers Might Impact Future Stomach Cancer Care?

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How Biomarkers Might Impact Future Stomach Cancer Care from Patient Empowerment Network on Vimeo.

How might biomarkers impact the future of stomach cancer care? Expert Dr. Joo Ha Hwang from Stanford Medicine discusses the status of biomarkers in gastric cancer research and how gastric cancer screening and health outcomes in the U.S. compare to the rest of the world. 

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 What Stomach Cancer Care Obstacles Do Asian and Latinx Patients Face?

What Stomach Cancer Care Obstacles Do Asian and Latinx Patients Face?

Transcript:

Lisa Hatfield:

Dr. Hwang, can you speak to emerging biomarkers for early gastric cancer that have shown the most promise in your research? And how might these biomarkers influence future therapeutic strategies and outcomes for gastric cancer patients?

Dr. Joo Ha Hwang:

Yeah, it’s still very, very early days for biomarkers in the field of gastric cancer. Unlike other more prevalent tumors in the United States, and this has to go towards funding for research. Gastric cancer research has been fairly underfunded in the United States. The incidence of gastric cancer is not low, actually. There’s a lot more research in esophageal cancer and Barrett’s esophagus, but actually the prevalence or the incidence of esophageal cancer is much lower than stomach cancer.

So, fortunately the funding environment is slowly starting to change. There are active studies ongoing, both in the United States and abroad on looking at biomarkers. But I would say it’s too preliminary to even suggest that there are any specific biomarkers out there that might help to detect early gastric cancer.

And that’s either by tissue biopsy or anything that might be in the blood. But it will come, I mean, it’s coming for other diseases like colon cancer. So I’m confident that eventually we’ll see biomarkers come for detection of early gastric cancer, and we really need these biomarkers, or we need to be doing something because right now outcomes in the United States for gastric cancer are some of the worst in the world because we really don’t do anything for gastric cancer.

For example, the five-year overall survival for gastric cancer, if you’re diagnosed to it within the U.S., is only 30 percent. But if you’re in Korea, Japan, the overall five-year survival is somewhere close to 70 percent. And the single reason for that is the stage of diagnosis. Japan and Korea have screening programs to detect early gastric cancer, and in the United States we really don’t do anything. And so there’s a lot of ground that can be made up. And what’s frustrating for me is that this is a very curable cancer. And there are pre-malignant conditions that we know of that we can survey for, but right now the general policy in the United States is don’t do anything. So we really need to change that.

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How Can Public Policy Measures Reduce Gastric Cancer in High-Risk Populations?

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How Can Public Policy Measures Reduce Gastric Cancer in High-Risk Populations? from Patient Empowerment Network on Vimeo.

What are some ways that gastric cancer disparities can potentially be reduced by public policy actions? Expert Dr. Joo Ha Hwang from Stanford Medicine explains the significance of USPSTF recommendations, how these recommendations have helped in screening guidelines of other cancers, and proactive patient advice to help close the gastric cancer disparity gap. 

[ACT]IVATION Tip

“…I would encourage the listeners, especially if you have relationships with people in Congress, we need to reexamine making recommendations at a population level, and we really need to make recommendations based on individual risks, especially when we have clear-cut data as to who’s at high risk and what screening methods work.”

 

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 What Is the Role of Biomarker Testing in Stomach Cancer?

Transcript:

Lisa Hatfield:

Dr. Hwang, what public policy measures do you believe are crucial for reducing gastric cancer incidence and mortality, particularly in high-risk groups?

Dr. Joo Ha Hwang:  

So, there’s one key thing that really needs to happen. And that is there’s a body called the United States Preventative Services Task Force. They make all the guideline recommendations for screening. And what is important about a USPSTF guideline recommendation is that insurance companies are mandated to cover these screening tests at no cost. So, for example, breast cancer screening is part of this, colon cancer screening is part of the USPSTF recommendations.

So, what we really need is the USPSTF to recommend gastric cancer screening in high-risk populations. And there are clear high risk populations in the United States. And again, these are mainly immigrants from high-risk regions. But for example there’s a recent study out that showed that immigrants from Korea, Korean Americans have a 12-fold higher risk of developing gastric cancer than the baseline population.

And that risk is actually higher than the risk of colon cancer in the baseline population. And the biologic, the USPSTF already recommends colon cancer screening for that threshold and colon cancer screening is much, much more invasive than upper endoscopy because it requires a prep as well as doing the endoscopy. So, there are clearly high-risk groups out there. We’ve tried to engage the USPSTF to help make these recommendations, but it appears that the population at risk is too small.

And so they’re reluctant to make any recommendations for such a small population. The problem I have with that is we are entering an era of what we call precision medicine or personalized medicine. And that’s where we look at each individual, we don’t look at it on a population level. We look at each individual and determine what’s your risk for each individual cancer or disease? And let’s treat you for that.

And the approach that the USPSTF takes is still more of a population-based approach and not a precision-based approach. And the activation that I would encourage the listeners, especially if you have relationships with people in Congress, we need to reexamine making recommendations at a population level, and we really need to make recommendations based on individual risks, especially when we have clear-cut data as to who’s at high risk and what screening methods work.

And so this is a challenge for patients, especially the immigrant population who’s at high risk for developing gastric cancer. There are very weak screening recommendations, and it’s typically not covered by insurance. And so there’s a high cost to the patient, where this really should be some. It’s an effective screening method by doing endoscopy or even H. pylori testing that should be covered, because cost-effectiveness studies have been performed that show that this is cost-effective.

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What Is the Role of Biomarker Testing in Stomach Cancer?

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What Is the Role of Biomarker Testing in Stomach Cancer? from Patient Empowerment Network on Vimeo.

What’s the current status of biomarker testing in gastric cancer? Expert Dr. Joo Ha Hwang from Stanford Medicine shares an update about biomarker testing in gastric cancer research, H. pylori infection testing, and proactive patient advice about H. pylori and potential symptoms.

[ACT]IVATION Tip

“…go to your doctor, especially if you come from an area, or your parents come from an area that has high prevalence of H. pylori, which is pretty much anywhere in the world besides the United States, then you should talk to your doctor about getting H. pylori testing, especially if you have any abdominal pain symptoms or changes in appetite.”

 

See More from [ACT]IVATED Gastric Cancer

Related Resources:

What Are the GAPS Study Key Findings About Gastric Precancer?

 What Key Ways Is Early Detection of Stomach Cancer Delayed?

 How Can Public Policy Measures Reduce Gastric Cancer in High-Risk Populations?

Transcript:

Lisa Hatfield:

Dr. Hwang, can you speak to the role biomarker testing plays in gastric cancer? And what key information should patients know about early detection as it relates to biomarker testing?

Dr. Joo Ha Hwang:

So, currently there are no good biomarkers to detect gastric cancer at an early stage. So there’s a lot of investigation going on. Unfortunately, up to this point, gastric cancer research has been woefully underfunded on a national level. Most gastric cancer research has been funded by foundations and smaller interests. The NIH up until now has not put a lot of money into gastric cancer. Fortunately, we see this environment changing, and there’s an increasing interest at the NIH to fund gastric cancer research.

But that’s where identification of biomarkers comes from. There are companies out there that are looking at like circulating tumor DNA and other biomarkers. Again, I would say that there are very preliminary. And so I wouldn’t at this point recommend having these tests done because they’re so preliminary.

The one thing that I wouldn’t call a traditional biomarker, but is something that really increases your risk would be the presence of H. pylori infection. And so you can be tested for H. pylori infection by, there’s serum testing, there’s breath testing, you can get it on endoscopy, or the most common way is a stool antigen to test to see if you had H. pylori. The reason that that’s important is H. pylori is considered the number one cause of chronic gastric inflammation that then leads to gastric cancer.

And so the WHO has classified this as a class one carcinogen. And if you do have H. pylori, you should definitely get that treated. And depending on your age and how long you’ve had H. pylori infection, you should probably have endoscopy if you’re over the age of 40 to determine whether or not there’s any changes in the lining of your stomach that would increase your risk for developing gastric cancer. 

So, my activation tip for this would be go to your doctor, especially if you come from an area, or your parents come from an area that has high prevalence of H. pylori, which is pretty much anywhere in the world besides the United States, then you should talk to your doctor about getting H. pylori testing, especially if you have any abdominal pain symptoms or changes in appetite.

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What Are the GAPS Study Key Findings About Gastric Precancer?

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What Are the GAPS Study Key Findings About Gastric Precancer? from Patient Empowerment Network on Vimeo.

What have been key findings on gastric precancer from the GAPS Study? Expert Dr. Joo Ha Hwang from Stanford Medicine discusses the GAPS Study, patient groups at risk of H. pylori and gastric intestinal metaplasia, and proactive patient advice for early detection of gastric cancer.

[ACT]IVATION Tip

“…talk with your physician on whether or not you’re at high risk and you should have endoscopic screening or if you have gastric intestinal metaplasia (GIM). So let’s say you’ve had endoscopy and you have been diagnosed with gastric intestinal metaplasia, there are some guidelines out there that actually are deceptive.”

 

See More from [ACT]IVATED Gastric Cancer

Related Resources:

What Is the Role of Biomarker Testing in Stomach Cancer?

 What Key Ways Is Early Detection of Stomach Cancer Delayed?

 How Can Public Policy Measures Reduce Gastric Cancer in High-Risk Populations?

Transcript:

Lisa Hatfield:

Dr. Hwang, can you tell us more about the gastric precancerous condition study, the GAPS Study and its key findings so far? And how do you combine clinical and endoscopic data with bio-specimens in the GAPS Study to improve early cancer detection?

Dr. Joo Ha Hwang:

So, the GAPS study is a study that we started at Stanford when I first got there about six years ago. This is a prospective study where we enroll patients who we feel are at high risk for developing gastric cancer and then follow them longitudinally. And we do endoscopy and we do biopsies, we do systematic biopsies using something called the Sydney Protocol, where we basically map the stomach and take biopsies. And then with those biopsies, we run several different analysis on them.

And our goal is to identify biomarkers that would help to identify patients who are particularly high risk. So the thing that we’re looking for in particular, there’s a condition called gastric intestinal metaplasia. And that’s the pre-cancerous condition. That’s a change in the lining of the stomach, typically from chronic inflammation, and most commonly due to chronic H. pylori infection.

So unfortunately it’s quite prevalent. If you look at the Asian population, it can be over 30 percent of the population of Asians, East Asians can have gastric intestinal metaplasia, but not all of those patients will then go on to gastric cancer. And so, there’s a cost, especially in the U.S. the cost is pretty high to do endoscopic screening and surveillance. And so what we’re trying to do is further identify those patients who are at particularly high risk, who have gastric intestinal metaplasia, who would warrant ongoing surveillance given their risk of developing gastric cancer in the future.

So, this is going to take many, many years because it takes a long time for this to evolve. And so, we’re hoping to follow hundreds of patients longitudinally and determine what biomarkers, what other clinical factors may help to predict the progression onto gastric cancer so that we can detect gastric cancer early in those patients and cure them of gastric cancer.

So my activation tip for this particular question or for this particular topic would be that, again, talk with your physician on whether or not you’re at high risk and you should have endoscopic screening or if you have gastric intestinal metaplasia (GIM). So let’s say you’ve had endoscopy and you have been diagnosed with gastric intestinal metaplasia, there are some guidelines out there that actually are deceptive. And if you are in the group that is at higher risk of developing gastric cancer, you should talk to your physician about how having endoscopic surveillance and what that interval should be for having endoscopic surveillance to make sure that you don’t progress onto developing gastric cancer.

Lisa Hatfield:

And just out of curiosity, with this GAPS Study, trying to identify biomarkers that might be used in the future to track that, are these biomarkers something that you find in the tissue from the biopsy, are they biomarkers you might find in the blood or saliva? So people can have less invasive means to have surveillance for gastric cancer?

Dr. Joo Ha Hwang:

We’re investigating all of that. So when we enroll a patient in GAPS, we collect saliva, we collect blood, serum. So ideally it would be a noninvasive biomarker, but the best biomarker is something that wouldn’t require endoscopy. But we are also looking at the tissue itself. So all of these things are being investigated. So stay tuned.

Lisa Hatfield:

And my last question about that, in case if a patient is watching this in the Bay Area, is your study currently enrolling participants?

Dr. Joo Ha Hwang:

Yes, we are actively enrolling and we welcome anyone’s participation.

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What Key Ways Is Early Detection of Stomach Cancer Delayed?

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What Key Ways Is Early Detection of Stomach Cancer Delayed? from Patient Empowerment Network on Vimeo.

How is early detection of gastric cancer commonly delayed? Expert Dr. Joo Ha Hwang from Stanford Medicine discusses symptoms that patients may experience, whether some patients may be asymptomatic, risk factors, and proactive patient advice for early detection.

[ACT]IVATION Tip

“…each person should know what their risk for gastric cancer is, and we know the main risk factors are your ethnicity, especially your immigrant status. So if you’re a recent immigrant from a high incidence area, then you’re at risk. And then number two, have you had H. pylori infection? Again, if you’re a recent immigrant from an area that’s endemic with H. pylori, you should get tested for H. pylori. And number three, talk with your physician about your risk factors and determine whether or not you weren’t having endoscopic screening or surveillance, especially if you have any symptoms whatsoever.”

 

See More from [ACT]IVATED Gastric Cancer

Related Resources:

What Is the Role of Biomarker Testing in Stomach Cancer?

 What Are the GAPS Study Key Findings About Gastric Precancer?

 How Can Public Policy Measures Reduce Gastric Cancer in High-Risk Populations?

Transcript:

Lisa Hatfield:

Dr. Hwang, what are the key challenges in the early detection of gastric cancer, and how is your research addressing these challenges?

Dr. Joo Ha Hwang:

Well, the key challenge in detecting early gastric cancer is that there are no symptoms, or the symptoms are very generalized. You can have some vague abdominal pain, your appetite might change a little bit, but we don’t see symptoms until the later stages of gastric cancer when it’s no longer curable. So the real key challenge is to diagnose it at an early stage when it’s still curable and what we’re doing in terms of our research, and then the research community in general, is one, trying to identify patients who are at particularly high risk for developing gastric cancer.

And we have a pretty good idea on who that is. And it’s essentially recent immigrants from high-risk areas such as East Asia, Eastern Europe, Western, South America. There are populations where we know there’s a high incidence of gastric cancer. And in many of these locations, they do endoscopy for early gastric cancer. And so the key really is to identify who is at higher risk for developing gastric cancer and then having them undergo endoscopic screening to further determine what their risk factor is to develop gastric cancer. And then those who are at extremely high risk, they should be on what we call a surveillance program for that.

Lisa Hatfield:

Do you have an activation tip for people for that particular question?

Dr. Joo Ha Hwang:

Yeah. I would say a couple activation tips. I know we’re trying to stick to just a few key ones, but number one would be know your risk for gastric cancer. So each patient, each person should know what their risk for gastric cancer is, and we know the main risk factors are your ethnicity, especially your immigrant status. So if you’re a recent immigrant from a high incidence area, then you’re at risk. And then number two, have you had H. pylori infection?

Again, if you’re a recent immigrant from an area that’s endemic with H. pylori, you should get tested for H. pylori. And number three, talk with your physician about your risk factors and determine whether or not you weren’t having endoscopic screening or surveillance, especially if you have any symptoms whatsoever.

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How Can Gastric Cancer Patients in Rural Areas Access Specialists?

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How Can Gastric Cancer Patients in Rural Areas Access Specialists? from Patient Empowerment Network on Vimeo.

How can rural gastric cancer patients gain access to specialists? Expert Dr. Jun Gong from Cedar-Sinai Medical Center discusses access to additional medical consults and a way to access more Asian and Hispanic patient groups.

[ACT]IVATION Tip

“…for challenges faced with timely access to Asian and Hispanic subgroups and all racial groups, in my opinion, is to seek…it’s always appropriate to seek second or third opinions particularly at larger comprehensive cancer centers for the availability of clinical trials or whether it’s about questions about standard of care therapies or actually just questions about can we have a supportive service that you may offer that our local community providers may not offer?”

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See More from [ACT]IVATED Gastric Cancer

Related Resources:

How Does Gastric Cancer Screening Differ for High-Risk Groups?

 Addressing Elevated Gastric Cancer Risks in Asian and Hispanic Communities

 What Gastric Cancer Challenges Do Asian and Hispanic Groups Face?

Transcript:

Lisa:

So there are maybe some patients who are in more rural communities or go to smaller cancer centers. You’re at a very large center that has a lot of these resources. Do you think there is some benefit to patients if they have the ability to have a consult done by a specialist like yourself who only see, or who sees mostly gastric cancer patients? Can they tap into that like as a one-time consult when they’re diagnosed, particularly if they have metastatic disease, and could they also tap into the resources of a larger center?

Dr. Jun Gong:

That is a great question, Lisa. And yes, we do do that. We, as part of a large urban medical center here, we have a great relationship with our community oncologist and primary care doctors and other subspecialists where we are often referred for a second opinion or a third opinion. Sometimes it’s really, is this the best treatment that I have? Or it’s simply a question of are there clinical trials because we would like to refer to an urban medical center, a larger comprehensive cancer center for clinical trial options.

And here what I would like to add is that the post pandemic period has really afforded, in my opinion, an easier way to do consultations. I know it’s specific to certain institutions and certain centers, but I actually am okay with virtual medicine consultations for those who are…who find it difficult to travel to an in-person visit, again, I can’t speak for all other cancer centers or oncologists, but we at least offer this ability to do that, to help with that barrier of transportation. And when they are connected with us sometimes if we are able to, we can even follow peripherally, almost like an extra care partner with the main local doctor who’s driving more of the day-to-day, and we’re providing our recommendations as an extension from an urban medical center.

Lisa:

Great. Thank you for that information. I know as a cancer patient and a patient advocate, I will always recommend seeking out a consult from another person just to have another set of eyes on, particularly if it’s a specialist like yourself who sees primarily that type of cancer. So, thank you.

Dr. Jun Gong:

My activation tip for challenges faced with timely access to Asian and Hispanic subgroups and all racial groups, in my opinion, is to seek…it’s always appropriate to seek second or third opinions – particularly at larger comprehensive cancer centers – for the availability of clinical trials or whether it’s about questions about standard of care therapies or actually just questions about can we have a supportive service that you may offer that our local community providers may not offer? Or can you help us in a later stage of our treatment? Not just a one-time consultation, really just raising awareness that we do have ancillary staff that are very, very, very helpful in terms of addressing a lot of these risk, healthcare access barriers.

The one thing I would’ve liked to add was I think involving church groups is a really, really great way for Asians and Hispanics, because they are so heavily invested in attending church services. And that’s one of the innovative approaches from the Cedars-Sinai perspective is that we actually have a disparity center, a center of community outreach where we are actually engaging both Asians and Hispanics and other racial groups with their leaders in the churches, the local churches, to actually educate and promote awareness.

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What Gastric Cancer Challenges Do Asian and Hispanic Groups Face?

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What Gastric Cancer Challenges Do Asian and Hispanic Groups Face? from Patient Empowerment Network on Vimeo.

 What kind of gastric cancer care barriers do Asian and Hispanic groups face? Expert Dr. Jun Gong from Cedar-Sinai Medical Center discusses specific barriers that are experienced by some patient groups and some solutions to overcome barriers.

Download Resource Guide | Descargar guía de recursos

See More from [ACT]IVATED Gastric Cancer

Related Resources:

How Does Gastric Cancer Screening Differ for High-Risk Groups?

 Addressing Elevated Gastric Cancer Risks in Asian and Hispanic Communities

 How Can Gastric Cancer Patients in Rural Areas Access Specialists?

Transcript:

Lisa:

What are the challenges faced by the Asian and Hispanic populations in accessing timely and appropriate treatment for stomach cancer and what strategies can be implemented to address these challenges?

Dr. Jun Gong:

There are several challenges that we see in our routine care of patients that are of Hispanic or Asian ethnicity with regards to access to treatment to stomach cancer. This often involves language barriers where, at least here geographically in Los Angeles, it’s a culturally diverse population, large metropolitan center where patients often speak non-English language. And this is often a barrier to communicating and getting timely access. Other concepts that we’ve come into as well is fear of insurance coverage denials in seeing the subspecialists or access to timely diagnostics and approval of treatments through insurance.

Other barriers include transportation. We have patients that actually have transportation issues. And although they try to take public transportation or whatever means necessary to get here, this still represents a formidable barrier to access. Other access related barriers that we often see is also caregiver support.

Here, patients are…stomach cancer is a quite complex illness. It can affect diet, it can affect strength. And so oftentimes these patients need more support to help with their daily activities as well. And so these are just a few of the growing kinds of risk factors or access related barriers that we’ve seen. How do we overcome this, is one of the major dilemmas right now in all of cancer care and medicine, in my opinion, not just exclusive to stomach cancer.

What I think is important here is advocacy groups. There are a lot of good stomach cancer advocacy groups such as the ones we’re participating under today. These can be accessed through public publicly available means either through word of mouth. They’re often health fairs that are a good place to distribute this.

I often think public libraries are also a great place for healthcare advocacy and connections. Obviously, the Internet is also one good means for doing this, but not all patients have internet access as well. So this is something that you also have to play into. As part of our clinical care team, we have our social worker and our case management teams that really comprise an important social, psychosocial resource to our patients where we do our best to connect them with advocacy support groups where we can connect them with resources such as transportation.

We certainly are more than happy to help with insurance related questions as well. And then another point I forgot to mention as well is that when you embark on treatment, sometimes patients are really debilitated and they’re not able to carry on their normal means of a living. And so here our supportive services teams within our cancer care team can really help with the financial impact of being on treatment such as chemotherapy for a period of time as well.

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Addressing Elevated Gastric Cancer Risks in Asian and Hispanic Communities

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Addressing Elevated Gastric Cancer Risks in Asian and Hispanic Communities from Patient Empowerment Network on Vimeo.

 How can higher gastric cancer risks for Asian and Hispanic populations be overcome? Expert Dr. Jun Gong from Cedar-Sinai Medical Center discusses H. pylori risk and screening and advice to patients to be proactive in their care.

[ACT]IVATION Tip

“…for the risk factors that are specific to the Asian and Hispanic populations is to understand the symptoms of H. pylori, which is one of the most common causes of stomach cancer, because they can be very effectively treated with antibiotics over a period of two weeks, oftentimes, and they’re very effective. This can be done at multiple provider levels from the primary care setting to the subspecialist setting. And also to know that symptoms, if they occur in family members that reside with the patient that is infected with h pylori or has stomach cancer, for them to be tested and the importance for their treatment as well.”

Download Resource Guide | Descargar guía de recursos

See More from [ACT]IVATED Gastric Cancer

Related Resources:

How Does Gastric Cancer Screening Differ for High-Risk Groups?

 What Gastric Cancer Challenges Do Asian and Hispanic Groups Face?

 How Can Gastric Cancer Patients in Rural Areas Access Specialists?

Transcript:

Lisa:

Dr. Gong, what can be done on an individual and systemic level to address the elevated risk for gastric cancer in the Asian and Hispanic populations?

Dr. Jun Gong:

To address the elevated risks for gastric cancer in Asian and Hispanic populations, I think it’s very important to understand what are probably some of the universal risks to both groups. And here, there’s been growing evidence that H. pylori infection affects both Asians and Hispanics and is one of the more pivotal risk factors to address on a systematic level. Here, there have been ongoing research where they’re just identifying H. pylori as a procedure and eradicating it with treatment.

This is usually with antibiotic containing treatment for about two weeks. And this imposes what we call a primary prevention method if we can actually eradicate one of the primary causes of stomach cancer. Is this the best way to address the greatest risk factor on a systematic level for Asians and Hispanics and other ethnic groups at high risk? On an individual level, I think again, this comes to tailoring what the diagnosis is with the respect of ethnicity of the patient and their cultural and their background as well as their familial background. Here, H. pylori, dietary lifestyle, hereditary causes are important to address, to minimize risk for stomach cancer.

And it’s also important to know that on the individual level, that family members that are living with patients with stomach cancer may also have what we call H. pylori incidence around the entire family. So it’s important to advise that sometimes your family members, because of the close living facilities and the shared utilities and restroom and how we dine together, that this shares a familial risk. And oftentimes it may need to be that your family needs to be treated if H. pylori is detected within the family as well.

Lisa:

So if a patient comes in and their family members are concerned, would it be advised that maybe their family members can go see their primary care provider and say, “Hey, my family member has gastric cancer. Will you test me for H. pylori? Is that…would that be a valuable question to ask?

Dr. Jun Gong:

So I think that raises the big question about should we systematically test all high-risk subgroups for H. pylori? And I think the jury is still out on that. There has to be formalized guidelines. What I recommend is family members who are with another family member that’s diagnosed with H. pylori and/or stomach cancer, if they are having any concerning symptoms of H. pylori infection, this is usually abdominal discomfort. It can actually be gastritis type symptoms of acid reflux. If you have any of those symptoms, then those are certainly indications for you to be tested either at the primary care level for H. pylori.

My activation tip for the risk factors that are specific to the Asian and Hispanic populations is to understand the symptoms of H. pylori, which is one of the most common causes of stomach cancer, because they can be very effectively treated with antibiotics over a period of two weeks, oftentimes, and they’re very effective. This can be done at multiple provider levels from the primary care setting to the subspecialist setting. And also to know that symptoms, if they occur in family members that reside with the patient that is infected with h pylori or has stomach cancer, for them to be tested and the importance for their treatment as well.

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How Does Gastric Cancer Screening Differ for High-Risk Groups?

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How Does Gastric Cancer Screening Differ for High-Risk Groups? from Patient Empowerment Network on Vimeo.

 Is gastric cancer screening different for some high-risk groups? Expert Dr. Jun Gong from Cedar-Sinai Medical Center shares how screening guidelines are evolving for some high-risk patient groups and advice to patients to ensure essential screening occurs.

[ACT]IVATION Tip

“…understanding whether you are in a specific high-risk subgroup it’s important to ask, whether diet and lifestyle can contribute to these risk factors are important to ask, and whether there is a risk of familial or hereditary causes of stomach cancer is important to ask as well. For us as oncologists to guide you to our supportive services and down the right path to address all of these concerns.”

Download Resource Guide | Descargar guía de recursos

See More from [ACT]IVATED Gastric Cancer

Related Resources:

Addressing Elevated Gastric Cancer Risks in Asian and Hispanic Communities

 What Gastric Cancer Challenges Do Asian and Hispanic Groups Face?

 How Can Gastric Cancer Patients in Rural Areas Access Specialists?

Transcript:

Lisa:

Are there any screening tests that are recommended for anyone who might be in a group that’s known to have a higher incidence of gastric cancer?

Dr. Jun Gong:

Screening for stomach cancer in the U.S. is very evolving. It’s somewhat controversial. Unlike in East Asia and parts of the world where they’ve actually implemented standard endoscopic screening protocols as young as 40 or age 50. Here in the U.S., there hasn’t been any formal screening guidelines implemented for stomach cancer.

However, a lot of consensus groups recognize the high-risk subgroups of stomach cancer and in these risk factor, high-risk factor groups, especially if you have a family member a first-degree family member with stomach cancer or you’re a part of one of these ethnic groups that are at high risk, they do encourage screening to be discussed with your provider. And this can entail endoscopy surveillance as well.

So my activation tip regarding risk factors is to always inquire whether from your provider or from ancillary staff.  It’s very common for us to refer our patients as well to cancer nutritionists, dieticians as well, in addition to going over what may be some possible familial or hereditary risk, if we sense that a strong family history is present.

And this is where referrals to genetic counselors are available. But understanding whether you are in a specific high-risk subgroup it’s important to ask, whether diet and lifestyle can contribute to these risk factors are important to ask, and whether there is a risk of familial or hereditary causes of stomach cancer is important to ask as well. For us as oncologists to guide you to our supportive services and down the right path to address all of these concerns.

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Do Gastric Cancer Risk Factors Differ Among Hispanic Communities?

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Do Gastric Cancer Risk Factors Differ Among Hispanic Communities? from Patient Empowerment Network on Vimeo.

Are there gastric cancer risk factors that differ for Hispanic communities? Expert Dr. Jun Gong from Cedar-Sinai Medical Center discusses risk factors for Hispanic and other higher risk stomach cancer groups.

Download Resource Guide | Descargar guía de recursos

See More from [ACT]IVATED Gastric Cancer

Related Resources:

What Early Phase Gastric Cancer Trials Are Showing Promise?

 Expert Guidance: Stomach Cancer Basics for Newly Diagnosed Patients

 How Is Gastric Cancer Screening and Care Impacted by Culture?

Transcript:

Lisa:

Are there any specific risk factors for gastric cancer that are more prevalent in Hispanic communities compared to other ethnic groups?

Dr. Jun Gong:

So this is an interesting question in terms of risk factors and certain ethnic groups. We’ve realized that actually gastric cancer is highly prevalent in East Asia. And there, the risk factors seem to be more diet-related. But then when you look on the Western side of the world, it’s different risk factors that exist for stomach cancer. You always have familial risk. These are genetic, ancestral, or hereditary causes of stomach cancer, which are fairly rare. And this is independent of geography.

But here on the West, we tend to see more of risk factors related to the Western lifestyle. Here, gastritis or chronic gastritis, heartburn, longstanding inflammation is a risk factor. Heavy smoking, heavy alcohol use, and obesity are emerging risk factors for stomach cancer as well. And also, we have a very unique risk factor in a bacteria called H. pylori that is known globally to be a risk factor for gastric cancer.

And we’ve done research on this in that although the demographics in the U.S. is very diverse, we do see that Asians and Hispanics and African Americans compose higher risk groups for stomach cancer when compared to non-Hispanic whites. And in certain ethnic groups such as the Koreans, it can be as much as five times the risk for non-Hispanic whites. And we think it is due to these unique variations in H. pylori risk across the different races. We’ve done research at Cedars-Sinai where we’re looking at the Hispanic population and we’ve seen over time that actually, in addition to Hispanic populations being at higher risk for stomach cancer, it seems to be affecting a younger group and in particular younger females.

So we’re looking into this kind of new epidemiologic evidence as to why stomach cancer in Hispanics is becoming younger in onset and tends to have a predilection for females. And these patients however, if they are afforded the correct treatment and the timely treatment, their outcomes are just as good as the non-Hispanic counterparts. So this is an emerging topic and a very important topic in my opinion.

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