A research team led by Professors Na-Young Kim and Yong-Hoon Choi from the Department of Gastroenterology at Seoul National University Bundang Hospital has demonstrated the potential of a blood test to identify individuals at high risk for gastric adenoma and early-stage gastric cancer—both precursors to full-blown stomach cancer.
In South Korea, the National Cancer Screening Program offers biennial endoscopic examinations for adults aged 40 and over. This initiative has played a key role in improving early detection and treatment outcomes for gastric cancer. However, the system reveals significant blind spots. An increasing number of patients under 40 are being diagnosed with the disease, while many patients over 70 find it physically challenging to undergo regular endoscopic screening.
Simply expanding the screening to younger populations is inefficient due to the relatively low incidence rate, and performing endoscopies on individuals over 75 is not generally recommended unless deemed necessary based on individual health conditions. Hence, the need arises for a more selective screening approach to identify those truly at high risk.
The researchers focused on a blood test kit known as the
GastroPanel, which measures serum pepsinogen levels. Gastric cancer typically develops over time through the progressive damage and transformation of the stomach lining—a process marked by a condition known as atrophic gastritis. The
GastroPanel indirectly assesses the degree of atrophic gastritis by measuring serum pepsinogen levels and determining
Helicobacter pylori infection status.
Analyzing clinical data from over 2,200 patients who underwent both endoscopy and blood testing at Seoul National University Bundang Hospital, the team found that individuals with a pepsinogen I/II ratio of 5.3 or lower had a significantly elevated risk of developing gastric adenoma and cancer. Notably, those with a low pepsinogen ratio and
H. pylori negativity were found to be 3.36 times more likely to have gastric adenoma and 2.25 times more likely to develop gastric cancer compared to the general population.
Interestingly,
H. pylori negativity was interpreted not as a positive indicator, but rather as a sign of advanced atrophic changes in the gastric mucosa. The explanation lies in the fact that
H. pylori, which initially contributes to mucosal damage, becomes unable to survive in the stomach's increasingly inhospitable environment as the damage progresses.
This study highlights the clinical potential of using combined serum pepsinogen levels and
H. pylori infection status as a non-invasive tool for early identification of high-risk individuals. Professor Kim’s team had previously shown that a combination of pepsinogen II levels and
H. pylori exposure could also identify high-risk groups for diffuse-type gastric cancer in young women, further underscoring the broad applicability of blood-based screening strategies.
“Elderly individuals who cannot undergo regular endoscopies and younger people not included in national screening programs are at risk of missing early signs of stomach cancer,” said Professor Kim. “Our findings provide strong clinical evidence that blood-based screening can serve as a practical alternative for these underserved groups.”
As personalized healthcare becomes more central in modern medicine, this research could lay the groundwork for more targeted and accessible gastric cancer screening strategies, bridging the gap in national healthcare systems.
