Gastric Cancer Prevention in Taiwan: Past Achievements and Future Perspectives.

Population-based screen-and-treat of Helicobacter pylori infection, a well-established cause of gastric cancer, is emerging as an effective strategy to reduce gastric cancer incidence and mortality, in line with recommendations from the working group convened by the International Agency for Research on Cancer. This report reviews the development of the population-based H. pylori screen-and-treat strategy as a healthcare policy for gastric cancer prevention in Taiwan from 2004 to 2025, tracing its evolution from localized pilot programs to regional initiatives and, ultimately, to full population-wide implementation. To support systematic implementation at the population level, Taiwan adopted a three-tiered foundation that includes: (1) a centralized planning committee; (2) screening service delivery through primary care providers, guided by clinical guidelines established by medical societies; and (3) community engagement to raise awareness of stomach health and promote participation in screen-and-treat programs through social media campaigns. Program execution strictly follows the principles of organized screening, supported by standardized quality indicators, integrated digital tracking systems, structured audit mechanisms, and both effectiveness and cost-effectiveness assessments. Strategies are tailored to local contexts: in the Matsu Islands, mass screening using the 13C urea breath test and subsequent eradication treatment led to reductions in H. pylori prevalence and gastric cancer incidence and mortality; in Changhua County, a pragmatic randomized clinical trial showed that stool sample-based screening using H. pylori stool antigen and fecal immunochemical testing improved participation and reduced gastric cancer incidence; and in indigenous communities, household-based approaches utilizing the 13C urea breath test could enhance H. pylori detection rate and reduce the intrafamilial transmission. In addition to the continuous assessment of its effectiveness in preventing both gastric cancer and peptic ulcer disease, it is also essential to evaluate the potential impacts on antibiotic resistance and gut microbial succession after mass H. pylori eradication. All these programs consistently maintain high standards of quality and equity, ensuring accessibility for diverse populations with varying socioeconomic positions. Collectively, it demonstrates how robust scientific evaluations, when combined with organized screening principles and systematic performance monitoring, can be effectively translated into sustainable, evidence-based programs for population-wide gastric cancer prevention.