Discovering any cancer's risk factors is of extreme importance to prevent it and diminish its incidence. Establishing gastric cancer's risk factors can aid doctors to make better decisions. The greater understanding of the pathogenesis of gastric cancer regarding Helicobacter pylori will allow the medical community to produce specific recommendations about systematic treatment or screening of HP.

The study published on NEJM, on january, 2020, provides solid evidence on the role of Helycobacter pylori as a risk factor for gastric cancer. The design of the study, which contemplates HP+ first-degree relatives of patients with gastric cancer, it’s very specific for a select group of patients who could possibly have genetic or familiar predisposition for the development of neoplastic growth. Next studies should aim the relation between HP asymptomatic infection and cancer in people without familiar historic of the disease, since prophylactic treatment it’s very diffused among patients without signs or symptoms that are diagnosed with HP and could relate to bacterial resistance.

If we know the risk factors for developing certain types of cancer and, hopefully, all types one day, gives us the possibility of early diagnosis, treatment and the chance to reduce mortality while improving quality of life. Besides that, the possibility of preventing the development of this type of cancer when the risk factor is removed it’s encouraging for doctors who deal with this disease and patients, like the treatment of H. pylori. Since gastric cancer has big incidence, recognize its risk factors and have the possibility to change them and then change the patients lives is a great thing for them, for science, for medicine and the future.

By knowing the risk factors for a disease - especially a cancer - we can diminish its incidence and prevalence substantially. Therefore, studies such these are fundamental for the improvement of the treatment for gastric cancer. Since Helicobacter pylori colonization is extremely common in the human gut, by recognising the association between such infection and oncogenesis we can hope to achieve lower levels of gastric cancer in the near future.

The investigation of risk factors is pivotal when it comes to cancers which are rarely diagnosed in early stages of disease, such as gastric cancer. Recognizing H. pylori infection as an evidence-proven risk factor for this type of neoplasia is a breakthrough of massive importance that could potentially decrease the dramatic consequences of late diagnosis of gastric cancer. That being said, establishing protocols for treatment of patients at risk (or, even more crucially, determining which patients have a larger risk of developing gastric cancer) is paramount, given the economic burden systematic treatment would represent to healthcare systems around the world.

Risk factors are one of the most powerful weapons we can indirectly use against diseases. The definition about the significance of HP for gastric cancer can be used as a important measure to establish risk population and from that clarify the best way to follow up those people, wheter using medication, exams or other ways. The specific study should be validated to other populations in order to increase its relevance.

It's impressive how gastric cancer can still be considered one of the worst malignant tumors worldwide, inasmuch as people are not aware of the risk factors that surround the disease, thus, when you don’t know the enemy, easier it gets to get sick of. Moreover, when you are coping with such tremendous condition, one must see whether the treatment is well recommended or not. By the way, the text above elicits doubt whether we should treat people with HP asymptomatic. Therefore we still have to look up for further ECRs and other studies in order to get a fierce control over the illness.

In spite of it's low and decreasing incidence, gastric cancer still represents one of the most harmful tumors among all neoplasias. Knowing that, efforts should be directed to understand the risk factors that culminate on it, in order to avoid untreatable cases. H.pylori infection is considered a class I carcinogen, and a research conducted by a Korean group using this information as background shows good evidence in favor of systematic treatment of asymptomatic patients with first-degree relatives with gastric cancer. More evidence must be produced extending the sample to patients without familiar history and non-asiatic to prove that systematic treatment is effective to prevent this type of cancer in a general perspective.

Since gastric cancer is still extremely prevalent in our society, it is imperative that we expand our treatment recommendations for H. Pylori. The NEJM study helps for cases with a family history, and has an important clinical relevance, despite its specific group analysis. However, we should seek to develop other studies that assist in these recommendations, such as studies with asymptomatic H.Pylori infection and no family history.

The more we know about various aspects (pathogenesis, etiology, family history, etc.) of a disease, the greater are the chances of reducing its incidence. Gastric cancer still has a high worldwide prevalence and its important risk factor, according to a study published in the NEJM, is infection by H. Pylori. That study showed a 55% reduction in gastric cancer risk among HP+ participants who received eradication therapy vs. placebo, but it was done in a specific population, so it should be reproduced in other locations and in a more heterogeneous population (such as asymptomatic and without a family history of gastric cancer), in order to make it more relevant, aiming to establish treatment protocols for risk groups, in order to reduce incidence of such disease.

The recognition of risk factors for several diseases, specially malignancies, is probably the corner stone of prevention and early diagnosis. Since H.Pylori's impact on gastric mucosa was uncovered, thirty years ago, it has been extensively studied but still remains a controversial topic. In this Korean randomized trial, HP erradication in selected participants was linked to decrease gastric cancer risk, which favours the systematic treatment. However, it is estimated that around 4 billion people are currently HP+, and more investigation is needed to understand the magnitude of its impact and to explain gastric cancer regional prevalence variability.

Although the incidence of gastric cancer is decreasing, the disease still remains as one of the most harmful neoplasias. It is necessary efforts to understand the risk factors, in order to prevent cases. The NEJM study showed a reduction in gastric cancer risk among HP+ participants who received eradication therapy vs. placebo. In spite of the specific group included in the analysis, the trial had an important clinical relevance.

Gastric cancer remains one of the most common and deadly cancers worldwide, stomach cancer is the 5th most common neoplasm and the 3rd most deadly cancer. The factors most associated with increased risk of gastric cancer were dermatomyositis, pernicious anemia, Addison's disease, dermatitis herpetiformis, IgG4-related disease, primary biliary cirrhosis, type 1 diabetes mellitus, systemic lupus erythematosus, and Graves' disease. Gastric cancer incidence and mortality are highly variable by region and highly dependent on diet and Helicobacter pylori infection.

It is important to recognize the risk factors for a cancer, therefore we can prevent those behaviors and try to screen the "red flag" population. The gastric cancer, as it seems, is on the top five incidence of malignant tumors. According to the text, the classic most relatable risk factors for gastric cancer are atrophic gastritis and the Helicobacter pylori infection. Plus, new trials identified autoimmunity as a important mechanism in the gastric carcinogenic cascade.

The discovery of Helicobacter pylori has revolutionized the understanding of gastric ulcers and also changed the way we treat and, especially, prevent gastric cancer. Knowing it is an important risk factor is extremely relevant to Brazilian reality, given the 70% prevalence of HP in our country – outrunning the 50% of prevalence in world statistics. By knowing the risk factors of any kind of cancer, new treatments emerge, as well as more efficient prevention programs. Therefore, HP - a pathogen that can be treated with a combination of reachable drugs - shows its value in medicine and Brazilian people’s lives.