Even at the age of 80: simple antibiotic treatment cuts the risk of dying from cancer in half

Stomach cancer is considered one of the deadliest types of cancer in the world. In 2022, it was ranked fifth in prevalence and death rate, with close to a million new cases and over 650,000 deaths worldwide. One of the main factors in the development of the disease is the chronic infection with the bacterium Helicobacter pylori, a bacterium that is often acquired in childhood and causes prolonged inflammation of the stomach lining. Over decades, the inflammation may progress to pre-cancerous changes and later to cancer.

While previous studies have shown that treatment to eradicate the bacteria reduces the risk of stomach cancer, an open question remains about its effectiveness in old age, especially in people who have already developed precancerous changes in the stomach lining.

To examine this, the researchers analyzed data from the National Health Service Database of South Korea, which included 916,438 adults aged 20 and over who received treatment to eradicate Helicobacter pylori between 2009 and 2011. Participants were followed up for an average of 12 years. Stomach cancer rates and mortality from it were compared to the general population matched for age and sex, by calculating a standardized incidence ratio and a standardized mortality ratio.

The findings were clear: in all age groups over 30, those who underwent treatment to eradicate the bacteria had less stomach cancer compared to people of the same age in the general population. Among 30 to 39 year olds there was a 28% decrease in the risk of the disease. At the age of 40 to 59 the decrease was about 35%, at the age of 60 to 69 about 40%, and at the age of 70 and over the risk was almost cut in half.

A similar picture was also seen in the number of deaths from stomach cancer. In all age groups, people who received treatment to eliminate the bacteria died less from the disease than their peers who were not treated. In some age groups there was a drop of more than 60% in mortality. These are clear and significant differences, which are not considered accidental from a statistical point of view.

According to the researchers, even when the treatment was given to people over 80, the incidence and mortality rates from stomach cancer were low compared to the general population. Their main conclusion is that there is no place to set a hard age limit for the treatment of Helicobacter pylori, as long as the patient is able to withstand antibiotic treatment.

However, they emphasize that the findings should not be interpreted as a recommendation to postpone treatment for old age. On the contrary, treatment at a younger age is better, since it may prevent the progress of the inflammatory process even before irreversible changes are formed in the gastric mucosa.

In an accompanying editorial, researchers from China noted that the data provide solid, real-world evidence that age alone should not be used as a reason to avoid treatment to eradicate the bacterium. According to them, as the feasibility of national programs to detect and treat Helicobacter pylori to prevent stomach cancer becomes clearer, it is necessary to develop wide-ranging implementation strategies, while adapting to the characteristics of the local population.

They emphasize that the capacity of the health system, the incidence of stomach cancer in the region and the carrier rate of the bacterium must be taken into account before implementing broad screening and treatment programs.

As mentioned, Helicobacter pylori is a very common bacterium in the world, and even in Israel the rate of carriers in the older population is not negligible. Tests to diagnose the bacteria are available and relatively simple, and the antibiotic treatment is usually short-term. The current study strengthens the approach according to which there is room to positively consider treatment even in old age, and not to avoid it just because of chronological age.