At the 2014 Gastrointestinal Cancer Symposium (ASCO-GI) meeting in San Francisco, USA, gastroenterologist Professor David Y. Graham (Baylor College of Medicine) made a bold prediction about gastric cancer in terms of its etiology, progression and treatment implications. “Before we have a lifetime, and mine, we will see the disappearance of this disease.” But eradicating gastric cancer will require a concerted world effort to eradicate H. pylori, Professor Graham explains. To validate his point, Professor Graham summarized decades of research on gastric cancer, translating into the following key points: 1. H. pylori infection causes more than 95 percent of gastric cancers. 2, H. pylori brings chronic inflammation, which directly produces genetic instability, and this can collectively lead to gastric cancer. 3. The risk of gastric cancer associated with the degree and severity of atrophic gastritis can be measured using a simple non-invasive test. None of the hypotheses about the possible benefit of H. pylori have withstood rigorous evaluation, and all support the value of eradicating H. pylori (an important human pathogen). Based on this knowledge, Professor Graham saw a clear pathway to eradicate gastric cancer: as a first step, adults and children infected with H. pylori were screened using non-invasive tests, such as urea breath tests or stool antigen tests. The test reveals the hidden bacteria, and the patient is offered treatment to clear the infection. However, especially in high-risk countries, additional steps involving risk assessment and surveillance are needed. Although eradication of H. pylori is the underlying cause of removal of gastric cancer, previously infected individuals who have suffered irreversible gastric mucosal damage are still at risk. In this population, the extent and severity of atrophic gastritis can be assessed by noninvasive testing based on changes in pepsinogen concentration, followed by confirmation and, if needed, histologic evaluation of gastric mucosal biopsies using a validated risk stratification system (e.g., the OLGA system). Individuals at high risk for gastric cancer will be screened with gastroscopy early in the disease. The two-pronged approach of primary prevention (H. pylori eradication) and secondary prevention (endoscopic surveillance in high-risk groups) has already led to steps in this direction in some countries with very high H. pylori prevalence. “In February of last year, the Japanese government approved universal treatment of H. pylori infection with the aim of eradicating gastric cancer in the country. Hopefully, the world will change with it,” Professor Graham said.