In an era when gastric cancer prevention still relies heavily on endoscopic detection, the National Taiwan University Hospital (NTUH) team proposed a markedly different strategy—one rooted in epidemiology, pathogen biology, and real-world implementation science. By centering gastric cancer prevention on Helicobacter pylori eradication rather than mass endoscopy, the NTUH team established the world’s first community-based H. pylori screening program on the Matsu Islands. Led by Superintendent Ming-Shian Wu and gastroenterologist Yi-Chia Lee, this long-term endeavor has become one of the most compelling population-level demonstrations of causality-driven cancer prevention.

After 20 years of continuous implementation, the outcomes are remarkable: H. pylori prevalence in Matsu dropped from 64.2% to roughly 10%; gastric cancer incidence decreased by 47%; and mortality fell by 25% . Modeling suggests that by 2030, gastric cancer may approach near-elimination in this community. These achievements earned the program Taiwan’s National Biotechnology & Medical Quality Award in 2024, recognizing it as a world-leading model of community-driven screening and intervention.

The turning point came when conventional strategies faltered. Earlier in Matsu, a four-year mass endoscopy program—similar to approaches in Japan and Korea—failed to produce significant improvements. This reflected a biological reality well known to experts: early gastric cancer has a notoriously short detectable window, demanding extremely high screening intensity and resource allocation. Instead, the NTUH team returned to first principles—addressing the root cause in the Correa’s cascade. They adopted non-invasive breath testing, followed by standardized antibiotic eradication for H. pylori-positive adults over 30. Negative follow-up breath tests confirmed bacterial clearance; persistent cases received tailored therapy.

Yet the scientific innovation alone does not explain the program’s success. Its true strength lies in an intricately structured public health framework. NTUH developed a three-tier system:

Tier 1: Governance and System Design—partnerships with local governments, hospitals, clinics, and community organizations to tailor workflows to each region, whether in Matsu, Changhua County, or Indigenous communities.
Tier 2: Implementation—high-coverage screening using breath or stool tests; standardized referral and treatment pathways; and on-site training for screening personnel.
Tier 3: Community Engagement—education on H. pylori, antibiotic therapy expectations, and proactive follow-up to ensure adherence and treatment success.

臺大醫院團隊首創以幽門桿菌篩檢來預防胃癌獲得國家生技醫療品質獎銀獎李宜家提供-2.webp — A team from National Taiwan University Hospital pioneered the use of *Helicobacter pylori* screening for gastric cancer prevention and received the Silver Award at the National Biotechnology & Medical Quality Awards. Provided by Lee Yi-Chia.

World’s first! Drs. Ming-Shiang Wu and Yi-Chia Lee, attending physician of the Department of Internal Medicine, Gastroenterology Section at the National Taiwan University Hospital, leads the team to pioneer Helicobacter pylori screening to prevent gastric cancer in Matsu Islands, successfully reducing the incidence and mortality rates of gastric cancer. In 2024, with “Teamwork, Community Engagement, Long-term Commitment: Leading the World in Helicobacter pylori Screening for Gastric Cancer Prevention,” they won the National Biotechnology and Medical Care Quality Award, Hospital Community Services Silver Award.

In fact, their achievements have long been recognized worldwide. The National Taiwan University Hospital team has twice authored global guidelines and been invited to share at places such as the World Health Organization (WHO) and the European Union. In Taiwan, National Health Insurance successfully revised the reimbursement policy for eradication therapy of Helicobacter pylori in 2024, allowing more infected individuals to receive treatment directly due to their research achievement.

臺大醫師李宜家前排左三代表團隊至世界衛生組織world-health-organization-who下屬的國際癌症研究機構inter.webp — Yi-Chia Lee (third from left in the front row) representing the team at the International Agency for Research on Cancer, a part of the World Health Organization (WHO), sharing the Matsu experience. Provided by Yi-Chia Lee

For Dr. Lee, however, the most meaningful recognition came from the community itself—a certificate naming him an honorary resident of Lienchiang County, the birthplace of this groundbreaking project. The inscription at Matsu’s iconic Mazu Temple reads: “A physician’s healing hands can restore life.” It is a fitting reflection of a project that not only transformed a small island’s health trajectory, but also reshaped the global conversation on gastric cancer prevention.

Yi-Chia Lee is an attending physician in the Department of Internal Medicine, Gastroenterology Section, and Deputy Director of the Medical Research Department at the National Taiwan University Hospital. He and the team have successfully reduced the incidence and mortality rates of gastric cancer in Matsu Islands through Helicobacter pylori screening and treatment. Over 20 years of effort, the prevalence of Helicobacter pylori in Matsu Islands decreased significantly from the initial 64.2% to about 10%, with a 47% reduction in gastric cancer incidence and a 25% reduction in mortality. By 2030, the incidence and mortality rates are expected to decrease further and close to the goal of eliminating gastric cancer, and the coverage and satisfaction rates of screening among residents exceed 90%.

The National Taiwan University Hospital team proposed a community-based Helicobacter pylori screening and treatment concept to prevent gastric cancer, contrasting with the traditional reliance on periodic endoscopic examinations for diagnosis. Yi-Chia Lee notes that an initial four-year endoscopic screening was conducted in Matsu with the current NTUH President Ming-Shiang Wu participating, but the results were ineffective. “Early gastric cancer is difficult to detect, and it evolves to late-stage gastric cancer within a short period, about two years. Countries like Japan and Korea use extensive biennial endoscopic examinations to find gastric cancer. However,in Korea, 53% of cancer prevention resources are used for upper endoscopy,” Yi-Chia Lee laments, noting this mass endoscopic screening method is not efficient without risk stratification and it is not appropriate to allocate the limited national resources predominantly for gastric diseases, considering the existence of other important diseases.

Realizing mass endoscopic screening was unfeasible in Matus Islands, Yi-Chia Lee pursued alternative methods. Research indicated a strong correlation between Helicobacter pylori infection and peptic ulcer and gastric cancer, prompting screening for residents over 30 using breath tests. Breath samples are collected and sent to laboratories in Taiwan for analysis, with results available in about one week.If the breath test returns positive, indicating Helicobacter pylori infection, a two-week oral antibiotic treatment is provided. After completing treatment, a second breath test is conducted to confirm the eradication of Helicobacter pylori. A negative result indicates successful eradication and concludes the treatment, while a positive result leads to an individualized treatment. The team uses community screening and antibiotic eradication to effectively prevent gastric cancer.