With Europe’s Beating Cancer Plan (EBCP), the European Commission follows a new approach to cancer prevention, treatment and care. The action ‘OBS-Learning From Progress In Addressing Cancer In Europe’ (OBS-PACE) contributes to this by improving the understanding of the national cancer control situation and policy actions in EU Member States.
OBS-PACE is collecting case studies of innovative actions in cancer research, care, and policy across the cancer care pathway. The case studies mirror the implementation of the EBCP at the national and regional level and can inform new actions to better tackle cancer across Europe. Each case study describes the objective of the new action, its implementation, including enablers and barriers, and its outcomes at the health system level.
13 February 2025 | Case Study
Portugal is piloting a population-based screening program for Helicobacter pylori (H. pylori) infection as a strategy to reduce gastric cancer incidence using a people-centred approach through local pharmacies. The immediate results will provide an estimate of the percentage of individuals with asymptomatic H. pylori infection, generating valuable data to evaluate the feasibility of a broader screening program.
Portugal has one of the highest gastric cancer incidence and mortality rates in Western Europe, partly due to the high prevalence of Helicobacter pylori (H. pylori) infection, which affects an estimated 60%–80% of the population. Recognized as a carcinogen by the International Agency for Research on Cancer, H. pylori can significantly increase the risk of gastric cancer. However, early detection and treatment of the infection have been shown to reduce this risk, positioning population-based screening as a promising strategy for primary prevention. Variations in gastric cancer incidence and H. pylori prevalence across the country are likely influenced by differences in population density and socioeconomic factors.
In March 2024, the National Cancer Hub of Portugal (NCH-PT) launched a pilot population-based H. pylori screening program on the island of Terceira in the Azores, where gastric cancer incidence exceeds the national average. Developed under the National Cancer Control Plan 2021–2030, the program targets asymptomatic adults aged 18 and older. Participants collect fecal samples using kits distributed free of charge through local pharmacies, returning them to the same location for analysis. Positive cases are invited for medical consultation and antibiotic treatment. The pilot aims to estimate the prevalence of asymptomatic H. pylori infection and assess the feasibility of scaling the program nationally.
The
project is expected to run for 6–12 months. During the initial phase, 2
000 collection kits were distributed. Of these, 1 800 were handed out
within four months, and 1 500 were successfully returned, reflecting
strong community interest and engagement. In addition to its primary
objectives of screening and treatment, the initiative includes a dedicated work package focused on literacy, communication, and awareness.
This has already yielded positive results, as evidenced by high
participation levels. The pilot has been featured in local newspapers
and TV shows, and even in national media outlets, as well as on social
media.
Enablers: Coalition of stakeholders that facilitated implementation (Governance), also supported by gastric cancer’s inclusion in European Commission screening recommendations; and the involvement of local pharmacies, which enhanced accessibility and adherence (Workforce).
Barriers: Limited initial funding, requiring the project coordinators to secure financial support from different sources (Financing), as well as lack of IT systems and protocols (Resources).
While still too early to fully assess the impact of this pilot, the proximity approach – engaging local pharmacies for kit distribution and collection – has proven to be a key factor in the project’s successful implementation. This people-centred strategy has been a significant enabler, offering a practical example for others to adopt similar models, such as auto-sampling for HPV testing. Distributing and collecting kits at local pharmacies fosters higher adherence compared to methods like mailing collection tubes, as it incorporates a vital “human” element that may help build trust.
Additionally, as with any population-based screening program, this project is expected to contribute to reducing health inequalities, particularly in access to services. The proximity-based strategy further supports this goal by addressing geographic and logistical barriers to participation.
Lessons learned: Multisectoral collaboration, as demonstrated by the involvement of a working group comprising stakeholders from various sectors was a key enabler and critical to address the complexities of the initiative. Another important takeaway is the value of proximity-based strategies. Leveraging existing relationships and infrastructure at the local level may enhance accessibility and programme uptake by the target population, underscoring the effectiveness of people-centred approaches.
For further details on this case study, please reach out to obs-pace@obs.who.int.
1. Peleteiro B, Severo M, La Vecchia C, Lunet N (2014a). Model-based patterns in stomach cancer mortality worldwide. Eur J Cancer Prev 23:524–531
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