For many families across the Pacific, a common childhood infection is quietly setting the stage for a looming health crisis. A new study published in the New Zealand Medical Journal warns that stomach cancer cases among Pacific communities in Aotearoa are projected to nearly double over the next two decades, unless urgent systemic changes are made to how the country screens for and treats a specific bacterial pathogen.
The projections are stark: annual stomach cancer cases among Pacific people are expected to rise from 45 to 87 by 2045—a 93 per cent increase. While stomach cancer cases across the general population of New Zealand are also expected to climb—rising from roughly 500 to 700 cases annually—the burden is falling disproportionately on Māori and Pacific populations, who are often diagnosed at younger ages and experience worse clinical outcomes.
At the heart of this disparity is Helicobacter pylori, a resilient bacterium that colonizes the stomach lining. While often benign, in many people it triggers a slow-motion cascade of chronic inflammation that can eventually mutate healthy cells into malignant tumors. For Pacific communities, the risk is not merely biological but structural, driven by socioeconomic disadvantages and living conditions that facilitate the spread of the bacteria during early childhood.
The Silent Path to Malignancy
As a physician, I have seen how the “silent” nature of H. Pylori makes it a dangerous adversary. The bacteria often enter the body in childhood, frequently through person-to-person contact in crowded households. Once established, the infection can remain dormant for decades, showing no outward symptoms while it slowly erodes the gastric mucosa.
“What we found is that stomach cancer cases in Aotearoa are likely to rise nearly 50 per cent by 2045… But for Māori and Pacific people, our cases are going to double over that time,” says Dr. Nina Bevin, a health expert and researcher involved in the study. Bevin notes that the infection is strongly associated with socioeconomic disadvantage, particularly in large, multi-generational households where the bacteria can spread easily among whānau.
The physiological progression is well-documented in medical literature: the bacteria cause chronic gastritis, which can lead to gastric atrophy and intestinal metaplasia. Over years or decades, this cellular instability increases the risk of adenocarcinoma, the most common form of stomach cancer. Because the early stages are asymptomatic, many patients do not seek help until the cancer has reached an advanced stage, significantly reducing the chances of successful treatment.
A Stark Divide in Risk and Access
The data reveals a profound gap in both the prevalence of the infection and the access to the care needed to stop it. Pacific people currently face the highest stomach cancer rates in New Zealand, with 14.4 cases per 100,000 people, compared to just 4.6 per 100,000 for European and other populations.
This disparity is mirrored in the infection rates of H. Pylori itself:
| Population Group | H. Pylori Infection Rate | Stomach Cancer Rate (per 100k) |
|---|---|---|
| Pacific People | ~38% | 14.4 |
| Māori | ~23% | (High) |
| European New Zealanders | ~13% | 4.6 |
Despite these higher risks, the study highlights a troubling paradox: Māori and Pacific communities often have lower rates of testing and treatment for H. Pylori than their European counterparts. This gap in healthcare equity means that those most likely to carry the bacteria are the least likely to receive the antibiotics necessary to clear it before it becomes cancerous.
“We’ve got to make sure that equity is at the centre of anything that we develop,” Bevin emphasizes. She argues that for screening to be effective, it must be designed in partnership with Māori and Pacific providers and communities to ensure the process is culturally safe, understood, and accessible.
The Blueprint for Prevention
The good news is that stomach cancer driven by H. Pylori is largely preventable. International medical evidence suggests that between 40 and 60 per cent of these cancer cases could be avoided through targeted “test-and-treat” programs. By identifying the bacteria early and treating it with a course of antibiotics and proton pump inhibitors, the inflammatory cycle can be broken.
New Zealand’s Cancer Action Plan 2019-2029 already recommends the adoption of these programs. To move this from policy to practice, health officials are now exploring how to expand screening. Dr. Karen Bartholomew, Director of Health Equity in Service Innovation and Improvement at Te Whatu Ora, says several trials are being prepared to test different screening approaches.
One primary goal is to determine if H. Pylori screening can be integrated into existing health programs, moving away from a model where patients must exhibit gastric symptoms before being tested. Because the infection is often asymptomatic, waiting for symptoms usually means waiting until the damage is already significant.
Currently, individuals experiencing gastric distress are encouraged to visit their primary care provider for testing. However, the shift toward a proactive, population-based screening model for high-risk groups is seen as the only way to flatten the projected rise in cases.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
The next critical phase for the health system involves the rollout of these screening trials. The findings from these trials will provide the evidence base required to establish a national screening program, aligning Aotearoa with international standards for gastric cancer prevention. As Te Whatu Ora continues to refine these approaches, the focus remains on ensuring that Pacific and Māori families are the primary beneficiaries of these new interventions.
Do you have questions about H. Pylori or gastric health? Share your thoughts in the comments or share this article with your community to raise awareness.
