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Social determinants of health

Vol. 28 No. Suppl 1 (2026): Special issue: H. pylori and Gastric Cancer in the Americas

Correa’s model of gastric carcinogenesis: Integrative evidence from Nariño, Colombia

DOI
https://doi.org/10.22267/rus.2628s1.10484
Submitted
August 21, 2026
Published
2026-10-05

Abstract

Introduction: The Correa cascade model has been fundamental to understanding gastric carcinogenesis. A substantial portion of the evidence supporting its development was generated in Nariño, Colombia, a region characterized by marked contrasts in gastric cancer risk.

Objective: To describe and synthesize the development of Correa’s gastric carcinogenesis model based on studies conducted in Nariño, integrating epidemiological, histopathological, experimental, and evolutionary evidence, and to discuss its implications for gastric cancer prevention.

Materials and methods: Review article integrating population- and hospital-based observational studies, serial histopathological assessments of gastric biopsies, randomized clinical trials of chemoprevention, and molecular and genetic studies of Helicobacter pylori and the human host, conducted between the 1960s and 2015 in Andean and coastal populations of Nariño.

Results: The accumulated evidence supports a sequential histopathological progression of precursor lesions, with the possibility of partial regression at early stages. H. pylori is identified as a major etiological determinant of non-cardia gastric cancer, whose effect is modulated by diet, immune response, and population context; however, gastric cancer may occur in the absence of infection. Early eradication of H. pylori is associated with sustained regression of precancerous lesions. In addition, evolutionary discordance between human ancestry and bacterial lineages is associated with greater inflammation and a higher risk of progression.

Conclusions: The evidence reviewed expands the classical Correa model by incorporating environmental, immunological, and evolutionary modulators and proposes an integrative conceptual framework to guide prevention and chemoprevention strategies tailored to populations at high risk of gastric cancer.

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