Knowledge and Practice Gaps in Gastric Cancer Prevention Among Physicians in Azerbaijan: Results of the TOGAS National Survey

Abstract

Background: Despite continuous advances in gastric cancer prevention, delayed recognition of premalignant gastric lesions and inconsistent implementation of evidence-based recommendations remain major barriers to reducing gastric cancer incidence and mortality. International guidelines emphasize Helicobacter pylori eradication, standardized biopsy protocols, OLGA/OLGIM risk stratification, and risk-adapted endoscopic surveillance. However, little is known regarding physicians’ awareness and adherence to these recommendations in Azerbaijan.
Aim: To evaluate physicians’ knowledge and clinical practice regarding gastric cancer prevention and to identify specialty-related differences in the diagnosis, biopsy strategy, surveillance, and management of gastric precancerous conditions.
Methods: A nationwide cross-sectional survey was conducted using the standardized TOGAS questionnaire. Among 967 completed questionnaires, 692 physicians representing four major specialties were included in the comparative analysis: general practitioners (n=372), family physicians (n=113), pediatricians (n=114), and gastroenterologists (n=93). The questionnaire evaluated knowledge of Helicobacter pylori infection, gastric precancerous lesions, diagnostic approaches to atrophic gastritis, biopsy practices, surveillance strategies, OLGA/OLGIM staging systems, and gastric cancer prevention. Categorical variables were compared using Pearson’s χ² test, while multivariable logistic regression adjusted for age and sex was performed to identify independent predictors of appropriate knowledge. Statistical significance was defined as p<0.05.
Results: Marked heterogeneity in physicians’ knowledge and clinical practice was observed across specialties. Recognition of gastric atrophy as a premalignant lesion significantly differed between family physicians, general practitioners, pediatricians, and gastroenterologists (82.3%, 47.8%, 66.7%, and 79.6%, respectively; χ²=63.5; p<0.001). Awareness of intestinal metaplasia demonstrated even greater variability (23.0%, 20.7%, 25.4%, and 76.3%, respectively; χ²=115.5; p<0.001), while recognition of gastric dysplasia also differed significantly (23.0%, 19.4%, 36.0%, and 30.1%; p=0.002).
Preferred diagnostic strategies for atrophic gastritis varied considerably. Biopsy was selected as the diagnostic standard by 47.8% of family physicians, 31.5% of general practitioners, 56.1% of pediatricians, and 61.3% of gastroenterologists (χ²=42.0; p<0.001), indicating substantial variation in adherence to evidence-based diagnostic pathways.
Knowledge regarding surveillance recommendations remained limited. Overall, only 13.2% of respondents correctly recognized that endoscopic surveillance is not indicated for every patient with gastric atrophy or intestinal metaplasia, whereas gastroenterologists demonstrated the highest level of appropriate responses (28.0%; p<0.001).
Awareness of modern risk stratification systems was particularly low among non-gastroenterologists. Familiarity with OLGA/OLGIM classifications was reported by only 0–2.7% of family physicians, general practitioners, and pediatricians compared with 38.7% of gastroenterologists (χ²=179.6; p<0.001). Likewise, knowledge of recommended Helicobacter pylori eradication regimens was substantially higher among gastroenterologists (57.0%) than among other specialties (3.2–9.6%; χ²=216.7; p<0.001).
After adjustment for age and sex, gastroenterologists remained independently associated with significantly greater awareness of OLGA/OLGIM staging systems (adjusted OR 52.1; 95% CI 22.8–118.9; p<0.001) and recommended eradication regimens (adjusted OR 34.6; 95% CI 18.1–66.0; p<0.001).
Conclusions: Substantial specialty-related knowledge gaps exist regarding evidence-based gastric cancer prevention in Azerbaijan. Limited awareness of intestinal metaplasia, OLGA/OLGIM staging, surveillance indications, and Helicobacter pylori eradication strategies among non-gastroenterologists may adversely influence early diagnosis and preventive care. These findings highlight the urgent need for national educational initiatives, standardized multidisciplinary training, and broader implementation of international gastric cancer prevention guidelines to improve clinical practice and facilitate future screening programs.