Abstract
Gastric cancer remains a significant public health issue in Aotearoa, disproportionately affecting Māori and Pacific populations. The marked ethnic inequity in cancer incidence and mortality, with Māori experiencing diagnosis at a younger age and higher rates than non-Māori, underscores an urgent need for targeted interventions. Helicobacter pylori infection, a known precursor to gastric cancer, is a critical contributor to this disparity. In this position paper, we discuss the current state of gastric cancer and H. pylori management in Aotearoa, identifying key challenges including inconsistent guidelines, rising antibiotic resistance and inequitable access to treatment. We provide a comprehensive review of international evidence on H. pylori management, highlight emerging approaches, outline strong evidence supporting a 'population-based test and treat' approach for H. pylori eradication, and present a 'road map' tailored to Aotearoa's needs. Our proposed strategies emphasise the development of Aotearoa-specific guidelines that incorporate polymerase chain reaction (PCR)-based antibiotic resistance testing, the need to promote post-eradication re-testing, the establishment of a national registry to monitor treatment outcomes, and the urgent rollout of a population-based test and treat programme. We advocate for a coordinated effort that aligns with the principles of Toitū Te Tiriti and prioritises equity and justice in healthcare delivery. By addressing these barriers with targeted, evidence-driven solutions, we aim to reduce the burden of gastric cancer among Māori and Pacific peoples and achieve more equitable health outcomes across Aotearoa.