Phd Defence Duco Mulder

Gastric cancer is highly fatal, but can be prevented. The challenge is to find the strategies that work best, for whom and at what cost. This thesis investigates which prevention strategies save most lives, while balancing inherent harms related to screening.

The research focuses on two main approaches: screen-and-treat of Helicobacter pylori, the bacterium causing most gastric cancers, and endoscopic screening to catch cancer early. By combining data analysis, ethical reflections and microsimulation modelling, the work evaluates the benefits, harms and trade-offs of these strategies across populations in Europe, Asia and the United States. 

A highlight of this thesis is the development of MISCAN-gastric, a new disease model in the MISCAN family, that is readily available for health policy analysis. The research also explores broader challenges, including antibiotic resistance, surveillance of precancerous lesions and the ethics of screening people based on race or ethnicity.