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We aimed to determine the optimal age for <jats:styled-content style=\"fixed-case\"><jats:italic>H.\u2009pylori<\/jats:italic><\/jats:styled-content> screen\u2010and\u2010treat.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>We developed a new microsimulation model, MISCAN\u2010gastric, which was calibrated to SEER incidence and clinical studies on the natural history of GC. One\u2010time screen\u2010and\u2010treat at ages 20\u201365 was compared to a no\u2010screening scenario in terms of cumulative incidence reduction, number needed\u2010to\u2010screen (NNS) and number needed\u2010to\u2010treat (NNT) to prevent one GC case. The NNS represents the number of individuals that require testing to prevent one GC case, while the NNT reflects the number requiring treatment. The optimal age was investigated for a high\u2010risk population subgroup (non\u2010Hispanic [NH] Black males) and compared to other subgroups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Without screening, 332 noncardia GC cases occurred in a population of 100,000 NH Black males. <jats:styled-content style=\"fixed-case\"><jats:italic>H.\u2009pylori<\/jats:italic><\/jats:styled-content> screen\u2010and\u2010treat reduced cumulative incidence by 43% when performed at age 20, but only by 5% when performed at age 65. The NNS was lowest at age 30 and increased markedly at older ages. The estimated NNS for test\u2010ages 20, 30, 40, and 65 were 645, 563, 769, and 5487, respectively. The NNT was lowest at the youngest age (261) and increased with age to 448 at age 40 and 3681 at age 65. The NNT and NNS were substantially higher in groups with lower GC risk: the optimal NNT was four times higher in NH White females compared to non\u2010Hispanic Black males.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\"><jats:italic>H.\u2009pylori<\/jats:italic><\/jats:styled-content> screen\u2010and\u2010treat maximized population benefits when performed before age 40, emphasizing the need for early interventions. When performed at the optimal age, the benefits of <jats:styled-content style=\"fixed-case\"><jats:italic>H.\u2009pylori<\/jats:italic><\/jats:styled-content> screen\u2010and\u2010treat may outweigh the harms for high\u2010risk racial groups.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hel.70039","type":"journal-article","created":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T09:17:58Z","timestamp":1748337478000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["The Optimal Age of <i>Helicobacter pylori<\/i> Screen\u2010and\u2010Treat for Gastric Cancer Prevention in the United States"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7226-322X","authenticated-orcid":false,"given":"Duco T.","family":"M\u00fclder","sequence":"first","affiliation":[{"name":"Department of Public Health Erasmus Medical Center  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James F.","family":"O'Mahony","sequence":"additional","affiliation":[{"name":"Department of Public Health Erasmus Medical Center  Rotterdam the Netherlands"},{"name":"School of Economics University College Dublin  Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1184-9758","authenticated-orcid":false,"given":"Dianqin","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Public Health Erasmus Medical Center  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luuk A.","family":"van Duuren","sequence":"additional","affiliation":[{"name":"Department of Public Health Erasmus Medical Center  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosita","family":"van den Puttelaar","sequence":"additional","affiliation":[{"name":"Department of Public Health Erasmus Medical Center  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Harlass","sequence":"additional","affiliation":[{"name":"Department of Public Health Erasmus Medical Center  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiran","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Public Health Erasmus Medical Center  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Huang","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Stanford University School of Medicine  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manon C. 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