Abstract
The rapidly increasing number of gastric cancer examinations performed over a short period might influence screening performance. Accessing the association between calendar month and gastric cancer detection rates might improve policy and guide institutional support. To evaluate the association between the increased number of examinations over a certain period and gastric cancer detection rates among a large population included in the Korean National Cancer Screening Program (KNCSP). This retrospective, population-based cohort study used data from the KNCSP comprising 26 765 665 men and women aged 40 years or older who participated in the screening program between January 1, 2013, and December 31, 2016. Data were analyzed from November 1, 2019, to March 31, 2020. Gastric cancer screening with endoscopy. The primary outcome was monthly gastric cancer detection rates in the KNCSP. A negative binomial regression model was used to evaluate the association between the screening month and detection rates. In total, 21 535 222 individuals underwent endoscopy (mean [SD] age, 55.61 [10.61] years; 11 761 709 women [54.62%]). The quarterly number of participants was the highest in the last quarter of the study period (2013-2014: 4 094 951 [41.39%], 2015-2016: 4 911 629 [42.19%]); this proportion was 2.48 to 2.84 times greater than that of the first quarter. Cancer detection rates were the lowest in December (2013-2014: 0.22; 95% CI, 0.22-0.23; 2015-2016: 0.21; 95% CI, 0.21-0.22); this was approximately a 40.0% to 45.0% reduction compared with the rates in January. The age group was the significant factor for monthly detection rates. After adjustment for the age group and taking account of the number of screenings, the estimated coefficient range for the screening month was negative and the detection rate in December was significantly different than in January for both the consequent cycles (2013-2014: -0.05 to -0.18; P < .001; and 2015-2016: -0.06 to -0.19; P < .001). In the multivariable logistic model, the association of calendar month with detected cancer remained after adjusting for other confounding factors (December, 2013-2014: odds ratio, 0.82; 95% CI, 0.76-0.87; P < .001; 2015-2016: odds ratio, 0.83; 95% CI, 0.79-0.89; P < .001). The findings of this cohort study suggest that the workload of endoscopists increased with the increasing number of examinations toward the end of the year, as demonstrated by the decreased cancer detection rates. These findings may help to improve gastric cancer detection rates of screening programs by controlling the monthly screening number and policy modifications.
Highlights
The prevalence of gastric cancer is decreasing, it remains the third leading cause of cancer mortality worldwide.[1,2] Early detection, diagnosis, and treatment are the only methods to reduce mortality associated with gastric cancer
Of participants who had negative results based on the upper endoscopy, 7276 participants (0.07%) and 4531 participants (0.04%) for each respective cycle were diagnosed with gastric cancer within 1 year of endoscopic examination
Of participants who had negative results based on the upper endoscopy, 7276 (0.07%) and 4531 (0.04%) for each respective cycle were diagnosed with gastric cancer within 1 year of endoscopic examination
Summary
The prevalence of gastric cancer is decreasing, it remains the third leading cause of cancer mortality worldwide.[1,2] Early detection, diagnosis, and treatment are the only methods to reduce mortality associated with gastric cancer. Diagnostic tools for early gastric cancer detection include upper gastrointestinal (UGI) series and endoscopy; previous studies have reported the superiority of upper endoscopy over UGI series for gastric cancer diagnosis.[3,4,5]. Some Asian countries, including Korea, conduct endoscopic screening programs for gastric cancer.[6] These screening programs may reduce the risk of death from gastric cancer.[7] In Korea, the Korean National Cancer Screening Program (KNCSP) for gastric cancer was launched in 1999 to provide gastric cancer screening via upper endoscopy or UGI series for individuals aged 40 years or older.[8] The total number of participants in the KNCSP for gastric cancer surveyed from 2002 to 2018 (except 2012) was 71 773 605.9-15 The individuals enrolled in the KNCSP are required to have their examinations completed by December 31 of the corresponding year or they may lose their opportunity to be examined the following year. Because endoscopic screening has better diagnostic accuracy than UGI series,[3,4] the number of individuals undergoing endoscopy has been increasing substantially.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
