Abstract
Although regular endoscopic screening may help in early detection of gastric cancer, interval cancer remains a problem in the screening program. This study evaluated the association between regular endoscopic screening and interval cancer detection in the Korean National Cancer Screening Program (KNCSP). We defined three groups (regularly, irregularly, and not screened) according to the screening interval, and the trends in the interval cancer rate (ICR) between the groups were tested using the Cochran–Armitage test. The influence of regular endoscopic screening on the risk of interval cancer was evaluated using multivariable logistic regression. Among the 11,642,410 participants who underwent endoscopy, the overall ICR was 0.36 per 1000 negative screenings. The ICR of the not screened group (0.41) was the highest among the three groups and the risk of interval cancer in this group was 1.68 times higher (p < 0.001) than that in the regularly screened group. Women in their 40s who had regular screening with no history of intestinal metaplasia and gastric polyps would have the lowest probability of having interval cancer (0.005%). Regular participation in endoscopic screening programs for reducing the risk of interval cancer may help to improve the quality of screening programs.
Highlights
Gastric cancer is considered as an important contributor to the global cancer burden, accounting for the fifth highest incidence among cancers and the third highest cause of cancer-related mortality [1]
The total cohort comprised of 21,535,222 participants who underwent endoscopy in the screening program between 2013 and 2016
The interval of an endoscopic screening program directly influences gastric cancerrelated survival [15], and individuals with a regular screening interval of
Summary
Gastric cancer is considered as an important contributor to the global cancer burden, accounting for the fifth highest incidence among cancers and the third highest cause of cancer-related mortality [1]. In 2018, there were over 1,000,000 new patients diagnosed with gastric cancer and 783,000 deaths [1]. The incidence of gastric cancer is high in Eastern Asia, including South Korea and Japan [1]. Early gastric cancer involves small-sized lesions with no apparent symptoms. Once the disease progresses because of the late detection of the lesion, the mortality of cancer patients increases. It is crucial to detect gastric cancer in the early stage, followed by appropriate treatments, for which some Asian countries have operated screening programs for gastric cancer. Some studies have reported that a screening program reduced gastric cancer-related mortality [2,3,4]. The efficiency of the screening program is still controversial [5,6]
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