Abstract
A majority of gastric cancer cases in China are diagnosed at advanced stages, chiefly due to lack of an established routine nationwide screening program. This study evaluated the effectiveness of a novel screening program for gastric cancer. Seven geographic communities were randomly selected, and residents ages 40-69 years were screened. Serologic tests of Helicobacter pylori antibodies and pepsinogens, and positive family history of gastric cancer in first-degree relatives (FDR), were used to differentiate individuals for further gastroscopic examination and gastric mucosal biopsies. Among 7,773 individuals who underwent examination of serum markers, gastric cancer was detected in 14 (1.8%; 10 men). The rate in terms of gastric cancer cases per 100 gastroendoscopies was 1.6% (14/872), which was greater than 0.87% previously reported. Eleven of 14 patients with gastric cancer (78.6%) were FDRs of patients with gastric cancer. Two-thirds of the subjects with cardia gastric cancer were FDRs of individuals with gastric cancer rather than cardia gastric cancer. Comparative analysis indicated that the gastric cancer subjects were significantly more likely to be FDRs of patients with gastric cancer, in contrast to those without gastric cancer. All the individuals with gastric cancer were aged ≥50 years. After conducting a reverse analysis, we propose a novel screening program for gastric cancer. In conclusions, the populations most vulnerable to gastric cancer are those with positive family history of gastric cancer in FDRs, male gender, and aged 50 years or older. This screening program using fewer serum markers combined individual risk factors, mainly FDRs, is novel for identification of high-risk individuals for further gastroscopy in detecting early gastric cancer.
Highlights
Gastric cancer is the third leading cause of cancer-related death globally, and its incidence is high in East Asia, including China, Japan, and Korea [1]
The following are the major novel findings. (i) The screening program detected 14 participants with gastric cancer, 11 of whom were at the early stage. (ii) The program yielded high rates of gastric cancer detection based on the serologic tests (1.8%) and gastroendoscopies (1.6%). (iii) The presence of an first-degree relatives (FDR) with gastric cancer was by far the most important individual risk factor for the development of gastric cancer
Considering that Helicobacter pylori (HP) infection is an important cause of atrophic gastritis/ intestinal metaplasia, the individuals identified during the screening program were referred for HP testing, and if confirmed, they were given medical treatments for their conditions. These premalignant lesions can progress to gastric cancer, and follow-up plans, including followup endoscopies, were made in accordance with the consensus on the management of chronic gastritis in China (Shanghai, 2017), and the patients were advised to schedule follow-up visits. (vi) A reverse analysis of the findings from this study indicated that this screening program for gastric cancer requires fewer serum markers and individual risk factors compared with the screening program reported previously [6]
Summary
Gastric cancer is the third leading cause of cancer-related death globally, and its incidence is high in East Asia, including China, Japan, and Korea [1]. In China alone, based on the data of 2012, gastric cancer has caused 324,439 deaths, accounting for 3.56% of deaths nationwide [1]. Gastric cancer at an early stage is generally asymptomatic, and early detection of the malignancy through a routine medical service is difficult. In China, most gastric cancer cases are diagnosed at an advanced stage. Note: Supplementary data for this article are available at Cancer Prevention Research Online (http://cancerprevres.aacrjournals.org/).
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