Abstract
BackgroundThere is a lack of agreement on which gastric cancer screening method is the most effective in the general population. The present study compared the relative performance of upper-gastrointestinal series (UGIS) and endoscopy screening for gastric cancer.MethodsA population-based study was conducted using the National Cancer Screening Program (NCSP) database. We analyzed data on 2,690,731 men and women in Korea who underwent either UGIS or endoscopy screening for gastric cancer between January 1, 2002 and December 31, 2005. Final gastric cancer diagnosis was ascertained through linkage with the Korean Central Cancer Registry. We calculated positivity rate, gastric cancer detection rate, interval cancer rate, sensitivity, specificity, and positive predictive value of UGIS and endoscopy screening.ResultsThe positivity rates for UGIS and endoscopy screening were 39.7 and 42.1 per 1,000 screenings, respectively. Gastric cancer detection rates were 0.68 and 2.61 per 1,000 screenings, respectively. In total, 2,067 interval cancers occurred within 1 year of a negative UGIS screening result (rate, 1.17/1,000) and 1,083 after a negative endoscopy screening result (rate, 1.17/1,000). The sensitivity of UGIS and endoscopy screening to detect gastric cancer was 36.7 and 69.0%, respectively, and specificity was 96.1 and 96.0%. The sensitivity of endoscopy screening to detect localized gastric cancer was 65.7%, which was statistically significantly higher than that of UGIS screening.ConclusionOverall, endoscopy performed better than UGIS in the NCSP for gastric cancer. Further evaluation of the impact of these screening methods should take into account the corresponding costs and reduction in mortality.
Highlights
Gastric cancer is the fourth most common type of cancer (988,602 new cases, 7.8% of all new cancer cases in 2008) and the second most common cause of cancer death (737,419 deaths annually) in the world [1]
Population-based photofluorography screening for gastric cancer has been mandated as a public policy matter in Japan, other opportunistic screening methods are used in clinical settings throughout Asia, including endoscopy, serum pepsinogen testing, and Helicobacter pylori antibody testing [14]
This study provides detailed estimates of key performance measures of upper-gastrointestinal series (UGIS) and endoscopy screening: positivity rate, gastric cancer detection rate, interval cancer rate (ICR), sensitivity, specificity, positive predictive value (PPV), and stage distribution of screen-detected gastric cancer by screening method
Summary
Gastric cancer is the fourth most common type of cancer (988,602 new cases, 7.8% of all new cancer cases in 2008) and the second most common cause of cancer death (737,419 deaths annually) in the world [1]. Some Asian countries, including China, Japan, and the Republic of Korea, have the highest gastric cancer incidences in the world [2]. Has been conducting mass gastric cancer screening using photofluorography (via indirect upper-gastrointestinal series) since 1960. Cohort and case-control studies have generally revealed a decreased risk of gastric cancer mortality in patients who have undergone photofluorography screening [5,6,13]. Population-based photofluorography screening for gastric cancer has been mandated as a public policy matter in Japan, other opportunistic screening methods are used in clinical settings throughout Asia, including endoscopy, serum pepsinogen testing, and Helicobacter pylori antibody testing [14]. The present study compared the relative performance of upper-gastrointestinal series (UGIS) and endoscopy screening for gastric cancer
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