Secondary prevention of gastric cancer: An alternative strategy

Abstract

Background: Early detection and treatment provide the only curative possibility for gastric cancer. A cost-effective strategy is imperative in developing countries with high mortality rates. The objective of this study is to analyse the results of an organized endoscopic screening in a symptomatic population 40 years and older. Methods: This was a prospective observational study of patients with gastrointestinal symptomology referred by primary care who had direct access to an endoscopy unit at the secondary referral centre. Physicians were trained, and an endoscopy request form and a flowchart for referral and patient management were designed. Endoscopic performance, early detection rates, resectability and survival, overall and disaggregated by sex, were evaluated. Findings: From July 1, 1996, to June 30, 2013, 25.304 endoscopies were performed, of which 14.521 were in individuals in risk groups (70% women). A total of 339 gastric cancers were detected, for a detection rate of 2.3%. The rate of early gastric cancer (EGC) among all cancers was 34% (f: 46.6%, m: 27.6%). The resectability for both sexes was 68.1% (f: 78.8%, m: 62.4%). The EGC rate in resected patients was 45% (f: 54.8%, m: 38.4%). The five-year survival rate for all cancers was 38.1% (f: 51.7%, m: 30.8%), and that for patients who underwent resection was 57.6% (f: 69.0%, m: 50.0%). The 10-year survival for all cancers was 27.5% (f: 40.5%, m: 20.5%), and that for patients who underwent resection was 43.1% (f: 55.0%, m: 35.0%). Interpretation: Organized screening in a symptomatic population aged 40 years and older by endoscopy has high performance, increases the rate of EGC and impacts survival. Women achieved results similar to those reported by countries with mass survey. For men to achieve these results, it is necessary to educate the population at risk, especially the most vulnerable. Keywords: gastric cancer; endoscopic screening; resectability; early detection; survival.