Gastric Cancer Screening Program Research Articles

Endoscopic Findings in a Mass Screening Program for Gastric Cancer in a High Risk Region - Guilan Province of Iran

Gastric cancer is a leading cause of cancer-related deaths in both sexes in Iran. This study was designed to assess upper GI endoscopic findings among people>50 years targeted in a mass screening program in a hot-point region. Based on the pilot results in Guilan Cancer Registry study(GCRS), one of the high point regions for GC - Lashtenesha - was selected. The target population was called mainly using two methods: in rural regions, by house-house direct referral and in urban areas using public media. Upper GI endoscopy was performed by trained endoscopists. All participants underwent biopsies for rapid urea test (RUT) from the antrum and also further biopsies from five defined points of stomach for detection of precancerous lesions. In cases of visible gross lesions, more diagnostic biopsies were taken and submitted for histopathologic evaluation. Of 1,394 initial participants, finally 1,382 persons (702 women, 680 men) with a mean age of 61.7 ± 9.0 years (range:50-87 years) underwent upper GI endoscopy. H.pylori infection based on the RUT was positive in 66.6%. Gastric adenocarcinoma and squamous cell carcinoma of esophagus were detected in seven (0.5%) and one(0.07%) persons, respectively. A remarkable proportion of studied participants were found to have esophageal hiatal hernia(38.4%). Asymptomatic gastric masses found in 1.1% (15) of cases which were mostly located in antrum (33.3%), cardia (20.0%) and prepyloric area (20.0%). Gastric and duodenal ulcers were found in 5.9% (82) and 6.9% (96) of the screened population. Upper endoscopy screening is an effective technique for early detection of GC especially in high risk populations. Further studies are required to evaluate cost effectiveness, cost benefit and mortality and morbidity of this method among high and moderate risk population before recommending this method for GC surveillance program at the national level.

Outcomes and efficiency of national gastric cancer screening program in Korea: Single-center, large-scale study.

29 Background: Gastric cancer is a major cause of death and a substantial socioeconomic burden in Korea. The National Cancer Screening Program for Medicaid recipients was initiated in 1999 and has contributed to reduction of cancer-related mortality in Korea. Endoscopy may be cost-effective screening tool in Korea, where the cost of endoscopy and UGIS are similar and the incidence of gastric cancer is high. Most of Japanese studies on the efficiency of mass screening for gastric cancer have dealt with photoflurography as a screening tool. Although biennial gastric cancer screening by endoscopy has been increasing in Korea as part of the National Cancer Screening Program, few studies have evaluated its efficiency. Therefore, we analyzed the outcomes and efficiency of the National Gastric Cancer Screening Program using endoscopy in Korea. Methods: We reviewed medical records from the National Gastric Cancer Screening Program at Chung-Ang University hospital in Korea from January 2007 to December 2010. The study population was comprised of Medicaid recipients ≥ 40 years of age who were taken from the National Health Insurance Corporation. Results: A total of 41,150 asymptomatic subjects underwent endoscopy for gastric cancer screening. The mean age of the screened subjects was 56.3 years for men and 48.9 years for women. The male to female ratio of the screened subjects was 1.57:1. Gastric cancer was diagnosed in 102 (0.24%) of 41,150 subjects (60 men and 42 women). Their mean age was 54.4 years. Of these, 76 subjects (0.18%) were diagnosed as early gastric cancer and 26 subjects (0.06%) as advanced gastric cancer. The proportion of early gastric cancer among total gastric cancers was 74.5%. During the period, only 6,586 (16.0%) subjects participated in the biennial gastric cancer screening (59% for men and 49% for women). Conclusions: Despite accomplishments of the National Gastric Cancer Screening Program in Korea, low compliance to the screening program remains an issue. Furthermore, its cost-effectiveness analysis will be needed for successful progression.

Who participates in the gastric cancer screening and on‐time rescreening in the National Cancer Screening Program? A population‐based study in Korea

Gastric cancer (GC) screening is a major challenge in countries where the disease is highly prevalent. This study was conducted to identify the factors associated with participation in GC screening and on-time rescreening among the average-risk population in Korea. The study population was derived from the National Cancer Screening Program database. The population for this study was 22 913 618 individuals aged ≥40 years who had been invited to participate in a GC screening program from 2005 to 2006. We determined whether these individuals had attended the GC screening program and which method - an upper gastrointestinal series (UGIS) or endoscopy-they underwent. We followed the participants to determine whether they had a second GC screening after 2 years. The overall participation rate in the GC screening was 20.5%. More people underwent UGIS than endoscopy. Individuals who had been screened by endoscopy rather than UGIS were more likely to be younger, male, or those who were National Health Insurance (NHI) beneficiaries with a higher premium rate. Of those who underwent baseline screening, 59.4% participated in a rescreening program 2 years later. NHI beneficiaries with a higher premium rate were significantly more likely to be rescreened than medical aid recipients. The results from this study showed that the UGIS were more commonly used in organized GC screenings in Korea, and those who underwent UGIS were more likely to return for subsequent screening compared to those who underwent an endoscopy.

Extended lymph node dissection for gastric cancer from a European perspective

Extended lymph node dissection for gastric cancer from a European perspective

Performance of gastric cancer screening by endoscopy testing through the National Cancer Screening Program of Korea

Recent reports have proposed endoscopy as an alternative strategy to radiography for gastric cancer (GC) screening. The current study presents the first reported population-based data from a large GC screening program that provided endoscopic examinations. A retrospective population-based study was conducted using the National Cancer Screening Program (NCSP) database. We evaluated GC detection rates, sensitivity, specificity, and the positive predictive value of an endoscopic screening program for the average-risk Korean population, aged 40 years and older, who underwent the NCSP from 2002 to 2005. The detection rates of GC by endoscopy in the first and subsequent rounds were 2.71 and 2.14 per 1000 examinations, respectively. Localized cancer accounted for 45.7% of screen-detected GC cases. The sensitivity of endoscopy was 69% (95% confidence interval [CI]: 66.3-71.8). The endoscopic screening was less sensitive for the detection of localized GC (65.7%, 95% CI = 61.8-69.5) than for regional or distant GC (73.6%, 95% CI = 67.4-79.8). In the multiple logistic models for localized GC and all combined GC, the odds ratio (OR) of sensitivity for the undifferentiated type was statistically significantly higher than that for the differentiated type, whereas the OR of sensitivity for the mixed type was lower than that for the differentiated type. The sensitivity of the endoscopic test in a population-based screening was slightly higher for the detection of regional or distant GC than for localized GC. Further evaluation of the impact of endoscopic screening should take into account the balance of cost and mortality reduction.

Gastric cancer screening in Korea: report on the national cancer screening program in 2008.

PurposeThe National Cancer Screening Program (NCSP) began in 1999. The objective of this report is to evaluate the results of the NCSP in 2008 and provide essential evidence associated with the gastric cancer screening program in Korea.Materials and MethodsData was obtained from the National Cancer Screening Information System; participation rates in gastric cancer screening were calculated. According to screening modalities, recall rates were estimated with 95% confidence intervals (CIs).ResultsThe target population of the gastric cancer screening program in 2008 was 7,132,820 Korean men and women aged 40 and over, 2,076,544 of whom underwent upper endoscopy or upper gastrointestinal (UGI) series as screening tools (participation rate, 29.1%). Disparities in participation rates were observed relating to gender and health insurance type. Overall, recall rates of upper endoscopy and UGI series were 3.1% (95% CI, 3.0 to 3.1) and 33.3% (95% CI, 33.3 to 33.4), respectively.ConclusionAccording to our research, efforts to facilitate participation and to reduce disparities in gastric cancer screening among Korean men and women are needed. These results will provide essential data for evidence-based strategies in gastric cancer control in Korea.

Results of a Population-Based Gastric Cancer Screening Program Conducted in Chile 1996-2008

Background Chile presents the second highest stomach cancer (SC) incidence and mortality in the Americas. Since 1980 the SC mortality rate has stabilized at around 20 per 100,000, reaching a level of 18.6 per 100,000 in 2008 (males 24.4, females 12.9). Beginning in 2006 the public and the private health insurance systems cover a secondary prevention program consisting of upper gastrointestinal endoscopy (UGE) for all symptomatic cases (epigastric pain with or without symptoms of poor prognosis) aged 40 and above; it also covers medical and surgical treatments of SC detected. This prevention program has been piloted since 1996 in La Florida County (66,412 beneficiaries 40 years and older). This is the largest SC detection program conducted in Chile so far. Its goals are to decrease SC mortality through early detection and treatment. Our aim is to evaluate the 12 years of experience using this strategy. Methods Patients consulting in the primary care clinics of the study area who satisfied the above mentioned criteria were referred to the secondary level for UGE. Any suspicious lesions at UGE were biopsied and detected SC cases were referred to the base hospital for treatment. We entered all SC patients detected in the screening program from 1996 to 2008. We describe SC cases by sex, age, and staging -TNM classification system-, calculate their 5 year survival rate using the Kaplan Maier method and identify prognostic factors using the Log rank test and Cox model. Results In the study period, 11,978 individuals were referred for UGE 29.7% males (mean age 53.3: 14-93 years) and 70.3% females (mean age 52.2: 14-95 years). We identified 234 SC cases (67.1% males; 32.9% females); mean age of SC patients was 65.7 years (males 65.2 yrs, females 66.9 yrs). Detection rate of SC was 4.4% and 0.9% for males and females respectively (p<0.00001). SC staging for all patients and for males and females were: stage I 39% (35%, 45%), stage II 5% (2%, 12%), stage III 15.8% (15%, 17%), and stage IV 40% (48%, 26%). At the 5-year follow-up, 64 (27.3%) patients remained alive, 132 (56.41%) had died from SC, 12 (5.1%) died from other causes and 26 (11.1%) were censored; the 5-year survival was 41.5% (35.9% and 52.8% for males and females, p=0.002). The only prognostic factors in multivariate analysis were stage (p<0.0001) and age (p=0.001). Discussion The 5-year survival rate for SC in the program (42%) was higher than previously reported in Chile in population-based studies (11%), although the survival range of hospital-based reports has been between12-49%. We needed 212 endoscopies to detect one early cancer. It is necessary to review the current strategy to focus the UGE on populations at higher risk of early cancers -people under 50 years of age-and to include biomarkers to triage the population.

Outcomes and efficiency of National Cancer Screening Program for gastric cancer in Korea.

13 Background: Gastric Cancer is a major cause of death and a substantial socioeconomic burden in Korea. The National Cancer Screening Program for Medicaid recipients was initiated in 1999 and has contributed to reduction of cancer-related mortality in Korea. Endoscopy may be cost-effective screening tool in Korea, where the cost of endoscopy and UGIS are similar and the gastric cancer incidence is high. Most of Japanese studies on the efficiency of mass screening for gastric cancer have dealt with photoflurography as a screening tool. Although biennial gastric cancer screening by endoscopy has been increasing in Korea as part of the National Cancer Screening Program, few studies have evaluated its efficiency. Therefore, we analyzed the outcomes and efficiency of the National Cancer Screening Program for gastric cancer using endoscopy in Korea. Methods: We reviewed results from the National Cancer Screening Program for gastric cancer at Chung-Ang University Yongsan Hospital in Korea from March 2003 to March 2008. The study population was comprised of Medicaid recipients ≥ 40 years of age who were taken from the National Health Insurance Corporation. Results: A total of 7,278 asymptomatic subjects underwent endoscopy for gastric cancer screening. The mean age of the screened subjects was 51.3 years for men and 48.9 years for women. The male to female ratio of the screened subjects was 1.2:1. Gastric cancer was diagnosed in 32 (0.44%) of 7,278 subjects (22 men and 10 women). Their mean age was 54.4 years. Of these, 21 subjects (0.29%) were diagnosed as early gastric cancer and 11 subjects (0.15%) were advanced gastric cancer. The proportion of EGCs among total gastric cancers was 65.6%. The compliance with this program was low (59% for men and 49% for women). Conclusions: Despite accomplishments of the National Cancer Screening Program for gastric cancer in Korea, its effectiveness remains an issue. Efficiency and cost-effectiveness analysis will be needed for successful progression. No significant financial relationships to disclose.

Usefulness of a New Gastric Cancer Screening Program Using the Combination Assay of Serum Anti-Helicobacter pylori IgG Antibody and the Serum Pepsinogen Levels

Purpose: This study was performed to evaluate a new gastric cancer screening program using this combination assay of the serum Hp and PG test method. Methods: Serum Hp and PG levels were measured in the total number of 48073 asymptomatic individuals (about 16000 per year; majority participants checked every year) at a work place in Tokyo as a primary screening between April 2007 and March 2010 (a ratio of man to woman=3.6, a mean age of 47.4 years). We classified into 1 of 4 groups based on the results of the serum Hp and PG levels; group A [Hp (-) PG (-)] (73.2%), group B [Hp (+) PG (-)] (16.4%), group C [Hp (+) PG (+)] (9.3%), and group D [Hp (-) PG (+)] (1.1%), respectively. Group A, B, C, and D were recommended to undergo endoscopic examination every 5 years, 3 years, 2 years, and every year, respectively, and we examined the detection rate of gastric cancers and details of detected cancers. Simultaneously, we estimated the annual increasing or decreasing ratio of each group, comparing the ratio of each group in 2007, 2008, and 2009. Results: In a total of 48073 participating individuals, 6965 planned to undergo endoscopic examination (4202 in group B, 2346 in group C, and 417 in group D). For the total of planned examination, 3921 individuals underwent endoscopic examination (2244 in group B, 1436 in group C, and 241 in group D). Gastric cancer was detected in 23 patients (12 patients in 2007, 8 patients in 2008, and 3 patients in 2009), and 16 and 7 of them were detected from group B and C, respectively. 18 of them were early gastric cancers and 12 of them could be resected endoscopically. Although 5 advanced cancers were detected in this screening program, it was the first time for all of them to have this program for reasons such as mid-career hiring. Histopathologically, 47.8% of the detected cancers were diffuse type, and the ratio of diffuse type was increasing gradually (25.0% in 2007, 62.5% in 2008, and 100% in 2009). The ratio of group A in 2007, 2008, and 2009 was 70.7%, 72.7%, and 75.8%, and the ratio of group B was 19.4%, 16.7%, and 13.5%, respectively. Consequently, the annual increasing ratio of group A per year was estimated about 3% and the decreasing rate of group B was about 3% per year. Conclusion: A mass screening for gastric cancer using the combination assay of the serum Hp and PG test method was useful to select a high-risk and low-risk population of developing gastric cancers and to detect not only intestinal type but also diffuse type cancers in early stage. The number of individuals in group A will continue to increase at a rate of about 3%, which is expected to contribute to a further reduction in the number of individuals who are advised to undergo a mass screening method for gastric cancer in the future.

地域がん登録との照合による胃がん・大腸がん検診の精度評価～感度・特異度の測定～

地域がん登録との照合による胃がん・大腸がん検診の精度評価～感度・特異度の測定～

Evaluation and Revision of Checklists for Screening Facilities and Municipal Governmental Programs for Gastric Cancer and Colorectal Cancer Screening in Japan

To evaluate the appropriateness of current checklists created by a governmental committee to assess screening programs run by municipal governments and service provider facilities for gastric and colorectal cancer, and to accumulate expert opinions to provide insights aimed at the next revision. We convened an expert panel that consisted of physicians nominated by regional offices of the Japanese Society for Gastrointestinal Cancer Screening and radiology technicians nominated by the technician chapter of the society. The panel rated the appropriateness of each checklist item on a scale of 1-9 (1, extremely inappropriate; 9, extremely appropriate) twice, between which they had a face-to-face discussion meeting. During the process they were allowed to propose modifications and additions to the items. In the first round of rating, the panelists rated all 57 and 56 checklists items for gastric and colorectal cancer, respectively, as appropriate based on an acceptance rule determined a priori. During the process of the face-to-face discussion, however, the panel proposed modifications to 23 (40%) and 22 (39%) items, respectively, and the addition of 27 new items each. After integrating overlapping items and rating again for appropriateness, 66 and 64 items, respectively, were accepted as the revised checklist set. The expert panel considered current checklists for colorectal and gastric cancer-screening programs and facilities to be suitable. Their proposals for a new set of checklist items will help further improve the checklists.

“Adjuvant” Therapy after Endoscopic Mucosal Resection of Early Gastric Cancer

“Adjuvant” Therapy after Endoscopic Mucosal Resection of Early Gastric Cancer

Gastric Cancer Screening and Diagnosis

Gastric cancer is the most common cancer in Korea and has overall survival rate of around 50%. Gastric cancer detected in early stage can be cured by endoscopic resection or less invasive surgical treatment and the subsequent prognosis is excellent. National cancer screening program for gastric cancer has been available for several years. The evaluation for efficacy of our screening strategy is strongly needed in terms of mortality reduction and cost-effectiveness. Accurate diagnosis and staging evaluation is important for proper management and prediction of a patients prognosis. It is recommended to understand the advantages and limitations of currently available guidelines and diagnostic modalities. The 7th edition of gastric cancer staging system from AJCC may have significant effect on our knowledge and patient management.

Factors associated with use of gastric cancer screening services in Korea

To identify the factors associated with participation in gastric cancer screening programs. Using data from the Korea National Health and Nutrition Examination Survey 2005 (KNHANES III), a nationwide health-related survey in Korea, a cross-sectional study was performed to investigate the multiple factors associated with gastric cancer screening attendance among persons aged at least 40 years. The study population included 4593 individuals who completed a gastric cancer screening questionnaire and had no previous cancer history. Four groups of individual-level or environmental level covariates were considered as potential associated factors. Using KNHANES III data, an estimated 31.71% of Korean individuals aged at least 40 years adhered to gastric cancer screening recommendations. Subjects who graduated from elementary school [adjusted odds ratio (aOR), 1.66; 95% CI: 1.21-2.26], middle/high school (aOR, 1.38; 95% CI: 1.01-1.89), and university or higher (aOR, 1.64; 95% CI: 1.13-2.37) were more likely to undergo gastric cancer screening than those who received no formal education at all. The population with the highest income tertile had more attendance at gastric screening compared to those with the lowest income tertile (aOR, 1.36; 95% CI: 1.06-1.73). Gastric screening was also negatively associated with excessive alcohol consumption (aOR, 0.71; 95% CI: 0.53-0.96). A positive attitude to preventive medical evaluation was significantly associated with better participation in gastric cancer screening programs (aOR, 5.26; 95% CI: 4.35-6.35). Targeted interventions for vulnerable populations and public campaigns about preventive medical evaluation are needed to increase gastric cancer screening participation and reduce gastric cancer mortality.

Exploring the cost‐effectiveness ofHelicobacter pyloriscreening to prevent gastric cancer in China in anticipation of clinical trial results

Gastric cancer is the second leading cause of cancer-related deaths worldwide. Treatment for Helicobacter pylori infection, the leading causal risk factor, can reduce disease progression, but the long-term impact on cancer incidence is uncertain. Using the best available data, we estimated the potential health benefits and economic consequences associated with H. pylori screening in a high-risk region of China. An empirically calibrated model of gastric cancer was used to project reduction in lifetime cancer risk, life-expectancy and costs associated with (i) single lifetime screening (age 20, 30 or 40); (ii) single lifetime screening followed by rescreening individuals with negative results and (iii) universal treatment for H. pylori (age 20, 30 or 40). Data were from the published literature and national and international databases. Screening and treatment for H. pylori at age 20 reduced the mean lifetime cancer risk by 14.5% (men) to 26.6% (women) and cost less than $1,500 per year of life saved (YLS) compared to no screening. Rescreening individuals with negative results and targeting older ages was less cost-effective. Universal treatment prevented an additional 1.5% to 2.3% of risk reduction, but incremental cost-effectiveness ratios exceeded $2,500 per YLS. Screening young adults for H. pylori could prevent one in every 4 to 6 cases of gastric cancer in China and would be considered cost-effective using the GDP per capita threshold. These results illustrate the potential promise of a gastric cancer screening program and provide rationale for urgent clinical studies to move the prevention agenda forward.

Study of Association Between Atrophic Gastritis and Body Mass Index: A Cross-Sectional Study in 10,197 Japanese Subjects

The aim of this study was to elucidate the association between body mass index (BMI) and both Helicobacter pylori and atrophic gastritis. The study involved 10,197 subjects participating in a Japanese mass endoscopic gastric cancer screening program. Atrophic gastritis was assessed by pepsinogen I to II ratio. In logistic regression models, BMI had an inverse association with atrophic gastritis, with the odds ratios (OR) decreasing progressively to 0.67 (95% confidence interval [CI] 0.57-0.79, P<0.0001) in the highest BMI quintiles (BMI >or=25.66) group compared with the lowest BMI quintiles (BMI <20.97) group. In linear regression models, atrophic gastritis predicted BMI (regression coefficient -0.326, 95% CI -0.469, -0.184, P<0.0001), whereas H. pylori antibody was not a predictor (regression coefficient 0.072, 95% CI -0.053, 0.198, P=0.3). A small, inverse association between BMI and atrophic gastritis was found in the general population. In contrast, no association was observed between H. pylori seropositivity and BMI.

Serum Pepsinogen and Gastric Cancer Screening

Since the 1990's, the test for serum pepsinogen as a marker for chronic atrophic gastritis has been incorporated into gastric cancer screening programs, on a trial basis, to identify people at high risk for gastric cancer. The addition of the serum test to the cancer screening program has been shown to improve the detection rate of cancer and pepsinogen testing is useful in detecting early-stage gastric cancers arising from atrophic gastric mucosa, which macroscopically tend to be elevated and histologically differentiated. Furthermore, the cost for the detection of a single cancer case is much less than that for conventional screening. Thus, with the introduction of pepsinogen testing, complimenting barium X-ray, a more efficient screening system is available.

Comparing mass screening techniques for gastric cancer in Japan.

To discuss the efficacy of endoscopic mass screening for gastric cancer. The data used in this study were the results of mass screening programs for gastric cancer in Niigata City from 2002 to 2004. The number of participants was 35,089 in 2002, 34,557 in 2003 and 36,600 in 2004. The finding ratio referred to the final diagnosis of gastric cancer after a double check of endoscopic files and histological findings. The costs of identifying one case of gastric cancer were calculated based on the total expense for each screening program and additional close examinations. From the analysis of individual screening program with endoscopy, individual screening program with X-ray (ISX) and mass screening program with photofluorography (MSP) in reference to the finding ratio of gastric cancer, endoscopic examination was the best for detecting early gastric cancer, the finding ratio was 0.87% in 2004, approximately 2.7 and 4.6 times higher than those of the ISX and MSP groups. In addition, this novel method was the cheapest means regarding the cost of identifying one case of gastric cancer, which was estimated to be 1,608,000 Japanese yen in 2004. Endoscopic mass screening is a promising method and can be effectively applied if a sufficient number of skilled endoscopists become available to staff the system and if city offices support it.

Evaluation of the mass screening program for gastric cancer:

Evaluation of the mass screening program for gastric cancer:

Gastric cancer screening of a high‐risk population in Japan using serum pepsinogen and barium digital radiography

With the aim of developing more efficient gastric cancer screening programs for use in Japan, we studied a new screening program that combines serum pepsinogen (PG) testing and barium digital radiography (DR). A total of 17 647 middle-aged male subjects underwent workplace screening over a 7-year period using a combination of PG testing and DR. This program's effectiveness, as well as other characteristics of the program, was analyzed. Forty-nine cases of gastric cancer were detected (comprising 88% early cancer cases). The detection rate was 0.28%, and the positive predictive value was 0.85%. The PG test detected 63.3% of cases, DR detected 69.4% of cases, and both tests were positive in 32.7% of cancer cases. The two methods were almost equally effective, and were considerably more effective than conventional screening using photofluorography. Each screening method detected a distinct gastric cancer subgroup; the PG test efficiently detected asymptomatic small early cancer with intestinal type histology, while DR was efficient at detecting cancers with depressed or ulcerated morphology and diffuse type histology. The cost for the detection of a single cancer was much less than that for conventional screening. In fact, it is possible to further reduce the cost of detecting a single cancer to a cost comparable to that of surgically resecting a single gastric cancer. Thus, it is probable that a highly efficient gastric cancer screening system can be implemented by combining the two screening methods. Such a screening program would be beneficial in a population at high risk for gastric cancer.