Gastric Cancer Screening Program Research Articles

Gastric cancer screening uptake trends in Korea: results for the National Cancer Screening Program from 2002 to 2011: a prospective cross-sectional study.

Although the effectiveness of mass screening for gastric cancer remains controversial, several countries with a high prevalence of gastric cancer have implemented nationwide gastric cancer screening programs. This study was conducted to assess trends in the use of either upper gastrointestinal series (UGIS) or endoscopy to screen for gastric cancer, as well as to assess factors strongly associated with changes therein, over a 10-year period.Data were obtained from the National Cancer Screening Program (NCSP) database from 2002 to 2011 in Korea. The NCSP provides biennial gastric cancer screening with either UGIS or endoscopy for men and women aged ≥40 years. Using the NCSP database, overall screening rates for gastric cancer and percentages of endoscopy use among participants were analyzed from 2002 to 2011. To estimate changes in participation rates and endoscopy use over time, we assessed the average annual percentage change (APC) by comparing the rates from 2002 and 2011 as relative rates.Participation rates for gastric cancer screening increased 4.33% annually from 2002 to 2011. In terms of screening method, a substantial increase in endoscopy use was noted among the gastric cancer screening participants over the 10-year period. The percentage of participants who had undergone endoscopy test increased from 31.15% in 2002 to 72.55% in 2011, whereas the percentage of participants who underwent UGIS decreased tremendously. Increased endoscopy test use was greatest among participants aged 40 to 49 (APC = 4.83%) and Medical Aid Program recipients (APC = 5.73%). Overall, men, participants of ages 40 to 49 years, and National Health Insurance beneficiaries of higher socioeconomic status were more likely to undergo screening via endoscopy.This study of nationwide empirical data from 2002 to 2011 showed that endoscopy is increasingly being used for gastric cancer screening in Korea, compared with UGIS. Nevertheless, further study of the impact of endoscopy on gastric cancer mortality is needed, and future evaluations of screening methods should take into account both cost and any associated reduction in gastric cancer mortality.

Optimal Interval for Repeated Gastric Cancer Screening in Normal-Risk Healthy Korean Adults: A Retrospective Cohort Study.

PurposeThis retrospective cohort study was conducted to estimate the optimal interval for gastric cancer screening in Korean adults with initial negative screening results.Materials and MethodsThis study consisted of voluntary Korean screenees aged 40 to 69 years who underwent subsequent screening gastroscopies after testing negative in the baseline screening performed between January 2007 and December 2011. A new case was defined as the presence of gastric cancer cells in biopsy specimens obtained upon gastroscopy. The follow-up periods were calculated during the months between the date of baseline screening gastroscopy and positive findings upon subsequent screenings, stratified by sex and age group. The mean sojourn time (MST) for determining the screening interval was estimated using the prevalence/incidence ratio.ResultsOf the 293,520 voluntary screenees for the gastric cancer screening program, 91,850 (31.29%) underwent subsequent screening gastroscopies between January 2007 and December 2011. The MSTs in men and women were 21.67 months (95% confidence intervals [CI], 17.64 to 26.88 months) and 15.14 months (95% CI, 9.44 to 25.85 months), respectively.ConclusionThese findings suggest that the optimal interval for subsequent gastric screening in both men and women is 24 months, supporting the 2-year interval recommended by the nationwide gastric cancer screening program.

Endoscopic individual screening program for gastric cancer in Fukuoka city

Endoscopic individual screening program for gastric cancer in Fukuoka city

Natural Course of Gastric Subepithelial Tumor

Subepithelial tumor (SET) is a protruding elevated mass covered with normal appearing mucosa, and is a relatively common finding during esophagogastroduodenoscopy. Recently, the incidence of asymptomatic small SETs is increasing due to esophagogastroduodenoscopy for national gastric cancer screening program in Korea. Unfortunately, the management of SETs is still controversial because the natural history of SETs is hardly known. There are only few studies about the natural history of SETs, especially in the stomach. According to studies, the overall rate of increased size of gastric SETs is 5.4∼28%. Tumor size, age, non-upper area of the stomach, and detection of anechoic lesion or echogenic foci on endoscopic ultrasound (EUS) are related with size increase in gastric SETs. Gastrointestinal stromal tumors (GISTs) are one of the most important tumors, and the prognosis of GISTs is closely connected with tumor size, mitotic count, and organ location. Among them, tumor size is relatively easy to approach with esophagogastroduodenoscopy or EUS. Asymptomatic gastric SETs ≤2 cm show a benign clinical course and the malignant potential of them is nearly 0%, even if the gastric SETs are confirmed as GISTs. However, asymptomatic gastric SETs ＞2 cm, ≤5 cm might be considered for detailed pathologic diagnosis and treatment, if the possibility of GISTs cannot be ruled out. Well-designed, prospective studies are required for more accurate management of SETs. (Korean J Helicobacter Up Gastrointest Res 2015;15:1-8)

A platform for gastric cancer screening in low- and middle-income countries.

Gastric cancer is the second leading cause of cancer death worldwide and screening programs have had a significant impact on reducing mortality. The majority of cases occur in low- and middle-income countries (LMIC), where endoscopy resources are traditionally limited. In this paper, we introduce a platform designed to enable inexpensive gastric screening to take place in remote areas of LMIC. The system consists of a swallowable endoscopic capsule connected to an external water distribution system by a multichannel soft tether. Pressurized water is ejected from the capsule to orient the view of the endoscopic camera. After completion of a cancer screening procedure, the outer shell of the capsule and the soft tether can be disposed, while the endoscopic camera is reclaimed without needing further reprocessing. The capsule, measuring 12 mm in diameter and 28 mm in length, is able to visualize the inside of the gastric cavity by combining waterjet actuation and the adjustment of the tether length. Experimental assessment was accomplished through a set of bench trials, ex vivo analysis, and in vivo feasibility validation. During the ex vivo trials, the platform was able to visualize the main landmarks that are typically observed during a gastric cancer screening procedure in less than 8 min. Given the compact footprint, the minimal cost of the disposable parts, and the possibility of running on relatively available and inexpensive resources, the proposed platform can potentially widen gastric cancer screening programs in LMIC.

Diagnostic values of serum levels of pepsinogens and gastrin-17 for screening gastritis and gastric cancer in a high risk area in northern Iran.

Gastric cancer (GC) is the second cause of cancer related death in the world. It may develop by progression from its precancerous condition, called gastric atrophy (GA) due to gastritis. The aim of this study was to evaluate the accuracy of serum levels of pepsinogens (Pg) and gastrin-17 (G17) as non-invasive methods to discriminate GA or GC (GA/GC) patients. Subjects referred to gastrointestinal clinics of Golestan province of Iran during 2010 and 2011 were invited to participate. Serum levels of PgI, PgII and G17 were measured using a GastroPanel kit. Based on the pathological examination of endoscopic biopsy samples, subjects were classified into four groups: normal, non-atrophic gastritis, GA, and GC. Receiver operating curve (ROC) analysis was used to determine cut-off values. Indices of validity were calculated for serum markers. Study groups were normal individuals (n=74), non-atrophic gastritis (n=90), GA (n=31) and GC patients (n=30). The best cut-off points for PgI, PgI/II ratio, G17 and HP were 80 μg/L, 10, 6 pmol/L, and 20 EIU, respectively. PgI could differentiate GA/GC with high accuracy (AUC=0.83; 95%CI: 0.76-0.89). The accuracy of a combination of PgI and PgI/II ratio for detecting GA/GC was also relatively high (AUC=0.78; 95%CI: 0.70-0.86). Our findings suggested PgI alone as well as a combination of PgI and PgI/II ratio are valid markers to differentiate GA/GC. Therefore, Pgs may be considered in conducting GC screening programs in high-risk areas.

Mean sojourn time of preclinical gastric cancer in Korean men: a retrospective observational study.

Objectives:This retrospective cohort study aimed to estimate the mean sojourn time (MST) of preclinical gastric cancer in Korean men.Methods:The subjects consisted of voluntary male screenees aged 40 to 69 years who underwent subsequent screening gastroscopies after testing negative at a baseline screening performed between January 2007 and December 2011. A new case was defined if gastric cancer cells were present in the biopsy specimens obtained from gastroscopy. The follow-up period was calculated as the number of person-years between the date of baseline screening gastroscopy and positive findings at a subsequent screening. The MST was calculated using transition rates of gastric cancer to determine the best screening interval.Results:Of the 171 979 voluntary male screenees, 61 688 (36%) underwent subsequent screening gastroscopies between January 2007 and December 2011. A total of 91 incident cases were found during 19 598 598 person-years of follow-up. The MST of gastric cancer was 2.37 years (95% confidence intervals, 1.92 to 2.96), and those aged 40 to 49 years had a shorter MST than those 50 to 69 years did.Conclusions:These findings support the 2-year interval of screening recommended by the nationwide gastric cancer screening program in Korea. Further studies for the age-specific MST among women are needed.

P-0071 - Gastric Cancer Risk Screening with Combined Assay for Serum Anti-Helicobacter Pylori IGG Antibody and Pepsinogen Level, So-Called “ABC Method”; Can We Need Imaging Study for Gastric Cancer Screening?

Introduction: Gastric cancer (GC) is the fifth most common cancer (952,000 in 2012) and the second leading cancer deaths (738,000 in 2008) worldwide. The highest incidence rates are in Eastern Asia, Eastern Europe, and South America. Regional variations in part reflect differences in dietary patterns and the Helicobacter pylori (Hp) infection. GC risk screening with combined assay for serum anti-Helicobacter pylori IgG antibody (HpAb) and serum pepsinogen level (PG), so-called “ABC method” classifies population into four different risk groups. Group A, or HpAb(-)PG(-) shows the lowest risk and is expected to have no GC. GC risk increases from B, or HpAb(+)PG(-) to C, or HpAb(+)PG(+). Group D, or HpAb(-)PG(+) reveals the greatest GC risk. Methods: We review the data of endoscopical GC screening program between Jun '12 and Dec '13 in our institute and analyze GC cases detected. Results: ABC method was done to 5850 cases among consecutive 6460 individuals of our endoscopical GC screening program. 70% cases were classified in Group A, 19% in B, 10% in C, and 1% in D. Ten cases of GC were found. Four GC cases belonged to Group A that should have no GC. Two were in B, and four in C. 23% of Group A had Hp eradication history (Hp-er Hx). Three GC cases in Group A experienced Hp eradication. 23% of Group A revealed Hp related findings endoscopically (Hp endo-findings) such as atrophic gastritis. The rest of one GC in Group A had such a condition without Hp-er Hx. No GC was found in all 2885 individuals without Hp-er Hx and Hp endo-findings in Group A. Conclusion: Even Group A in ABC method contains some cases with Hp-er Hx or Hp endo-findings. Such population has certain GC risk. Group A without Hp-er Hx and Hp endo-findings might need no imaging study for GC anymore.

Risk factors and clinical outcomes of gastric cancer identified by screening endoscopy: A case–control study

A customized screening program for gastric cancer would optimize the benefits of screening endoscopy. This study investigated the risk factors for gastric cancer detected during screening and factors affecting clinical outcomes. From April 2000 to December 2010, subjects who underwent screening endoscopy at Asan Medical Center were included. To investigate risk factors, age- and sex-matched control group was selected. The clinical outcomes of gastric cancer identified during screening (screening group) were compared with age, sex, and date of diagnosis-matched subjects who were diagnosed with gastric cancer in the outpatient clinic (outpatient group). Of 109 530 subjects, 327 were diagnosed with gastric cancer. The median age of the screening group was 63.6 years (interquartile range 56-71 years), and the male-to-female ratio was 2.4:1. When comparing with the control group, Helicobacter pylori seropositivity (odds ratio [OR] 2.933, P < 0.001), carcinoembryonic antigen (OR 8.633, P = 0.004), family history of gastric cancer (OR 2.254, P = 0.007), and drinking (OR 3.312, P < 0.001) were independent positive risk factors, and the use of aspirin a negative risk factor for gastric cancer (OR 0.445, P = 0.012) in multivariate analysis. Low-density lipoprotein cholesterol (hazard ratio [HR] 0.987, P = 0.005), cancer antigen 19-9 (HR 21.713, P < 0.001), resectability (HR 59.833, P < 0.001), and family history (HR 0.308, P = 0.009) were independent risk factors for death. The 5-year survival rate was significantly higher in the screening group than in the outpatient group (P < 0.001). Early detection of gastric cancer by screening endoscopy while asymptomatic enhances patient outcomes, especially in high-risk groups.

Risk factors and clinical outcomes of gastric cancer identified by screening endoscopy: A case-control study.

8 Background: A customized screening program for gastric cancer would optimize the benefits of screening endoscopy. This study investigated the risk factors for gastric cancer detected during screening, and factors affecting clinical outcomes. Methods: From April 2000 to December 2010, subjects who underwent screening endoscopy at Asan Medical Center were included. To investigate risk factors, age and sex-matched control group were selected.The clinical outcomes of gastric cancer identified during screening (screening group) were compared with age, sex and date of diagnosis-matched subjects who were diagnosed with gastric cancer in the outpatient clinic (outpatient group). Results: Of 109,530 subjects, 327 were diagnosed with gastric cancer. The median age of the screening group was 63.6 years (interquartile range: 56-71 years), and the male to female ratio was 2.4:1. When comparing with the control group, H. pylori seropositivity (odds ratio [OR] 2.933, p&lt;0.001), carcinoembryonic antigen (OR 8.633, p=0.004), family history of gastric cancer (OR 2.254, p=0.007), and drinking (OR 3.312, p&lt;0.001) were independent positive risk factors, and the use of aspirin a negative risk factor for gastric cancer (OR 0.445, p=0.012) in multivariate analysis. Low density lipoprotein cholesterol (hazard ratio [HR] 0.987, p=0.005), cancer antigen 19-9 (HR 21.713, p&lt;0.001), resectability (HR 59.833, p&lt;0.001), and family history (HR 0.308, p=0.009) were independent risk factors for death. The 5-year survival rate was significantly higher in the screening group than in the outpatient group (p&lt;0.001). Conclusions: Early detection of gastric cancer by screening endoscopy while asymptomatic enhances patient outcomes, especially in high risk groups.

Quality indicator for esophagogastroduodenoscopy in screening gastric cancer.

25 Background: The national gastric cancer screening program including endoscopy has been introduced in Korea in which the high incidence of gastric cancer have been reported. The good quality indicators of screening endoscopy for gastric cancer are mandatory to improve the detection rate. However, most quality indicators were focused on the standardization of an endoscopy unit rather than the individual assessment of endoscopists for cancer screening ability. We aimed to identify quality-assessment indicators associated with screening gastric cancer. Methods: The database records for 54,889 subjects who underwent esophagogastroduodenoscopy (EGD) for screening purpose at the Yonsei University Severance Hospital Health Promotion Center, Seoul, Korea between February 2006 and July 2013 were analyzed. All the endoscopists (n=66) involved in this study were experienced endoscopists who performed 1,000 or more EGDs. The detection rate of early gastric neoplasm according to endoscopists were assessed. The detection rates of various gastric lesions other than gastric epithelial neoplasms were also analyzed. The scoring formula for predicting the qualified endoscopists was proposed and analyzed. Results: Of the enrolled subjects, mean age was 48 years and the percentage of males was 59.7%. The percentage of gastric dysplasia, early gastric cancer, and advanced gastric cancer was 0.18%, 0.10%, and 0.04%, respectively. Most frequently detected lesions were gastric erosions (22.30%) followed by atrophic gastritis and intestinal metaplasia. In multivariate analysis, the detection rates of gastric subepithelial lesion or gastric diverticulum were independent associate factors with early gastric neoplasm detection. Cochran-Armitage trend test confirmed that higher quality score group was associated with significant higher early gastric neoplasm detection rate. Conclusions: The detection rates of gastric subepithelial lesion or gastric diverticulum are well correlated with early gastric neoplasm detection. the proposed quality score formula can be a good indicator assessing endoscopist's ability to detect early gastric neoplasm.

Metachronous gastric cancer after successful Helicobacter pylori eradication.

The high incidence of gastric cancer in Japan initially resulted in establishment of a country-wide gastric cancer screening program to detect early and treatable cancers. In 2013 countrywide Helicobacter pylori (H. pylori) eradication was approved coupled with endoscopy to assess for the presence of chronic gastritis. Current data support the notion that cure of the infection in those with non-atrophic gastritis will prevent development of gastric cancer. However, while progression to more severe damage is halted in those who have already developed, atrophic gastritis/gastric atrophy remain at risk for subsequent development of gastric cancer. That risk is directly related to the extent and severity of atrophic gastritis. Methods to stratify cancer risk include those based on endoscopic assessment of the atrophic border, histologic grading, and non-invasive methods based on serologic testing of pepsinogen levels. Continued surveillance is required because those with atrophic gastritis/gastric atrophy retain considerable gastric cancer risk even after H. pylori eradication. Those who have already experienced a resectable early gastric cancer are among those at highest risk as metachronous lesions are frequent even after H. pylori eradication. We review the role of H. pylori and effect of H. pylori eradication indicating the incidence and the predictive factors on development of metachronous cancer after endoscopic therapy of early gastric cancer. Studies to refine risk markers to stratify for risk, surveillance methods, intervals, and duration after successful H. pylori eradication, and whether adjuvant therapy would change risk are needed.

Su1971 Efficiency of Gastric Cancer Screening Programs in Korea: Organized Versus Opportunistic Models

lower 65 (30.1%); Period II: upper 37 (20.0%), middle 85 (45.9%), lower 61 (33.0%), Period III: upper 35 (22.2%), middle (40.5%), lower 55 (35.9%). Pathological examination revealed as follows (differentiated type/ undifferentiated/ others/ unknown); Period I: 132/ 69/0/17; Period II: 123/54/2/6; Period III: 103/43/2/0. These data indicated the locations and pathological features of the stomach cancer in this survey were not changed in recent 10 years. Regarding therapeutic approach to gastric cancer, open laparotomy was mainly applied to the gastric cancer in period I (2002-2004) as 159 out of 216 (73.6%) patients. Endoscopic treatment was performed in 38 patients (17.6%), whereas only 4 patients (1.9%) were treated under laparoscopy. In Period II (2005-2007), the ratio endoscopic treatment increased significantly (24.3%, 45/153). The ratio of laparoscopic surgery increased form 1.9% to 13.0% (24/153), although the number of gastric cancer patients treated by open laparotomy was decreased (58.9% 109/185). In Period III, the ratio of laparoscopic surgery (32.0% 49/153) was markedly increased compared to Periods I & II, while increase in the ratio of endoscopic treatment was limited (52/153 34.0%). because application of endoscopic treatment was limited to the gastric cancer within themucosa. This study clearly demonstrated therapeutic approach to the gastric cancer was replaced open laparotomy with endoscopic treatment and laparoscopic surgery in recent 10 years, although backgrounds of the gastric cancer were not changed.

Cost-effectiveness Outcomes of the National Gastric Cancer Screening Program in South Korea

Although screening is necessary where gastric cancer is particularly common in Asia, the performance outcomes of mass screening programs have remained unclear. This study was conducted to evaluate cost-effectiveness outcomes of the national cancer screening program (NCSP) for gastric cancer in South Korea. People aged 40 years or over during 2002-2003 (baseline) were the target population. Screening recipients and patients diagnosed with gastric cancers were identified using the NCSP and Korea Central Cancer Registry databases. Clinical outcomes were measured in terms of mortality and life-years saved (LYS) of gastric cancer patients during 7 years based on merged data from the Korean National Health Insurance Corporation and National Statistical Office. We considered direct, indirect, and productivity-loss costs associated with screening attendance. Incremental cost-effectiveness ratio (ICER) estimates were produced according to screening method, sex, and age group compared to non-screening. The age-adjusted ICER for survival was 260,201,000-371,011,000 Korean Won (KW; 1USD=1,088 KW) for the upper-gastrointestinal (UGI) tract over non-screening. Endoscopy ICERs were lower (119,099,000-178,700,000 KW/survival) than UGI. To increase 1 life-year, additional costs of approximately 14,466,000-15,014,000 KW and 8,817,000-9,755,000 KW were required for UGI and endoscopy, respectively. Endoscopy was the most cost-effective strategy for males and females. With regard to sensitivity analyses varying based on the upper age limit, endoscopy NCSP was dominant for both males and females. For males, an upper limit of age 75 or 80 years could be considered. ICER estimates for LYS indicate that the gastric cancer screening program in Korea is cost-effective. Endoscopy should be recommended as a first-line method in Korea because it is beneficial among the Korean population.

Effectiveness of gastric cancer screening programs in South Korea: Organizedvsopportunistic models

To investigate the outcome and effectiveness of two screening programs, National Cancer Screening Program (NCSP) and opportunistic screening (OS), for the detection of gastric cancer. A total of 45 654 subjects underwent upper endoscopy as part of the NCSP or OS at the Chung-Ang University Healthcare System in Korea between January 2007 and December 2010. The study population was comprised of subjects over the age of 40 years. More specifically, subjects who took part in the NCSP were Medicaid recipients and beneficiaries of the National Health Insurance Corporation. Still photographs from the endoscopies diagnosed as gastric cancer were reviewed by two experienced endoscopists. The mean age of the screened subjects was 55 years for men and 54 years for women. A total of 126 cases (0.28%) of gastric cancer were detected from both screening programs; 100 cases (0.3%) from NCSP and in 26 cases (0.2%) from OS. The proportion of early gastric cancer (EGC) detected in NCSP was higher than that in OS (74.0% vs 53.8%, P = 0.046). Among the 34 416 screenees in NCSP, 6585 (19.1%) underwent upper endoscopy every other year as scheduled. Among the 11 238 screenees in OS, 3050 (27.1%) underwent upper endoscopy at least once every two years during the study period. The detection rate of gastric cancer was found to be significantly higher during irregular follow-up than during regular follow-up in both screening programs (0.3% vs 0.2%, P = 0.036). A higher incidence of EGC than advanced gastric cancer was observed during regular follow-up compared with irregular follow-up. Compliance to the screening program is more important than the type of screening system used.

Outcomes and Efficiency of National Gastric Cancer Screening Program in Korea

Outcomes and Efficiency of National Gastric Cancer Screening Program in Korea

CA72-4 may contribute to real-time reconnaissance of gastric cancer

Objective: Data from prospective studies indicate a positive impact of gastric cancer screening programs on mortality associated with the disease. Unfortunately, endoscopic procedures, widely regarded as uncomfortable, face low patient compliance, thus underscoring the need for reliable biological markers capable of detection of tumor growth in bodily fluids. Furthermore, in light of the emerging patient-friendly, still devoid of histopathological capabilities, capsule endoscopy, gastric fluid may prove valuable for biomarker-assisted cancer diagnosis. We set out to determine whether CA72-4 measurement in gastric fluid may be of benefit for detection of gastric cancer. Design : Open prospective study. Setting: Sample collection was performed at a tertiary referral center for patients with gastroenterological diseases; immunological analysis was performed at the R&amp;D facility of a commercial biotechnology company. Studies were part of an EU-FP6 project (NEMO). Patients: 176 patients referred for endoscopy due to gastrointestinal complaints. Interventions: Gastric juice was aspirated endoscopically according to standard operating procedures, volume and pH were measured immediately and samples stored at -80&deg;C. Outcome measures: Concentration of CA72-4 tumor marker was evaluated by enzyme-linked immunosorbent assay (ELISA). Results: Median CA72-4 levels were about 4-fold higher in cancer patients compared with patients with normal gastric findings, gastric inflammation, intestinal metaplasia or other diseases (p=0.001). Multivariate linear regression analysis revealed that elevated CA72-4 was significantly predicted by gastric carcinoma adjusted for H. pylori status, age, smoking status, PPI dose, and pH of aspirate (R2=0.27, p&lt;0.0001). In this model, diagnosis of gastric carcinoma had by far the greatest influence. At a cut-off level of 100 U/ml, CA72-4 had 75% sensitivity and 89% specificity for detection of gastric cancer. Conclusions: Based on our findings, CA72-4 level assessment in gastric fluid, featuring yet unmatched accuracy of malignant neoplasia detection may prove beneficial for gastric cancer screening.

CA72-4 may contribute to real-time reconnaissance of gastric cancer

Objective: Data from prospective studies indicate a positive impact of gastric cancer screening programs on mortality associated with the disease. Unfortunately, endoscopic procedures, widely regarded as uncomfortable, face low patient compliance, thus underscoring the need for reliable biological markers capable of detection of tumor growth in bodily fluids. Furthermore, in light of the emerging patient-friendly, still devoid of histopathological capabilities, capsule endoscopy, gastric fluid may prove valuable for biomarker-assisted cancer diagnosis. We set out to determine whether CA72-4 measurement in gastric fluid may be of benefit for detection of gastric cancer.Design: Open prospective study.Setting: Sample collection was performed at a tertiary referral center for patients with gastroenterological diseases; immunological analysis was performed at the R&amp;D facility of a commercial biotechnology company. Studies were part of an EU-FP6 project (NEMO).Patients: 176 patients referred for endoscopy due to gastrointestinal complaints.Interventions: Gastric juice was aspirated endoscopically according to standard operating procedures, volume and pH were measured immediately and samples stored at -80°C.Outcome measures: Concentration of CA72-4 tumor marker was evaluated by enzyme-linked immunosorbent assay (ELISA).Results: Median CA72-4 levels were about 4-fold higher in cancer patients compared with patients with normal gastric findings, gastric inflammation, intestinal metaplasia or other diseases (p=0.001). Multivariate linear regression analysis revealed that elevated CA72-4 was significantly predicted by gastric carcinoma adjusted for H. pylori status, age, smoking status, PPI dose, and pH of aspirate (R2=0.27, p&lt;0.0001). In this model, diagnosis of gastric carcinoma had by far the greatest influence. At a cut-off level of 100 U/ml, CA72-4 had 75% sensitivity and 89% specificity for detection of gastric cancer.Conclusions: Based on our findings, CA72-4 level assessment in gastric fluid, featuring yet unmatched accuracy of malignant neoplasia detection may prove beneficial for gastric cancer screening.

Time to follow up after an abnormal finding in organized gastric cancer screening in Korea

BackgroundThe prognosis for an abnormal medical finding is affected by both early detection and adherence to the presecribed schedule for follow-up examinations. In this study, we examined the time to follow up after an abnormal finding and determined the risk factors related to delays in follow up in a population-based screening program.MethodsThe study population consisted of patients who were newly diagnosed with gastric cancer through a gastric cancer screening program sponsored by the National Cancer Screening Program (NCSP) in 2005. Due to the skewed nature of the distribution of time to follow up, medians and interquartile ranges (IQR) are presented, and we analyzed the number of days preceding the follow-up time as a binary variable (≤90 days or >90 days). We used logistic regression analyses to evaluate the risk factors for a long delay.ResultsThe median number of days to follow-up initiation after an abnormal finding was 11 (IQR 7–27); 13.9% of the patients with gastric cancer obtained their follow-up evaluation more than 90 days. Age, type of health insurance, screening method, and screening results were risk factors for delays in follow up.ConclusionsThis study examined delays from the time of the discovery of an abnormal finding to time of the follow-up evaluation. Because inadequate follow up of abnormal exam results undermines the potential benefits of cancer screening, it is important to organize services that minimize delays between cancer screening and treatment.

Population-based gastric cancer screening in Zhuanghe, Liaoning, from 1997 to 2011

To investigate the feasibility of gastric cancer screening for the susceptible population in the high-risk areas of China and to optimize the screening programme. By using the two-round screening method i.e. serum pepsinogen test combined with gastric mucosa biopsy, large-scale population screening programs were carried out in Zhuanghe, Liaoning province. All adults or residents above 35 years old with a positive family history of gastric cancer or gastrointestinal symptoms were targeted. Three large-scale population screenings were developed over the past 15 years. All together, 13078 participants accepted the two-round screening, and 108 gastric cancer cases were detected. Among them, the detection rate of early gastric cancer was 56.82%, 51.22% and 82.61%, respectively. The pathologically confirmed gastric cancer cases were immediately arranged to have early surgical treatment, and meanwhile, the follow-up files for the patients were established. With a consecutive and regular 10-year postoperative follow-up, the 5-year survival rate for these early gastric cancer patients reached 90.48%. Effectiveness and health economic evaluation confirmed that there are good specificity and sensitivity for the two round screening programs. It is cost-effective. As the primary screening method serum PG test can improve the screening examination rate and concentrate the gastric cancer risk populations. It is feasible to develop the gastric cancer screening program among the susceptible population in high-risk areas in our country, and the two-round screening method is of practical value. Research for early detection of gastric cancer should be further enhanced, and multidisciplinary and multicenter cooperation should be organized. It is necessary to extend the implementation the gastric cancer screening and to further improve the early detection programme, in order to make a breakthrough based on the present practice.