Endoscopy 2022; 54(09): 848-858
DOI: 10.1055/a-1728-5673
Original article

Beneficial effects of endoscopic screening on gastric cancer and optimal screening interval: a population-based study

Wen-Qing Li*
1   Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China
,
Xiang-Xiang Qin*
1   Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China
,
Zhe-Xuan Li
1   Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China
,
Le-Hua Wang
2   Linqu County People’s Hospital, Linqu, China
,
Zong-Chao Liu
1   Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China
,
Xiao-Han Fan
1   Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China
,
Li-Hui Zhang
3   Department of Disease Control, Linqu County Public Health Bureau, Linqu, China
,
Yi Li
2   Linqu County People’s Hospital, Linqu, China
,
Xiu-Zhen Wu
2   Linqu County People’s Hospital, Linqu, China
,
Jun-Ling Ma
1   Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China
,
Yang Zhang
1   Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China
,
Lan-Fu Zhang
2   Linqu County People’s Hospital, Linqu, China
,
Ming Li
3   Department of Disease Control, Linqu County Public Health Bureau, Linqu, China
,
Tong Zhou
1   Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China
,
Jing-Ying Zhang
1   Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China
,
Jian-Xi Wang
3   Department of Disease Control, Linqu County Public Health Bureau, Linqu, China
,
Wei-Dong Liu
4   Department of Epidemiology, Institute for Gastric Cancer Prevention, Linqu, China
,
Wei-Cheng You
1   Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China
,
Kai-Feng Pan
1   Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Cancer Epidemiology, Peking University Cancer Hospital and Institute, Beijing, China
› Author Affiliations
Supported by: Natural Science Foundation of Beijing Municipality 7194245
Supported by: Beijing Municipal Administration of Hospitals’ Ascent Plan DFL20181102
Supported by: The National Key R&D Program of China 2018YFC1313105

Abstract

Background The effectiveness of endoscopic screening on gastric cancer has not been widely investigated in China and the screening interval of repeated screening has not been determined.

Methods In a population-based prospective study, we included 375,800 individuals, 14,670 of whom underwent endoscopic screening (2012–2018). We assessed the associations between endoscopic screening and risk of incident gastric cancer and gastric cancer-specific mortality, and examined changes in overall survival and disease-specific survival following screening. The optimal screening interval for repeated endoscopy for early detection of gastric cancer was explored.

Results Ever receiving endoscopic screening significantly decreased the risk of invasive gastric cancer (age- and sex-adjusted relative risk [RR] 0.69, 95 % confidence interval [CI] 0.52–0.92) and gastric cancer-specific mortality (RR 0.33, 95 %CI 0.20–0.56), particularly for noncardia gastric cancer. Repeated screening strengthened the beneficial effect on invasive gastric cancer-specific mortality of one-time screening. Among invasive gastric cancers, screening-detected individuals had significantly better overall survival (RR 0.18, 95 %CI 0.13–0.25) and disease-specific survival (RR 0.18, 95 %CI 0.13–0.25) than unscreened individuals, particularly for those receiving repeated endoscopy. For individuals with intestinal metaplasia or low grade intraepithelial neoplasia, repeated endoscopy at an interval of < 2 years, particularly within 1 year, significantly enhanced the detection of early gastric cancer, compared with repeated screening after 2 years (P-trend = 0.02).

Conclusion Endoscopic screening prevented gastric cancer occurrence and death, and improved its prognosis in a population-based study. Repeated endoscopy enhanced the effectiveness. Screening interval should be based on gastric lesion severity.

* These authors contributed equally to this work.


Tables 1 s–3 s, Figs. 1 s–3 s



Publication History

Received: 02 July 2021

Accepted: 28 December 2021

Accepted Manuscript online:
28 December 2021

Article published online:
15 March 2022

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