Cancer Res Treat.  2018 Apr;50(2):582-589. 10.4143/crt.2017.048.

Effectiveness of Gastric Cancer Screening on Gastric Cancer Incidence and Mortality in a Community-Based Prospective Cohort

• Kim H
• Hwang Y
• Sung H
• Jang J
• Ahn C
• Kim SG
• Yoo KY
• Park SK

• KMID: 2411146
• DOI: http://doi.org/10.4143/crt.2017.048

Abstract

PURPOSE
This study was performed to investigate the effectiveness of gastric cancer (GC) screening methods in a community-based prospective cohort of the Korean Multi-center Cancer Cohort (KMCC) with over a 10-year follow-up.
MATERIALS AND METHODS
A total 10,909 and 4,773 subjects from the KMCC with information on gastroendoscopy (GE) and upper gastrointestinal series (UGIS) were included in this study. Cox proportional hazard model adjusted for age, sex, Helicobacter pylori infection, cigarette smoking, and alcohol drinking was used to estimate the hazard ratios (HRs) and 95% confidence interval (CI).
RESULTS
The GE screened subjects had almost half the risk of GC-specific death than that of unscreened subjects (HR, 0.58; 95% CI, 0.36 to 0.94). Among the GC patients, GE screenees had a 2.24-fold higher survival rate than that of the non-screenees (95% CI, 1.61 to 3.11). In particular, GE screenees who underwent two or more screening episodes had a higher survival rate than that of the non-screenees (HR, 13.11; 95% CI, 7.38 to 23.30). The effectiveness of GE screening on reduced GC mortality and increased survival rate of GC patients was better in elderly subjects (≥ 65 years old) (HR, 0.47; 95% CI, 0.24 to 0.95 and HR, 8.84; 95% CI, 3.63 to 21.57, respectively) than that in younger subjects (< 65 years old) (HR, 0.66; 95% CI, 0.34 to 1.29 and HR, 1.83; 95% CI, 1.24 to 2.68, respectively). In contrast, UGIS screening had no significant relation to GC mortality and survival.
CONCLUSION
The findings of this study suggest that a decreased GC-specific mortality and improved survival rate in GC patients can be achieved through GE screening.

Keyword

Stomach neoplasms; Cohort studies; Mortality; Gastrointestinal endoscopy; Gastroscopy

MeSH Terms

Aged
Alcohol Drinking
Cohort Studies*
Endoscopy, Gastrointestinal
Follow-Up Studies
Gastroscopy
Helicobacter pylori
Humans
Incidence*
Mass Screening*
Mortality*
Proportional Hazards Models
Prospective Studies*
Smoking
Stomach Neoplasms*
Survival Rate

Reference

References

1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015; 136:E359–86.

2. Jung KW, Won YJ, Oh CM, Kong HJ, Cho H, Lee DH, et al. Prediction of cancer incidence and mortality in Korea, 2015. Cancer Res Treat. 2015; 47:142–8.

3. Yoo KY. Cancer control activities in the Republic of Korea. Jpn J Clin Oncol. 2008; 38:327–33.

4. Lee S, Jun JK, Suh M, Park B, Noh DK, Jung KW, et al. Gastric cancer screening uptake trends in Korea: results for the National Cancer Screening Program from 2002 to 2011: a prospective cross-sectional study. Medicine (Baltimore). 2015; 94:e533.

5. National Cancer Center. Cancer Facts & Figures 2015 [Internet]. Sejong: Minister for Health and Welfare;2015. [cited 2015 Jun 10]. Available from: https://www.ncc.re.kr/main.ncc?uri=english/sub04_FactsandFigures.

6. Choi KS, Jun JK, Suh M, Park B, Noh DK, Song SH, et al. Effect of endoscopy screening on stage at gastric cancer diagnosis: results of the National Cancer Screening Programme in Korea. Br J Cancer. 2015; 112:608–12.

7. Lee H, Min BH, Lee JH, Son HJ, Kim JJ, Rhee JC, et al. Survival outcome associated with the screening interval for gastric cancer in Korea. Digestion. 2011; 84:142–8.

8. Gong EJ, Ahn JY, Jung HY, Lim H, Choi KS, Lee JH, et al. Risk factors and clinical outcomes of gastric cancer identified by screening endoscopy: a case-control study. J Gastroenterol Hepatol. 2014; 29:301–9.

9. Choi KS, Jun JK, Park EC, Park S, Jung KW, Han MA, et al. Performance of different gastric cancer screening methods in Korea: a population-based study. PLoS One. 2012; 7:e50041.

10. Yoo KY, Shin HR, Chang SH, Lee KS, Park SK, Kang D, et al. Korean multi-center cancer cohort study including a biological materials bank (KMCC-I). Asian Pac J Cancer Prev. 2002; 3:85–92.

11. Lu CY, Kuo CH, Lo YC, Chuang HY, Yang YC, Wu IC, et al. The best method of detecting prior Helicobacter pylori infection. World J Gastroenterol. 2005; 11:5672–6.

12. Matsumoto S, Yoshida Y. Efficacy of endoscopic screening in an isolated island: a case-control study. Indian J Gastroenterol. 2014; 33:46–9.

13. Hamashima C, Ogoshi K, Okamoto M, Shabana M, Kishimoto T, Fukao A. A community-based, case-control study evaluating mortality reduction from gastric cancer by endoscopic screening in Japan. PLoS One. 2013; 8:e79088.

14. Fukao A, Tsubono Y, Tsuji I, HIsamichi S, Sugahara N, Takano A. The evaluation of screening for gastric cancer in Miyagi Prefecture, Japan: a population-based case-control study. Int J Cancer. 1995; 60:45–8.

15. Pisani P, Oliver WE, Parkin DM, Alvarez N, Vivas J. Case-control study of gastric cancer screening in Venezuela. Br J Cancer. 1994; 69:1102–5.

16. Matsumoto S, Ishikawa S, Yoshida Y. Reduction of gastric cancer mortality by endoscopic and radiographic screening in an isolated island: a retrospective cohort study. Aust J Rural Health. 2013; 21:319–24.

17. Cooper GS, Yuan Z, Chak A, Rimm AA. Association of prediagnosis endoscopy with stage and survival in adenocarcinoma of the esophagus and gastric cardia. Cancer. 2002; 95:32–8.

18. Hosokawa O, Miyanaga T, Kaizaki Y, Hattori M, Dohden K, Ohta K, et al. Decreased death from gastric cancer by endoscopic screening: association with a population-based cancer registry. Scand J Gastroenterol. 2008; 43:1112–5.

19. Dan YY, So JB, Yeoh KG. Endoscopic screening for gastric cancer. Clin Gastroenterol Hepatol. 2006; 4:709–16.

20. Inaba S, Hirayama H, Nagata C, Kurisu Y, Takatsuka N, Kawakami N, et al. Evaluation of a screening program on reduction of gastric cancer mortality in Japan: preliminary results from a cohort study. Prev Med. 1999; 29:102–6.

21. Kaneko S, Tamakoshi A, Ohno Y, Mizoue T, Yoshimura T; JACC Study Group. Menstrual and reproductive factors and the mortality risk of gastric cancer in Japanese menopausal females. Cancer Causes Control. 2003; 14:53–9.

22. Lee KJ, Inoue M, Otani T, Iwasaki M, Sasazuki S, Tsugane S, et al. Gastric cancer screening and subsequent risk of gastric cancer: a large-scale population-based cohort study, with a 13-year follow-up in Japan. Int J Cancer. 2006; 118:2315–21.

23. Miyamoto A, Kuriyama S, Nishino Y, Tsubono Y, Nakaya N, Ohmori K, et al. Lower risk of death from gastric cancer among participants of gastric cancer screening in Japan: a population-based cohort study. Prev Med. 2007; 44:12–9.

24. Hamashima C, Shibuya D, Yamazaki H, Inoue K, Fukao A, Saito H, et al. The Japanese guidelines for gastric cancer screening. Jpn J Clin Oncol. 2008; 38:259–67.

25. Tashiro A, Sano M, Kinameri K, Fujita K, Takeuchi Y. Comparing mass screening techniques for gastric cancer in Japan. World J Gastroenterol. 2006; 12:4873–4.

26. Higashi T, Machii R, Aoki A, Hamashima C, Saito H. Evaluation and revision of checklists for screening facilities and municipal governmental programs for gastric cancer and colorectal cancer screening in Japan. Jpn J Clin Oncol. 2010; 40:1021–30.

27. Oh HK, Kim JM, Kim CG, Park YS, Seon JR, Choi IS. Quality control of upper gastrointestinal seriese (UGIS) by the Image Quality Evaluation Table of Korea and Japan. J Radiol Sci Technol. 2011; 34:277–85.

28. Nam SY, Choi IJ, Park KW, Kim CG, Lee JY, Kook MC, et al. Effect of repeated endoscopic screening on the incidence and treatment of gastric cancer in health screenees. Eur J Gastroenterol Hepatol. 2009; 21:855–60.

29. Mori Y, Arita T, Shimoda K, Yasuda K, Yoshida T, Kitano S. Effect of periodic endoscopy for gastric cancer on early detection and improvement of survival. Gastric Cancer. 2001; 4:132–6.