Abstract:
Objective: Upper gastrointestinal cancer is one of the malignant tumours which seriously threaten human health. However, there are no multicentre studies evaluating the effectiveness of the endoscopic screening for upper gastrointestinal cancer in urban area. We aimed to estimate the effectiveness of one-time endoscopic screening in prevention of upper gastrointestinal cancer in urban population of China.
Methods: From 2014 to 2015, we assessed 192 805 individuals aged 40 to 69 for eligibility to build a prospective cohort study in 7 cities (Jinan, Qingdao, Chongqing, Ningbo, Quzhou, Xuzhou, and Hefei) of 5 provinces in China. Participants were classified as high risk or low risk of upper gastrointestinal cancer using an established risk scoring system that included cigarette smoking, alcohol consumption, history of upper gastrointestinal disease, family history of upper gastrointestinal cancer and so on. Participants who were evaluated to be high risk for upper gastrointestinal cancer were recommended to undergo endoscopic examination and were classified into screened and non-screened groups on the basis of whether or not they had the endoscopy examination. The effectiveness of one-time endoscopic screening was evaluated by a comparison of the screened and non-screened groups in terms of upper gastrointestinal cancer incidence and mortality using Cox proportional hazards model.
Results: 39 986 participants at high risk were enrolled in the study: 10 433 in the screened group and 29 533 in the non-screened group. By the end of December 2020, after a median follow-up of 5.8 years (IQR 5.6–5.9), 211 had an upper gastrointestinal cancer diagnosis, of whom 154 had gastric cancer and 57 had oesophageal cancer. Compared with non-screened group, upper gastrointestinal cancer incidence density was 25% higher (HR = 1.25, 95% CI = 0.93-1.67), and upper gastrointestinal cancer mortality was 55% lower (HR = 0.45, 95% CI = 0.22-0.90) in the screened group. Mortality of gastric cancer and oesophageal cancer decreased by 31% (HR = 0.69, 95% CI = 0.31-1.50) and 88% (HR = 0.12, 95% CI = 0.02-0.87), respectively, in those having endoscopic examination. All-site cancer mortality and all-cause mortality was 38% lower (HR = 0.62, 95% CI = 0.47-0.83) and 36% lower (HR = 0.64, 95% CI = 0.52-0.78), respectively, for participants in the screened group.
Conclusion: Among high risk individuals aged 40 to 69 years in urban population of China, one-time endoscopic screening was associated with a significant decrease in upper gastrointestinal cancer mortality, all-site cancer mortality and all-cause mortality.
Keywords: upper gastrointestinal cancer, screening, endoscopy, effectiveness
Acknowledgments: We thank all the subjects who participated in the study and all the collaborators who contributed to its success.
Audience Take Away Notes:
- Our findings show the effectiveness of one-time endoscopic screening in reducing upper gastrointestinal cancer mortality, all-site cancer mortality and all-cause mortality for a population at high risk of upper gastrointestinal cancer
- Previous research to evaluate the effectiveness for upper gastrointestinal cancer screening was mostly small-sample sized, single-center studies or based on rural population. This is the first study to evaluate the effectiveness of a one-time endoscopic screening in urban China in a multicenter cohort study
- The results indicate the feasibility of implementation of an endoscopic screening program for upper gastrointestinal cancer in urban China
- Our results point to the promise of one-time endoscopic examination in other developing countries with a heavy burden of upper gastrointestinal cancer and limited medical sources
