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{{CMG}}{{AE}}{{PSD}}
{{CMG}}; {{AE}} {{PSD}} {{MAD}}
{{Stomach cancer}}
{{Stomach cancer}}
==Overview==
==Overview==
The two main modalities for [[gastric cancer]] [[Screening (medicine)|screening]] are [[upper endoscopy]] and [[Contrast medium|contrast]] [[radiography]]. Universal [[screening]] is recommended in countries with a high [[incidence]] of [[gastric cancer]] such as East Asian countries. In areas of low [[gastric cancer]] [[incidence]], [[screening]] for [[gastric cancer]] with [[upper endoscopy]] should be reserved specifically for high-risk subgroups. [[Upper endoscopy]] has a sensitivity of 69 % and [[Upper gastrointestinal series|upper GI series]] has a [[Sensitivity (tests)|sensitivity]] of 37%. Both studies have a [[Specificity (tests)|specificity]] of 96%.


==Screening cancer==
==Screening ==
Gastric cancer remains the second leading cause of
 The two main modalities for [[gastric cancer]] [[screening]] are [[upper endoscopy]] and [[Contrast medium|contrast]] [[radiography]].
 
cancer death worldwide. About half of the incidence
 
of gastric cancer is observed in East Asian countries,
 
which show a higher mortality than other countries.
 
The effectiveness of 3 new gastric cancer screening
 
techniques, namely, upper gastrointestinal endoscopy,
 
serological testing, and “screen and treat” method were
 
extensively reviewed. Moreover, the phases of development
 
for cancer screening were analyzed on the basis
 
of the biomarker development road map. Several observational
 
studies have reported the effectiveness of
 
endoscopic screening in reducing mortality from gastric
 
cancer. On the other hand, serologic testing has mainly
 
been used for targeting the high-risk group for gastric
 
cancer. To date, the effectiveness of new techniques
 
for gastric cancer screening has remained limited.


However, endoscopic screening is presently in the last
=== '''Upper endoscopy''' ===
* [[Upper endoscopy]] is more [[Sensitivity (tests)|sensitive]] than other [[Screening (medicine)|screening]] studies. It allows direct visualization of the [[gastric]] [[Mucosal|mucosa]] and allows for obtaining [[Biopsy|biopsies]].<ref name="pmid8198977">{{cite journal| author=Pisani P, Oliver WE, Parkin DM, Alvarez N, Vivas J| title=Case-control study of gastric cancer screening in Venezuela. | journal=Br J Cancer | year= 1994 | volume= 69 | issue= 6 | pages= 1102-5 | pmid=8198977 | doi= | pmc=1969457 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8198977  }}</ref>


WJG 20th Anniversary Special Issues (8): Gastric cancer
=== '''Contrast radiography''' ===
* [[Barium meal|Barium radiographs]] can identify [[malignant]] [[Gastric ulcer|gastric ulcers]], infiltrating [[lesions]], and some early [[Gastric cancer|gastric cancers]].<ref name="pmid6383166">{{cite journal| author=Dooley CP, Larson AW, Stace NH, Renner IG, Valenzuela JE, Eliasoph J et al.| title=Double-contrast barium meal and upper gastrointestinal endoscopy. A comparative study. | journal=Ann Intern Med | year= 1984 | volume= 101 | issue= 4 | pages= 538-45 | pmid=6383166 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6383166  }}</ref> 
* [[Barium follow-through|Barium studies]] can be false negative in 50 percent of cases and the [[Sensitivity (tests)|sensitivity]] of a [[Barium meal|barium study]] may be 14 percent.<ref name="pmid2916797">{{cite journal| author=Longo WE, Zucker KA, Zdon MJ, Modlin IM| title=Detection of early gastric cancer in an aggressive endoscopy unit. | journal=Am Surg | year= 1989 | volume= 55 | issue= 2 | pages= 100-4 | pmid=2916797 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2916797  }}</ref> 
* In [[patients]] with [[linitis plastica]], a [[Barium follow-through|barium study]] may be superior to [[upper endoscopy]].


TOPIC HIGHLIGHT
=== '''Sensitivity of tests''' ===
* [[Upper endoscopy]] has a [[sensitivity]] of 69 % and [[Upper gastrointestinal series|upper GI series]] has a [[Sensitivity (tests)|sensitivity]] of 37%.


WJG|www.wjgnet.com 13767 October 14, 2014|Volume 20|Issue 38|
* Both studies had a [[Specificity (tests)|specificity]] of 96%.


trial phase of development before their introduction to
* The [[upper endoscopy]] [[Sensitivity (tests)|sensitivity]] in detecting a localized [[gastric cancer]] is higher than [[Upper gastrointestinal series|upper GI series]].<ref name="pmid25490528">{{cite journal| author=Choi KS, Jun JK, Suh M, Park B, Noh DK, Song SH et al.| title=Effect of endoscopy screening on stage at gastric cancer diagnosis: results of the National Cancer Screening Programme in Korea. | journal=Br J Cancer | year= 2015 | volume= 112 | issue= 3 | pages= 608-12 | pmid=25490528 | doi=10.1038/bjc.2014.608 | pmc=4453643 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25490528  }}</ref>


population-based screening. To effectively introduce
== Screening Strategies ==


new techniques for gastric cancer screening in a community,
=== '''Universal screening''' ===
* Universal [[Screening (medicine)|screening]] is recommended in countries with a high [[incidence]] of [[gastric cancer]] such as East Asian countries.<ref name="pmid1759081">{{cite journal| author=Llorens P| title=Gastric cancer mass survey in Chile. | journal=Semin Surg Oncol | year= 1991 | volume= 7 | issue= 6 | pages= 339-43 | pmid=1759081 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1759081  }}</ref>


incidence and mortality reduction from gastric
* In Japan, population-based [[Screening (medicine)|screening]] for [[gastric cancer]] is recommended for individuals older than 50 years with conventional double-contrast [[barium]] [[radiograph]] with photofluorography every year or [[upper endoscopy]] every two to three years<ref name="pmid25505714">{{cite journal| author=Choi IJ| title=Endoscopic gastric cancer screening and surveillance in high-risk groups. | journal=Clin Endosc | year= 2014 | volume= 47 | issue= 6 | pages= 497-503 | pmid=25505714 | doi=10.5946/ce.2014.47.6.497 | pmc=4260096 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25505714  }}</ref>


cancer must be initially and thoroughly evaluated by
* [[Screening]] interval is recommended to be every two years but may be widened to a three-year interval without significant effect.<ref name="pmid24613579">{{cite journal| author=Park CH, Kim EH, Chung H, Lee H, Park JC, Shin SK et al.| title=The optimal endoscopic screening interval for detecting early gastric neoplasms. | journal=Gastrointest Endosc | year= 2014 | volume= 80 | issue= 2 | pages= 253-9 | pmid=24613579 | doi=10.1016/j.gie.2014.01.030 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24613579  }}</ref>


conducting reliable studies. In addition to effectiveness
=== '''Selective screening of high-risk subgroups''' ===
* In areas of low [[gastric cancer]] [[incidence]], [[screening]] for gastric cancer with [[upper endoscopy]] should be reserved for specific high-risk subgroups.<ref name="pmid1853856">{{cite journal| author=Tersmette AC, Goodman SN, Offerhaus GJ, Tersmette KW, Giardiello FM, Vandenbroucke JP et al.| title=Multivariate analysis of the risk of stomach cancer after ulcer surgery in an Amsterdam cohort of postgastrectomy patients. | journal=Am J Epidemiol | year= 1991 | volume= 134 | issue= 1 | pages= 14-21 | pmid=1853856 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1853856  }}</ref>


evaluation, the balance of benefits and harms must be
*Individuals at increased risk for [[gastric cancer]] include those [[patients]] having the following:
 
**[[Gastric]] [[Adenoma|adenomas]]
carefully assessed before introducing these new techniques
**[[Pernicious anemia]]
 
**[[Gastric]] [[intestinal]] [[metaplasia]]
for population-based screening.
**[[Familial adenomatous polyposis]]
 
**[[Lynch syndrome]]
'''SCREENING MODALITIES''' 
**[[Peutz-Jeghers syndrome]]
 
**[[Juvenile polyposis syndrome]]
The two main modalities for gastric cancer screening are upper endoscopy and contrast radiography.
 
'''Upper endoscopy''' 
 
Upper endoscopy allows for direct visualization of the gastric mucosa and for biopsies to be obtained for diagnosing precancerous lesions such as gastric atrophy, intestinal metaplasia, or gastric dysplasia in addition to gastric cancer. Although it is more invasive and has a higher cost, upper endoscopy is also more sensitive for diagnosing a variety of gastric lesions as compared with alternative diagnostic strategies.
 
'''Contrast radiography''' 
 
Double-contrast barium radiographs with photofluorography or digital radiography can identify malignant gastric ulcers, infiltrating lesions, and some early gastric cancers. However, false-negative barium studies can occur in as many as 50 percent of cases [3]. In early gastric cancer, the sensitivity of a barium study may be as low as 14 percent [4]. The one scenario in which a barium study may be superior to upper endoscopy is in patients with linitis plastica. The decreased distensibility of the stiff, "leather-flask" appearing stomach is more obvious on the radiographic study, and the endoscopic appearance may be relatively normal.
 
'''COMPARISON OF SCREENING METHODS'''
 
'''Test performance''' 
 
studies suggest that endoscopic screening may be a more sensitive test for screening for gastric cancer [17-21].
 
 A population-based study in South Korea included 2,690,731 individuals who underwent screening for gastric cancer with either upper endoscopy or an upper gastrointestinal (GI) series [22].
 
Gastric cancer detection rates were 2.61 and 0.68 per 1000 screenings, respectively. The sensitivity rates for upper endoscopy versus upper GI series in detecting gastric cancer were 69 and 37 percent, respectively. Both studies had a specificity of 96 percent. The sensitivity of upper endoscopy in detecting a localized gastric cancer was also significantly higher as compared with upper GI series (68 versus 32 percent). In total, 2067 interval cancers occurred within one year of a negative upper GI series and 1083 cancers occurred after a negative upper endoscopy, but there was no difference in interval cancer rates (1.2 per 1000 screenings for both groups).
 
'''Effectiveness''' 
 
Although some observational studies suggest that screening in areas of high gastric cancer incidence has contributed to the detection of cancer in early stages and an overall decline in gastric cancer mortality, there are no data from large randomized trials demonstrating lower gastric cancer-related mortality in screened populations [17,23-30]. In addition, lead time bias, length bias, and selection bias must be considered when appraising the overall effectiveness of screening demonstrated in observational studies. In a retrospective cohort study of 19,168 gastric cancer patients in Korea, endoscopy-screened patients and patients screened with upper GI series were significantly more likely to be diagnosed with localized gastric cancer as compared with never-screened patients (odds ratio 2.1, 95% CI 1.9-2.3 and 1.2, 95% CI 1.1-1.4, respectively) [30]. However, this study did not include data as to which patients were symptomatic or had undergone evaluation outside of the screening program for evaluation of symptoms.
 
Screening for gastric cancer may be cost-effective for high-risk subgroups, but not low-risk populations [31,32]. A cost-effectiveness analysis found that in a high-risk group of Chinese men ages 50 to 70 years (standardized incidence of gastric cancer of 25.9 per 100,000 population), screening with upper endoscopy every two years was highly cost-effective ($28,836 per quality-adjusted life-years saved [31]). By contrast, averting one gastric cancer death in men in the United States, assuming an incidence of gastric cancer of <10 per 100,000 population, would cost approximately $247,600, which does not compare favorably with other generally accepted cancer screening interventions
 
'''SCREENING STRATEGIES''' 
 
'''Universal screening''' 
 
Universal or population-based screening for gastric cancer has been implemented in some countries with a high incidence of gastric cancer (eg, Japan, Korea, Venezuela, and Chile) [17-19]. However, the recommended screening modality and intervals vary. As examples:
 
In Japan, population-based screening for gastric cancer is recommended for individuals older than 50 years with conventional double-contrast barium radiograph with photofluorography every year or upper endoscopy every two to three years [20,33,34].
 
In Korea, upper endoscopy is recommended every two years for individuals aged 40 to 75 years [34-36].
 
The optimal interval for screening has not been established in randomized trials. A two-year interscreen interval is supported by at least one study that evaluated the mean sojourn time (MST) for gastric cancer (ie, the asymptomatic period during which a cancer can be detected through screening tests before typical symptoms develop) in a cohort of 61,000 Korean men voluntarily attending a cancer screening program and rescreened by endoscopy [37]. A total of 91 incident cases were found during 19,598,598 person-years of follow-up, and the MST for gastric cancer was 2.4 years (95% CI 1.9-3.0). Of note, the MST was shorter in individuals 40 to 49 years of age (1.3 years, 95% CI 1.0-1.7) than the MST in those 50 to 59 years of age or 60 to 69 (3.2 and 3.7, respectively).  
 
At least some data suggest that the screening interval may be widened to a three-year rather than a two-year interval without significantly decreasing the proportion of gastric neoplasms that can be adequately treated by endoscopic methods [38-40]. However, intervals longer than three years may be associated with a greater risk of more advanced stage cancer at diagnosis. As an example, in a retrospective cohort study of 2485 patients with gastric adenocarcinoma in Korea, as compared with individuals who underwent annual screening for gastric cancer, the risk of advanced cancer was higher in individuals who underwent screening at four- or five-year intervals (four-year interval odds ratio [OR] 2.5, 95% CI 1.4-4.5, five-year interval OR 2.2, 95% CI 1.3-3.7), but not in individuals who underwent screening at two- or three-year intervals [38]. In subgroup analysis, individuals with a family history of gastric cancer and individuals in their 60s were more likely to be diagnosed with a higher stage of gastric cancer if upper endoscopies were performed every three years as compared with annually (family history of gastric cancer OR 2.68, 95% CI 1.3-5.7, gastric cancer in 60s OR 2.09, 95% CI 1.0-4.3).
 
'''Selective screening of high-risk subgroups''' 
 
In areas of low gastric cancer incidence, screening for gastric cancer with upper endoscopy should be reserved for specific high-risk subgroups [41-52]. The intensity of screening should be based upon an appraisal of the magnitude of risk in each patient, their suitability for treatment should a lesion be detected, and their willingness to accept the uncertain benefits and risks of a screening program.
 
Individuals at increased risk for gastric cancer include those with the following:
 
●Gastric adenomas
 
●Pernicious anemia
 
●Gastric intestinal metaplasia
 
●Familial adenomatous polyposis
 
●Lynch syndrome
 
●Peutz-Jeghers syndrome
 
●Juvenile polyposis syndrome


==References==
==References==
{{reflist|2}}
{{reflist|2}}
[[Category:Disease]]
[[Category:Types of cancer]]
[[Category:Conditions diagnosed by stool test]]
[[Category:Primary care]]
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Latest revision as of 11:55, 5 April 2019


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2] Mohammed Abdelwahed M.D[3]

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Overview

The two main modalities for gastric cancer screening are upper endoscopy and contrast radiography. Universal screening is recommended in countries with a high incidence of gastric cancer such as East Asian countries. In areas of low gastric cancer incidence, screening for gastric cancer with upper endoscopy should be reserved specifically for high-risk subgroups. Upper endoscopy has a sensitivity of 69 % and upper GI series has a sensitivity of 37%. Both studies have a specificity of 96%.

Screening

 The two main modalities for gastric cancer screening are upper endoscopy and contrast radiography.

Upper endoscopy

Contrast radiography

Sensitivity of tests

Screening Strategies

Universal screening

  • Screening interval is recommended to be every two years but may be widened to a three-year interval without significant effect.[7]

Selective screening of high-risk subgroups

References

  1. ↑ Pisani P, Oliver WE, Parkin DM, Alvarez N, Vivas J (1994). "Case-control study of gastric cancer screening in Venezuela". Br J Cancer. 69 (6): 1102–5. PMC 1969457. PMID 8198977.
  2. ↑ Dooley CP, Larson AW, Stace NH, Renner IG, Valenzuela JE, Eliasoph J; et al. (1984). "Double-contrast barium meal and upper gastrointestinal endoscopy. A comparative study". Ann Intern Med. 101 (4): 538–45. PMID 6383166.
  3. ↑ Longo WE, Zucker KA, Zdon MJ, Modlin IM (1989). "Detection of early gastric cancer in an aggressive endoscopy unit". Am Surg. 55 (2): 100–4. PMID 2916797.
  4. ↑ Choi KS, Jun JK, Suh M, Park B, Noh DK, Song SH; et al. (2015). "Effect of endoscopy screening on stage at gastric cancer diagnosis: results of the National Cancer Screening Programme in Korea". Br J Cancer. 112 (3): 608–12. doi:10.1038/bjc.2014.608. PMC 4453643. PMID 25490528.
  5. ↑ Llorens P (1991). "Gastric cancer mass survey in Chile". Semin Surg Oncol. 7 (6): 339–43. PMID 1759081.
  6. ↑ Choi IJ (2014). "Endoscopic gastric cancer screening and surveillance in high-risk groups". Clin Endosc. 47 (6): 497–503. doi:10.5946/ce.2014.47.6.497. PMC 4260096. PMID 25505714.
  7. ↑ Park CH, Kim EH, Chung H, Lee H, Park JC, Shin SK; et al. (2014). "The optimal endoscopic screening interval for detecting early gastric neoplasms". Gastrointest Endosc. 80 (2): 253–9. doi:10.1016/j.gie.2014.01.030. PMID 24613579.
  8. ↑ Tersmette AC, Goodman SN, Offerhaus GJ, Tersmette KW, Giardiello FM, Vandenbroucke JP; et al. (1991). "Multivariate analysis of the risk of stomach cancer after ulcer surgery in an Amsterdam cohort of postgastrectomy patients". Am J Epidemiol. 134 (1): 14–21. PMID 1853856.

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