Stomach cancer screening
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Parminder Dhingra, M.D. [2]
|
Stomach cancer Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Stomach cancer screening On the Web |
|
American Roentgen Ray Society Images of Stomach cancer screening |
|
Risk calculators and risk factors for Stomach cancer screening |
Overview
Screening cancer
The two main modalities for gastric cancer screening are upper endoscopy and contrast radiography.
Upper endoscopy
- Upper endoscopy is more sensitive than other screening studies. It allows direct visualization of the gastric mucosa and obtaining biopsies. [17-21].
Contrast radiography
- Barium radiographs can identify malignant gastric ulcers, infiltrating lesions, and some early gastric cancers.
- Barium studies can be false negative in 50 percent of cases. On the other hand, the sensitivity of a barium study may be 14 percent [4] [3]
- In patients with linitis plastica, barium study may be superior to upper endoscopy.
COMPARISON OF SCREENING METHODS
Test performance
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
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].
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 STRATEGIES
Universal screening
In countries with a high incidence of gastric cancer such as east asia countaries, universal screening is recommended. [17-19]
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].
Screening interval is recommended to be every two years but may be widened to a three-year rather than a two-year interval without significant effect [38-40].
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].
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