Benefits and limitations of gastric cancer risk screening as a gateway to population-based gastric cancer screening

<p>Objective: Esophagogastroduodenoscopy has been available for the population-based screening of gastric cancer since 2016. However, endoscopy for population-based screening has issues regarding the participation rate, human resources, and cost.</p><p>Subjects and methods: In this study, we summarized and reviewed the results of gastric cancer screening using upper gastrointestinal tract X-ray examination (X-ray screening), gastric examination including X-ray or pepsinogen examination (PG examination), and gastric cancer risk stratification screening (gastric cancer risk screening) conducted in Yokosuka City from 1994 to 2019.</p><p>Results: The screening participation rate was approximately 6% until 2000, when only X-ray screening was introduced. After introducing PG examination for gastric screening, the rate rose to approximately 12% and exceeded 16% in 2011. Among those who underwent gastric screening, 85% chose PG examination. The same screening rate was maintained in 2012 when gastric cancer risk screening was introduced. Eight years after the introduction of gastric cancer risk screening, 59,871 people, i.e., 43% of the target population, were screened. The average detection rate of gastric cancer in the gastric cancer risk screening was 0.48%, and the positive predictive value was 1.4%. The gastric cancer risk screening conducted from May 2012 to February 2020 achieved a sufficient participation rate. Performing endoscopy screening in the high-risk population was almost three times more efficient than performing endoscopy screening in all populations; This method of gastric cancer risk screening saved costs and human recourses.</p><p>However, among those who underwent gastric cancer risk screening and Helicobacter pylori (H. pylori) eradication therapy from 2012 to 2014, 45 cases of gastric cancer were detected during follow-up through 2019, with an average time to detection of 3 years and 2 months. Thirteen of these patients had advanced gastric cancer. Appropriate follow-up of individuals at high risk for gastric cancer under the public health insurance and enhanced aggregated data management is necessary because the citizens are no longer eligible for gastric cancer risk screening if they undergo H. pylori eradication therapy.</p><p>Conclusions: Based on the long-term participation rate in gastric cancer screening and the results of gastric cancer risk screening in Yokosuka City, less invasive gastric cancer risk screening was found to be a viable gateway to population-based gastric cancer screening.</p>