Effect of risk-based screening for upper gastrointestinal cancers: a multi-center real-world study

Area of Science:

• Gastroenterology
• Oncology
• Public Health

Background:

• Upper gastrointestinal (UGI) cancer screening aims to improve outcomes through early detection.
• Traditional universal screening methods can be resource-intensive and less efficient.
• Developing targeted screening strategies is crucial for optimizing cancer detection and resource allocation.

Purpose of the Study:

• To assess the feasibility, effectiveness, and cost-effectiveness of a risk-based sequential screening approach for UGI cancer.
• To evaluate a questionnaire-based quantitative model for identifying high-risk individuals for UGI cancer screening.
• To compare the outcomes of risk-based screening with historical universal screening data.

Main Methods:

• A risk-based screening strategy was implemented in two regions of China (Longde and Litong).
• Participants completed questionnaire-based risk assessments to identify high-risk individuals.
• High-risk participants were subsequently invited for endoscopic screening.

Main Results:

• Out of 9492 participants, 26.89% were identified as high-risk, with 46.94% of these undergoing endoscopic examination.
• Risk-based screening demonstrated a 2.28 times higher detection rate than universal screening (p=0.002).
• The average cost per detected case and per early detected case was significantly lower (30.76% and 28.99% reduction, respectively) compared to universal screening.

Conclusions:

• Risk-based sequential screening is a feasible and effective method for detecting UGI cancers.
• This approach proves to be cost-effective, offering significant savings in detecting both overall and early-stage UGI cancers.
• The study supports the potential for broader implementation of risk-based screening strategies in other regions.