An Opportunistic Screening Strategy for Gastric Cancer Based on Questionnaire and Sequential Serology: A...

Area of Science:

• Gastroenterology
• Oncology
• Preventive Medicine

Background:

• Developing effective candidate selection strategies is crucial for opportunistic endoscopic screening (OES) in early gastric cancer detection, especially without mass screening programs.
• Risk stratification and cost-effectiveness are key considerations for optimizing OES protocols.

Purpose of the Study:

• To develop and validate a candidate selection strategy for opportunistic endoscopic screening (OES) for early gastric cancer detection.
• To assess the cost-effectiveness of the developed risk stratification scoring systems.

Main Methods:

• A hospital-based cross-sectional study involving 58,218 participants (619 gastric cancer patients).
• Data collection included questionnaires (demography, comorbidities, family history) and serology (hemoglobin, CEA, CA19-9).
• Multivariate analyses and cost-effectiveness evaluations were performed to identify risk factors and construct scoring systems.

Main Results:

• Independent risk factors for gastric cancer included male sex, age >40, family history, upper digestive tract benign diseases (UDTBDs), anemia, and elevated CEA/CA19-9.
• Recommended OES criteria: age ≥50, family history of gastric cancer, and/or comorbid UDTBDs.
• Alternative criteria for OES consideration: anemia and/or elevated CEA/CA19-9 in males and/or individuals aged 41-50.
• The developed strategy showed comparable detection rates and superior cost-effectiveness compared to alternative protocols.

Conclusions:

• An integrated strategy combining questionnaires and sequential serology is effective and cost-effective for identifying high-risk gastric cancer candidates for OES.
• Further research is needed to refine screening and surveillance protocols for optimized detection rates and cost-effectiveness.