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Participation Barriers in Risk-Stratified Endoscopic Screening for Upper GI Cancer: A Mixed-Methods Study
Zeyu Yan1, Lei Chen1, Jinbao Ma2
1Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genetics, Peking University Cancer Hospital and Institute, Beijing, China.
JCO Global Oncology
|July 29, 2026
Summary
Many high-risk individuals do not participate in upper GI cancer screening due to factors like age, sex, and lack of knowledge. Improving program accessibility and education can boost uptake for this vital cancer screening.
Area of Science:
- Oncology
- Public Health
- Health Services Research
Background:
- Upper GI (UGI) cancer screening programs are crucial for early detection.
- Risk-stratified approaches aim to target high-risk populations effectively.
- Understanding participation determinants is key to optimizing screening program implementation.
Purpose of the Study:
- To identify factors influencing participation among high-risk individuals in a risk-stratified UGI cancer screening program.
- To explore barriers and facilitators to screening adherence in this population.
Main Methods:
- A sequential mixed-methods study combining quantitative and qualitative approaches.
- Quantitative data collected from 2,571 high-risk individuals using validated diagnostic models.
- Qualitative interviews with 42 participants analyzed thematically using the Capability, Opportunity, and Motivation-Behavior framework.
Main Results:
- Over half (52.8%) of high-risk individuals declined endoscopy.
- Nonparticipation was linked to older age, male sex, Hui ethnicity, non-smoking/drinking status, no family history, fewer symptoms, and no prior UGI exam.
- Key qualitative barriers included insufficient knowledge, physical limitations, low perceived risk, fear of gastroscopy, cost, time, and inadequate information.
Conclusions:
- Limited knowledge and program accessibility significantly hinder participation in risk-stratified UGI cancer screening.
- Interventions addressing these barriers are essential for improving screening uptake and program effectiveness.
- Enhanced public education and streamlined program logistics can facilitate better real-world implementation.
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