Effectiveness of Intensive Endoscopic Screening for Esophageal Cancer in China: A Community-Based Study

Liu, Mengfei; He, Zhonghu; Guo, Chuanhai; Xu, Ruiping; Li, Fenglei; Ning, Tao; Pan, Yaqi; Li, Yong; Ding, Hui; Zheng, Li; Zhou, Yue; Tian, Xiuyun; Yang, Wenjun; Wang, Xueqian; Lu, Fuhua; Zhang, Yanyan; Zhao, Yiqiang; Guo, Fangcen; Chen, Ke; Gao, Lei; Sun, Min; Liu, Ying; Liu, Fangfang; Hua, Dong; Shen, Na; Li, Jingjing; Xu, Zhongyao; Wang, Qiyan; Zhang, Chanyuan; Abliz, Amir; Deng, Qiuju; Li, Xiang; Liu, Zhen; Zhang, Chaoting; Yuan, Wenqing; Wang, Hui; Weiss, Noel S.; Cai, Hong; Ke, Yang

doi:10.1093/aje/kwy291

Cited by 49 publications

(46 citation statements)

References 20 publications

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“…However, it is important to note that the baseline demographics did not differ between the intervention group and the control group. And the endoscopic compliance rate in our study was comparable or even higher compared with existed endoscopic screening of EC/GC [ 6 , 8 ]. We may further evaluate potential confounders in our future analysis to adjust potential select bias.…”

Section: Discussionsupporting

confidence: 63%

“…Many studies showed that endoscopic screening might be associated with reduced mortality on EC and GC in some high-risk areas of Asia [ 4 – 8 ]. Considering the fact that striking geographic variations exist in the incidences of EC and GC within China, which can vary more than tenfold in different regions [ 9 ], whether endoscopic screening remains a cost-effective method with reduced mortality on EC and GC in areas with non-high risk were not well known.…”

Section: Introductionmentioning

confidence: 99%

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Initial results from a multi-center population-based cluster randomized trial of esophageal and gastric cancer screening in China

et al. 2020

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Background We initiated the first multi-center cluster randomized trial of endoscopic screening for esophageal cancer and gastric cancer in China. The objective of the study was to report the baseline screening findings in this trial. Methods We recruited a total of 345 eligible clusters from seven screening centers. In the intervention group, participants from high-risk areas were screened by endoscopy; in non-high-risk areas, high-risk individuals were identified using a questionnaire and advised for endoscopy. Lugol’s iodine staining in esophagus and indigo carmine dye in stomach were performed to aid in the diagnosis of suspicious lesions. The primary outcomes of this study were the detection rate (proportion of positive cases among individuals who underwent endoscopic screening) and early detection rate (the proportion of positive cases with stage 0/I among all positive cases). Results A total of 149,956 eligible subjects were included. The detection rate was 0.7% in esophagus and 0.8% in stomach, respectively. Compared with non-high-risk areas, the detection rates in high-risk areas were higher, both in esophagus (0.9% vs. 0.1%) and in stomach (0.9% vs. 0.3%). The same difference was found for early-detection rate (esophagus: 92.9% vs. 53.3%; stomach: 81.5% vs. 33.3%). Conclusions The diagnostic yield of both esophagus and stomach were higher in high-risk areas than in non-high-risk areas, even though in non-high-risk areas, only high-risk individuals were screened. Our study may provide important clues for evaluating and improving the effectiveness of upper-endoscopic screening in China. Trial registration: Protocol Registration System in Chinese Clinical Trial Registry, ChiCTR-EOR-16008577. Registered 01 June 2016-Retrospectively registered, http://www.chictr.org.cn/showprojen.aspx?proj=14372

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Section: Discussionsupporting

confidence: 63%

Section: Introductionmentioning

confidence: 99%

Initial results from a multi-center population-based cluster randomized trial of esophageal and gastric cancer screening in China

et al. 2020

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“…Only one study by Liu et al reported reductions in cumulative incidence and mortality from upper gastrointestinal cancer, in which the standardised incidence ratio was 0.57 (95% CI 0.38 to 0.86) and the standardised mortality ratio was 0.47 (95% CI 0.25 to 0.88). 9 However, the results were largely limited by few events (23 incident cases and 10 deaths) in the screened group, while the control group was estimated through calculations. 5 Evidence from observational studies shows inconsistent results in gastric cancer screening.…”

Section: Results In Relation To Other Studiesmentioning

confidence: 99%

“…Developed countries such as Japan and South Korea have launched nationwide endoscopic screening programmes, 6 7 while developing countries such as China and Iran conduct endoscopic screening only in high risk areas due to a larger cancer burden, capabilities of local doctors and availability of technology. [8][9][10][11] The current evidence from large population studies has confirmed that endoscopic screening is a cost-effective screening method for gastric cancer, 12 while the evidence for the effectiveness of oesophageal cancer screening are based predominately on smallsample sized, single-centre observational studies. 8 9 Furthermore, two ongoing randomised controlled trials are limited to intermediate outcomes due to insufficient follow-up time.…”

Section: What Are the New Findings?mentioning

confidence: 99%

Effectiveness of one-time endoscopic screening programme in prevention of upper gastrointestinal cancer in China: a multicentre population-based cohort study

Chen

Liu

Song³

et al. 2020

Gut

120

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ObjectivesTo estimate the effectiveness of endoscopic screening programme in reducing incidence and mortality of upper gastrointestinal cancer in high risks areas of China.DesignThis multicentre population-based cohort study was conducted in six areas in China from 2005 to 2015. All permanent residents aged 40 to 69 years were identified as target subjects. We refer to those who were invited for screening collectively as the invited group. Of these, we classify those who were invited and undertook endoscopic screening as the screened group and those who were invited but did not accept screening as the non-screened group. Target subjects who were not invited to the screening were assigned to the control group. The effectiveness of the endoscopic screening and screening programme were evaluated by comparing reductions in incidence and mortality from upper gastrointestinal cancer in the screened and invited group with control group.ResultsOur cohort analysis included 637 500 people: 299 483 in the control group and 338 017 in the invited to screening group, 113 340 (33.53%) of whom were screened eventually. Compared with subjects in the control group, upper gastrointestinal cancer incidence and mortality decreased by 23% (relative risk (RR)=0.77, 95% CI 0.74 to 0.81) and 57% (RR=0.43, 95% CI 0.40 to 0.47) in the screened group, respectively, and by 14% (RR=0.86, 95% CI 0.84 to 0.89) and 31% (RR=0.69, 95% CI 0.66 to 0.72) in the invited group, respectively.ConclusionAmong individuals aged 40 to 69 years in high risk areas of upper gastrointestinal cancer, one-time endoscopic screening programme was associated with a significant decrease in upper gastrointestinal cancer incidence and mortality.

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“…[6][7][8] Many studies showed that endoscopic screening might be associated with reduced mortality on UGC in some areas of Asia with high incidence. [8][9][10][11][12] Therefore, China initiated a major public health program named Cancer Screening Program in Urban China (CanSPUC) in 2012 which was implemented in nationwide including high-incidence and non-high-incidence areas. 13 UGC screening in the CanSPUC was carried out through two-step screening method-a questionnaire combined with endoscopy.…”

Section: Introductionmentioning

confidence: 99%

Development and external validation of a nomogram to predict the risk of Upper gastrointestinal precancerous lesions in a non‐high‐incidence area

Xiao

Yan

et al. 2020

Cancer Medicine

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Effectiveness of Intensive Endoscopic Screening for Esophageal Cancer in China: A Community-Based Study

Cited by 49 publications

References 20 publications

Initial results from a multi-center population-based cluster randomized trial of esophageal and gastric cancer screening in China

Initial results from a multi-center population-based cluster randomized trial of esophageal and gastric cancer screening in China

Effectiveness of one-time endoscopic screening programme in prevention of upper gastrointestinal cancer in China: a multicentre population-based cohort study

Development and external validation of a nomogram to predict the risk of Upper gastrointestinal precancerous lesions in a non‐high‐incidence area

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