Endoscopic Findings in a Mass Screening Program for Gastric Cancer in a High Risk Region - Guilan Province of Iran

Abstract

Background & Objectives: Gastric cancer is a leading cause of cancer-related deaths in both sexes in Iran. This study was designed to assess upper GI endoscopic findings among people > 50 years targeted in a mass screening program in a hot-point region. Methods: Based on the pilot results in Guilan Cancer Registry study (GCRS), one of the high point regions for GC -Lashtenesha-was selected. The target population was called mainly using two methods: in rural regions, by house-house direct referral and in urban areas using public media. Upper GI endoscopy was performed by trained endoscopists. All participants underwent biopsies for rapid urea test (RUT) from the antrum and also further biopsies from five defined points of stomach for detection of precancerous lesions. In cases of visible gross lesions, more diagnostic biopsies were taken and submitted for histopathologic evaluation. Results: Of 1,394 initial participants, finally 1,382 persons (702 women, 680 men) with a mean age of 61.7±9.0 years (range: 50-87 years) underwent upper GI endoscopy. H. pylori infection based on the RUT was positive in 66.6%. Gastric adenocarcinoma and squamous cell carcinoma of esophagus were detected in seven (0.5%) and one (0.07%) persons, respectively. A remarkable proportion of studied participants were found to have esophageal hiatal hernia (38.4%). Asymptomatic gastric masses found in 1.1% (15) of cases which were mostly located in antrum (33.3%), cardia (20.0%) and prepyloric area (20.0%). Gastric and duodenal ulcers were found in 5.9% (82) and 6.9% (96) of the screened population. Conclusion: Upper endoscopy screening is an effective technique for early detection of GC especially in high risk populations. Further studies are required to evaluate cost effectiveness, cost benefit and mortality and morbidity of this method among high and moderate risk population before recommending this method for the GC surveillance program at the national level.

Prevalence of gastric precancerous lesions among chronic dyspeptic patients and related common risk factors

“…In Iran, this is a very important fact as this country is categorized as an intermediate-risk area, where the seroprevalance of H. pylori infection reaches 62-90% (Malekzadeh et al, 2004;Islami and Kamangar, 2008;Mansour-Ghanaei et al, 2012a, 2012b. Some parts of Iran are also considered high-prevalence areas (Hossein Somi et al, 2006;Malekzadeh et al, 2009;Mansour-Ghanaei et al, 2012a, 2012b. In the present study, the prevalence of precancerous lesions including atrophy, IM, and dysplasia and their relation with some common risk factors were evaluated in a population of chronic dyspeptic patients.…”

Serum Gastrin and the Pepsinogen I/II Ratio as Markers for Diagnosis of Premalignant Gastric Lesions

“…Lashtenesha has a population over 45000 persons (49.6% males, 50.4% females), among them 10500 persons have >50 years old. Most of the people settled in rural regions (70.0%) (Mansour-Ghanaei et al, 2010).…”

“…Prevention unpublished works regarding cancerrelated death in Guilan province during 1999-2002 in the Gastrointestinal and Liver Diseases Research Center (GLDRC) confirmed gastric cancer as the leading cause of cancer-related death which led to 31.4% of all cancer deaths over the province; These emerged the necessary of surveillance programs for GC especially among high risk population (Mansour-Ghanaei et al, 2010). This study is a part of a large-scaled study in hot point regions for GC designed to assess prognostic value of screening biomarkers like pepsinogen I/II and Gastrin among people >50 years as a cost-effective screening method for early detection of gastric carcinoma.…”

Cost-effectiveness Outcomes of the National Gastric Cancer Screening Program in South Korea

“…In Iran, performance of national-level endoscopy screening was effective for a high-risk region. (Mansour-Ghanaei et al, 2012) The costeffectiveness of mass screenings may also vary according to the cost of the screening examination. For example, endoscopic screening costs in Korea are less than 50% of those in other countries, like Japan and Singapore (Chang et al, 2012).…”