Screening for gastric cancer in China: Advances, challenges and visions

Abstract

Gastric cancer (GC) is one of the major cancers in China and all over the world. Most GCs are diagnosed at an advanced stage with unfavorable prognosis. Along with some other countries, China has developed the government-funded national screening programs for GC and other major cancers. GC screening has been shown to effectively decrease the incidence of and mortality from GC in countries adopting nationwide screening programs (Japan and Korea) and in studies based on selected Chinese populations. The screening of GC relies mostly on gastroendoscopy, the accuracy, reliability and safety of which have been indicated by previous studies. However, considering its invasive screening approach, requirements on skilled endoscopists and pathologists, and a high cost, developing noninvasive methods to amend endoscopic screening would be highly needed. Numerous studies have examined biomarkers for GC screening and the combination of biomarkers involving pepsinogen, gastrin, and Helicobacter pylori antibodies has been proposed for risk stratification, seeking to narrow down the high-risk populations for further endoscopy. Despite all the achievements of endoscopic screening, evidence on appropriate screening age, intervals for repeated screening, novel biomarkers promoting precision prevention, and health economics need to be accumulated to inform policymakers on endoscopic screening in China. With the guide of Health China 2030 Planning Outline , we have golden opportunities to promote prevention and control of GC. In this review, we summarize the characteristics of screening programs in China and other East Asian countries and introduce the past and current approaches and strategies for GC screening, aiming for featuring the latest advances and key challenges, and illustrating future visions of GC screening.

Digestive cancer incidence and mortality among young adults worldwide in 2020: A population-based study

“…Another opportunity to improve the outcomes of young adult patients with digestive cancer is screening and ensuring timely diagnosis[ 7 , 17 ]. However, no age-specific screening tests are currently available for young adults, and the screening targets are limited to individuals 40 years or older[ 33 , 34 ]. Increased colonoscopy screening and the removal of precursor lesions have decreased the incidence of colorectal cancer in adults older than 50 years in some countries, whereas the incidence in young adults continues to increase[ 3 , 35 ].…”

The Incidence-Based Mortality and Survival Trends in Patients with Gastric Signet Ring Cell Carcinoma

“…Much of this decline may be attributed to the recent advance in gastric cancer screening. Screening methods include imaging examination, electronic endoscopy, and magnetically controlled capsule endoscopy (MCE) [ 12 ]. Advanced endoscopy allows for detection of early-stage GC and curable premalignant lesions in the stomach [ 13 ].…”

“…Advanced endoscopy allows for detection of early-stage GC and curable premalignant lesions in the stomach [ 13 ]. The novel biomarkers identified in recent years may promote precision prevention and reduce mortality [ 12 ]. Moreover, the development of gene diagnosis can immediately affect the mortality rate of gastric cancer.…”

Application of a novel scoring system for gastric cancer opportunistic screening in hospital visits

“…In Japan and South Korea, gastroscopy is readily available and affordable and has become a major screening tool recommended for men and women aged 40 years and older [ 17 , 18 ]. However, it is unlikely that screening gastroscopy can be offered to all populations in China because endoscopy professionals and facilities are relatively limited compared with the large Chinese population [ 19 , 20 ]. Therefore, it is important to develop a prediction rule for estimating GC risk and an appropriate GC screening procedure for the Chinese high-risk population.…”