Optimal Screening Interval for Gastric Cancer: 3 Years

Korean Policy Change Needed

Nick Mulcahy

July 17, 2012

July 17, 2012 — A new study from Korea, where there is a high incidence of gastric cancer, suggests that the optimal interval between screening endoscopies is 3 years.

In Korea, the current guidelines recommend screening every 2 years; the study authors think this policy should be changed.

However, the results are probably not relevant to Western countries, where the prevalence of gastric cancer is much lower, say the authors, led by Il Ju Choi, MD, PhD, from the National Cancer Center in Goyang, South Korea.

Their findings were published online July 16 in Cancer.

The study was conducted in men and women newly diagnosed with gastric cancer. In adults screened at intervals ranging from 1 to more than 5 years, there was a significant improvement in the cancer stage at diagnosis, compared with adults who were never screened.

However, shorter intervals (3 years or less) were more strongly associated with an earlier stage at diagnosis than longer intervals.

"The optimal screening strategy appears to be every 3 years," summarized Dr. Choi in a press statement.

The study also found that patients with a family history of gastric cancer benefited more from frequent endoscopies.

"If you have a family member with gastric cancer...you may need to undergo upper endoscopy screening more frequently than every 3 years," said Dr. Choi. "Patients with a family history of gastric cancer were more likely to have a higher stage at diagnosis if they [were screened at] a 3-year interval rather than a 1-year interval."

Endoscopy screening in high-risk populations, such as those of China, Japan, and Korea, "may reduce gastric cancer mortality by detecting cancer earlier," according to the authors. The stage of gastric cancer is "well correlated" with survival rates, they note.

Why 3 Years?

The study population consisted of 2485 patients with newly diagnosed gastric adenocarcinoma who presented to the Center for Gastric Cancer at the Korean National Cancer Center in Goyang from January 2004 to December 2009. All patients were screened with upper gastrointestinal endoscopy, one of a number of screening methods for this cancer.

Patients were stratified by screening interval into never-screened, 1-year, 2-year, 3-year, 4-year, 5-year, and more than 5-year groups.

The risk for a higher cancer stage at diagnosis increased by 23% with every year added to the interval (odds ratio [OR], 1.23, 95% confidence interval [CI], 1.19 to 1.28).

Compared with the never-screened group, the odds ratio of having a higher stage of cancer decreased gradually, from 0.53 (95% CI, 0.41 to 0.69) for an interval of the more than 5 years to 0.31 (95% CI, 0.24 to 0.40) for an interval of 1 year, the authors report.

In other words, a higher stage at diagnosis was more likely with a longer interval between screening endoscopies.

However, the 3-year interval looked optimal.

The authors explain that the percentage of patients with stage I gastric cancer was similar in the groups with screening intervals of 3 years or less (approximately 70%).

But when they looked at advanced gastric cancer (T2 and beyond), 3 years made sense.

The risk for advanced gastric cancer did not increase with a 2-year (OR, 1.11; P > .05) or 3-year (OR, 1.21; P > .05) interval, but it did increase with a 4- or 5-year interval. Thus, a 2-year interval yielded no great benefit than a 3-year interval.

Gastric cancer is the most common cancer in Korea, but the optimal frequency of endoscopy screening has been undefined, the authors note.

Nevertheless, since 1999, biennial gastric cancer screening (either an upper gastrointestinal series or upper endoscopy) has been conducted in Korea nationwide for people 40 years and older.

A "few Asian studies" have indicated that with screening endoscopies every 2 years, the early detection rate of gastric cancer increases, but with screening every 5 years, there is no reduction.

"Our data suggest that changing the current recommendation of biennial gastric cancer screening in Korea to one of screening every 3 years should be considered," the authors conclude.

The ratio of males to females in the study was 2:1. There were no differences in the stage of cancer at the time of diagnosis between sexes. Also, smoking and drinking status and education level did not affect the stage of cancer at diagnosis. The Helicobacter pylori infection rate was 78.8%, which did not differ by the stage of cancer.

The authors have disclosed no relevant financial relationships.

Cancer. Published online July 16, 2012. Abstract

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