Endoscopy
DOI: 10.1055/a-2564-9756
Original article

Assessment of the participation rate and effectiveness of upper gastrointestinal cancer screening in China: a multicenter population-based screening study

Song Song
1   Office of Cancer Screening, National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
,
Han Liu
1   Office of Cancer Screening, National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
,
Xianyi Geng
1   Office of Cancer Screening, National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
,
Ru Chen
2   National Central Cancer Registry, National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
,
Rongshou Zheng
2   National Central Cancer Registry, National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
,
Ni Li
1   Office of Cancer Screening, National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
,
Wanqing Chen
1   Office of Cancer Screening, National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
,
2   National Central Cancer Registry, National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
,
Jiansong Ren
1   Office of Cancer Screening, National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
› Author Affiliations
Supported by: National Key R&D Program of China 2016YFC0901405,2023YFC2507000
Supported by: National Science & Technology Fundamental Resources Investigation Program of China 2019FY101105

Abstract

Background

This study estimated the participation rate and effectiveness of endoscopic screening of upper gastrointestinal cancer (UGIC) in China.

Methods

From 2014 to 2015, we recruited 192805 adults from seven cities in China to build a prospective cohort for UGIC screening, including esophageal cancer and gastric cancer. Overall, 39991 participants were at high risk for UGIC according to an established risk score system and were recommended for endoscopic examination. Participation rates were reported, and their associated factors were explored. After inverse probability of treatment weighting (IPTW) based on propensity scores, Poisson regression was used to estimate the incidence rate ratio (IRR) and 95%CI for UGIC incidence and mortality between screened and non-screened groups from cohort entry until 31 December 2021.

Results

10442 participants underwent endoscopy, giving a participation rate of 26.1%. Higher participation was observed among individuals with higher education levels, history of upper gastrointestinal diseases, and family history of cancer. After a median follow-up of 6.8 years (interquartile range 6.7–6.9), UGIC incidences after IPTW were 94.6 per 100000 person-years in the screened group and 84.7 per 100000 person-years in the non-screened group. The weighted UGIC mortality rates were 13.1 and 33.4 per 100 000 person-years, respectively. The screened group had significantly lower UGIC mortality than the non-screened group, with a weighted IRR of 0.39 (95%CI 0.19–0.82).

Conclusion

Participation in endoscopic screening among a high-risk UGIC population in China was low. We found that one-time endoscopic screening significantly reduced mortality caused by UGIC.

Supplementary Material



Publication History

Received: 28 October 2024

Accepted after revision: 02 March 2025

Article published online:
08 April 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 
  • References

  • 1 Ferlay J, Ervik M, Lam F. et al. Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer. 2024 Accessed September 02, 2024 at: https://gco.iarc.who.int/today
  • 2 Han B, Zheng R, Zeng H. et al. Cancer incidence and mortality in China, 2022. J Natl Cancer Cent 2024; 04: 47-53
  • 3 Guan C, Song G, Li B. et al. Endoscopy screening effect on stage distributions of esophageal cancer: a cluster randomized cohort study in China. Cancer Sci 2018; 109: 1995-2002
  • 4 Zeng H, Ran X, An L. et al. Disparities in stage at diagnosis for five common cancers in China: a multicentre, hospital-based, observational study. Lancet Public Health 2021; 6: e877-e887
  • 5 Katai H, Ishikawa T, Akazawa K. et al. Five-year survival analysis of surgically resected gastric cancer cases in Japan: a retrospective analysis of more than 100,000 patients from the nationwide registry of the Japanese Gastric Cancer Association (2001–2007). Gastric Cancer 2018; 21: 144-154
  • 6 Zeng H, Zheng R, Sun K. et al. Cancer survival statistics in China 2019–2021: a multicenter, population-based study. J Natl Cancer Cent 2024; 4: 203-213
  • 7 Wang G, Jiao G, Chang F. et al. Long-term results of operation for 420 patients with early squamous cell esophageal carcinoma discovered by screening. Ann Thoracic Surg 2004; 77: 1740-1744
  • 8 Ciocirlan M, Lapalus MG, Hervieu V. et al. Endoscopic mucosal resection for squamous premalignant and early malignant lesions of the esophagus. Endoscopy 2007; 39: 24-29
  • 9 Merkow R, Bilimoria K, Keswani R. et al. Treatment trends, risk of lymph node metastasis, and outcomes for localized esophageal cancer. J Natl Cancer Inst 2014; 106: dju133
  • 10 Sumiyama K. Past and current trends in endoscopic diagnosis for early stage gastric cancer in Japan. Gastric Cancer 2017; 20: 20-27
  • 11 Wang G, Abnet C, Shen Q. et al. Histological precursors of oesophageal squamous cell carcinoma: results from a 13 year prospective follow up study in a high risk population. Gut 2005; 54: 187-192
  • 12 Mannath J, Ragunath K. Role of endoscopy in early oesophageal cancer. Nat Rev Gastroenterol Hepatol 2016; 13: 720-730
  • 13 Lin JT. Screening of gastric cancer: who, when, and how. Clin Gastroenterol Hepatol 2014; 12: 135-138
  • 14 Liu H, Song S, Geng X. et al. Gastric mucosal status and risk of gastric cancer in high-risk individuals: a population-based, multicenter prospective study in China. Cancer Med 2024; 13: e70331
  • 15 Liu M, Yang W, Guo C. et al. Effectiveness of endoscopic screening on esophageal cancer incidence and mortality: a 9-year report of the endoscopic screening for esophageal cancer in China (ESECC) randomized trial. J Clin Oncol 2024; 42: 1655-1664
  • 16 Chen R, Liu Y, Song G. et al. Effectiveness of one-time endoscopic screening programme in prevention of upper gastrointestinal cancer in China: a multicentre population-based cohort study. Gut 2021; 70: 251-260
  • 17 Wei W, Chen Z, He Y. et al. Long-term follow-up of a community assignment, one-time endoscopic screening study of esophageal cancer in China. J Clin Oncol 2015; 33: 1951-1957
  • 18 Zhang N, Li Y, Chang X. et al. Long-term effectiveness of one-time endoscopic screening for esophageal cancer: a community-based study in rural China. Cancer 2020; 126: 4511-4520
  • 19 Xia C, Li H, Chen W. Reduction in esophageal cancer incidence and mortality by screening endoscopy. J Clin Oncol 2024; 42: 3376-3378
  • 20 Matsumoto S, Ishikawa S, Yoshida Y. Reduction of gastric cancer mortality by endoscopic and radiographic screening in an isolated island: a retrospective cohort study. Aust J Rural Health 2013; 21: 319-324
  • 21 Li WQ, Qin XX, Li ZX. et al. Beneficial effects of endoscopic screening on gastric cancer and optimal screening interval: a population-based study. Endoscopy 2022; 54: 848-858
  • 22 Chen H, Li N, Ren J. et al. Participation and yield of a population-based colorectal cancer screening programme in China. Gut 2019; 68: 1450-1457
  • 23 Xia C, Basu P, Kramer BS. et al. Cancer screening in China: a steep road from evidence to implementation. Lancet Public Health 2023; 8: e996-e1005
  • 24 Colditz GA, Atwood KA, Emmons K. et al. Harvard report on cancer prevention volume 4: Harvard Cancer Risk Index. Risk Index Working Group, Harvard Center for Cancer Prevention. Cancer Causes Control 2000; 11: 477-488
  • 25 He J, Chen WQ, Li ZS. et al. China guideline for the screening, early detection and early treatment of esophageal cancer (2022, Beijing). Zhonghua Zhong Liu Za Zhi 2022; 44: 491-522
  • 26 Li H, Cao M, Sun D. et al. A comparative analysis of the distribution of the high-risk population of upper gastrointestinal cancer and endoscopic screening compliance in two urban areas and two rural areas in China. Zhonghua Zhong Liu Za Zhi 2022; 44: 531-539
  • 27 Li H, Teng Y, Yan X. et al. Profiles and findings of population-based esophageal cancer screening with endoscopy in China: systematic review and meta-analysis. JMIR Public Health Surveill 2023; 9: e45360
  • 28 Jia S, Li H, Zeng H. et al. Association of cancer prevention awareness with esophageal cancer screening participation rates: results from a population-based cancer screening program in rural China. Chin J Cancer Res 2019; 31: 601-608
  • 29 Guo L, Zhang S, Liu S. et al. Determinants of participation and detection rate of upper gastrointestinal cancer from population-based screening program in China. Cancer Med 2019; 8: 7098-7107
  • 30 Yu Z, Zuo T, Yu H. et al. Outcomes of upper gastrointestinal cancer screening in high-risk individuals: a population-based prospective study in Northeast China. BMJ Open 2022; 12: e046134
  • 31 He S, Li H, Cao M. et al. Geographic, demographic, and socioeconomic disparities and factors associated with cancer literacy in China: national cross-sectional study. JMIR Public Health Surveill 2023; 9: e43541