Community-based pilot study of a screening program for gastric cancer in a Chinese population

A majority of gastric cancer (GC) cases in China are diagnosed at advanced stages, chiefly due to lack of an established routine nationwide screening program. This study evaluated the effectiveness of a novel screening program for GC. Seven geographical communities were randomly selected, and residents aged 40 to 69 years were screened. Serological tests of Helicobacter pylori antibodies and pepsinogens, and positive family history of GC in first-degree relatives (FDRs), were used to differentiate individuals for further gastroscopic examination and gastric mucosal biopsies. Among 7773 individuals who underwent examination of serum markers, GC was detected in 14 (1.8‰;10 men). The rate in terms of GC cases per 100 gastroendoscopies was 1.6% (14/872), which was greater than 0.87% previously reported. Eleven of 14 patients with GC (78.6%) were FDRs of GC patients. Two-thirds of the subjects with cardia GC were FDRs of individuals with GC rather than cardia GC. Comparative analysis indicated that the GC subjects were significantly more likely to be FDRs of GC patients, in contrast to those without GC. All the individuals with GC were aged ≥50 years. After conducting a reverse analysis, we propose a novel screening program for GC. In conclusions, the populations most vulnerable to GC are those with positive family history of GC in FDRs, male gender, and aged 50 years or older. This screening program using fewer serum markers combined individual risk factors, mainly FDRs, is novel for identification of high-risk individuals for further gastroscopy in detecting early GC.