Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Jan 30, 2023
Open Peer Review Period: Dec 27, 2022 - Jan 10, 2023
Date Accepted: Apr 18, 2023
(closed for review but you can still tweet)
Profiles and findings of population-based esophageal cancer screening with endoscopy in China: A systematic review and meta-analysis
ABSTRACT
Background:
Population-based esophageal cancer (EC) screening trials and programs have been conducted in China for decades; however, screening strategies were adopted in different regions, and screening profiles were unclear.
Objective:
We performed a meta-analysis to profile EC screening in China by positivity rate, compliance rate, and endoscopy findings, aiming to provide explicit evidence and recommendations for EC screening programs.
Methods:
English (MEDLINE, Embase) and Chinese (China National Knowledge Infrastructure, Wanfang) language databases were systematically searched for population-based EC screening studies in the Chinese population until April 30, 2022. A meta-analysis was performed by standard methodology using a random effects model. Pooled prevalence rates were reported in three groups: high-risk areas for EC with a universal endoscopy strategy, rural China with a risk-stratified endoscopic screening (RSES) strategy, and urban China with an RSES strategy.
Results:
Sixty-five eligible studies were included, covering more than 2 million asymptomatic average-risk individuals and 979,338 individuals with endoscopic examinations. The pooled positivity rate of the high-risk population was higher in rural China (44.12%) than in urban China (23.11%). The compliance rate of endoscopic examinations was highest in rural China (52.43%), followed by high-risk areas for EC (44.42%), and the lowest in urban China (20.77%). The pooled detection rate of high-grade intraepithelial neoplasia (HGIN) decreased from 1.09% (95% CI: 0.88-1.35%) in high-risk areas for EC to 0.48% (95% CI: 0.25-0.93%) in rural China and 0.12% (95% CI: 0.07-0.21%) in urban China. The pooled early detection rate was 82.64% (95% CI: 76.60-87.38%). A higher detection rate of HGIN was observed among males than among females and at older ages.
Conclusions:
Under the current screening framework, a higher screening benefit was observed in high-risk areas for EC than in other regions. To promote EC screening and improve the current inequality of screening benefits in China, more focus should be given to optimizing strategies of high-risk individual assessment and surveillance management to improve compliance with endoscopic examination. Clinical Trial: PROSPERO CRD42022375720
Citation
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