JMIR Publications

ABSTRACT

Background:

Previous studies have proved the efficacy of endoscopic screening in rural areas. Nevertheless, evidence regarding the efficacy of sequential screening strategies in resource-rich regions is currently lacking.

Objective:

The objective was to validate the efficacy of risk-adapted sequential screening strategies in upper gastrointestinal cancer(UGC) prevention and control, and assess its potential to lower mortality rates.

Methods:

A prospective cohort study based on population was conducted to recruit individuals from four cities in China from 2013-2019. Those identified as having a high risk of UGC according to a validated risk-score model were advised to undergo endoscopy tests. Outcomes were tracked until June 2021. Incidence of UGC, UGC-related mortality, and all-cause mortality were evaluated between the screened and non-screened cohorts.

Results:

The study included 153,079 participants at baseline. Among them, 74.4% were evaluated as low-risk for UGC, while 25.6% were deemed high-risk and invited for endoscopy tests, with a compliance rate of 24.6%. Over a median follow-up of 6.05 years, 622 UGC cases, 180 UGC deaths, and 1958 all-cause death cases were traced. The screened cohort exhibited the highest cumulative incidence of UGC(119.2 per 100,000 person-years), followed by the non-screened and low-risk cohorts. Obvious reductions in both all-cause mortality and UGC mortality were observed among those who undertook screening(153.7 and 4.7 per 100,000 person-years) and non-screened group(245.3 and 27.0 per 100,000 person-years). The screening population showed a significant 36% and 82% reduction in both all-cause mortality(HR 0.64, 95% CI 0.49-0.83) and UGC mortality(0.18, 0.04-0.74) compared to the non-screened group.

Conclusions:

Our study suggests the significance of risk-adapted UGC screening in reducing both all-cause mortality and UGC mortality, particularly among high-risk individuals, indicating its effectiveness in UGC prevention and management.