Gastric cancer screening
- Annie On On Chan, MD
Annie On On Chan, MD
- Department of Medicine
- University of Hong Kong
- Benjamin Wong, DSc, MD, PhD
Benjamin Wong, DSc, MD, PhD
- Honorary Clinical Professor
- Department of Medicine
- University of Hong Kong
- Section Editors
- Mark Feldman, MD, MACP, AGAF, FACG
Mark Feldman, MD, MACP, AGAF, FACG
- Section Editor — Acid Peptic Disease
- Texas Health Presbyterian Hospital Dallas
- Clinical Professor of Internal Medicine
- University of Texas Southwestern Medical School at Dallas
- Joann G Elmore, MD, MPH
Joann G Elmore, MD, MPH
- Editor-in-Chief — Primary Care (Adult)
- Section Editor — General Medicine
- Professor of Medicine, Adjunct Professor of Epidemiology
- University of Washington School of Medicine
- Deputy Editors
- Shilpa Grover, MD, MPH
Shilpa Grover, MD, MPH
- Deputy Editor — Gastroenterology/Hepatology
- Clinical Instructor in Medicine
- Harvard Medical School
- Diane MF Savarese, MD
Diane MF Savarese, MD
- Senior Deputy Editor — UpToDate
- Deputy Editor — Oncology and Palliative Care
- Clinical Instructor of Medicine
- Harvard Medical School
Gastric cancer is one of the most common cancers worldwide . However, there are significant differences in the incidence of gastric cancer by region. The value of screening asymptomatic individuals for gastric cancer is controversial even in areas with a relatively high incidence of gastric cancer . This topic will review the screening of gastric cancer. The epidemiology, risk factors, pathogenesis, clinical features, diagnosis, and management of gastric cancer are discussed in detail, separately. (See "Epidemiology of gastric cancer" and "Risk factors for gastric cancer" and "Pathology and molecular pathogenesis of gastric cancer" and "Clinical features, diagnosis, and staging of gastric cancer" and "Early gastric cancer: Epidemiology, clinical manifestations, diagnosis, and staging" and "Early gastric cancer: Treatment, natural history, and prognosis" and "Surgical management of invasive gastric cancer" and "Adjuvant and neoadjuvant treatment of gastric cancer".)
The two main modalities for gastric cancer screening are upper endoscopy and contrast radiography.
Upper endoscopy — Upper endoscopy allows for direct visualization of the gastric mucosa and for biopsies to be obtained for diagnosing precancerous lesions such as gastric atrophy, intestinal metaplasia, or gastric dysplasia in addition to gastric cancer. Although it is more invasive and has a higher cost, upper endoscopy is also more sensitive for diagnosing a variety of gastric lesions as compared with alternative diagnostic strategies. (See 'Test performance' below.)
Contrast radiography — Double-contrast barium radiographs with photofluorography or digital radiography can identify malignant gastric ulcers, infiltrating lesions, and some early gastric cancers. However, false-negative barium studies can occur in as many as 50 percent of cases . In early gastric cancer, the sensitivity of a barium study may be as low as 14 percent . The one scenario in which a barium study may be superior to upper endoscopy is in patients with linitis plastica. The decreased distensibility of the stiff, "leather-flask" appearing stomach is more obvious on the radiographic study, and the endoscopic appearance may be relatively normal. (See "Early gastric cancer: Epidemiology, clinical manifestations, diagnosis, and staging", section on 'Diagnosis' and "Clinical features, diagnosis, and staging of gastric cancer", section on 'Diagnosis'.)
Other tests — While other modalities of screening for gastric cancer or its precursors have been proposed, further studies are needed to support their use.
- Torre LA, Bray F, Siegel RL, et al. Global cancer statistics, 2012. CA Cancer J Clin 2015; 65:87.
- Leung WK, Wu MS, Kakugawa Y, et al. Screening for gastric cancer in Asia: current evidence and practice. Lancet Oncol 2008; 9:279.
- Dooley CP, Larson AW, Stace NH, et al. Double-contrast barium meal and upper gastrointestinal endoscopy. A comparative study. Ann Intern Med 1984; 101:538.
- Longo WE, Zucker KA, Zdon MJ, Modlin IM. Detection of early gastric cancer in an aggressive endoscopy unit. Am Surg 1989; 55:100.
- Miki K. Gastric cancer screening using the serum pepsinogen test method. Gastric Cancer 2006; 9:245.
- Yoshida T, Kato J, Inoue I, et al. Cancer development based on chronic active gastritis and resulting gastric atrophy as assessed by serum levels of pepsinogen and Helicobacter pylori antibody titer. Int J Cancer 2014; 134:1445.
- Miki K, Fujishiro M, Kodashima S, Yahagi N. Long-term results of gastric cancer screening using the serum pepsinogen test method among an asymptomatic middle-aged Japanese population. Dig Endosc 2009; 21:78.
- Dinis-Ribeiro M, da Costa-Pereira A, Lopes C, et al. Validity of serum pepsinogen I/II ratio for the diagnosis of gastric epithelial dysplasia and intestinal metaplasia during the follow-up of patients at risk for intestinal-type gastric adenocarcinoma. Neoplasia 2004; 6:449.
- Väänänen H, Vauhkonen M, Helske T, et al. Non-endoscopic diagnosis of atrophic gastritis with a blood test. Correlation between gastric histology and serum levels of gastrin-17 and pepsinogen I: a multicentre study. Eur J Gastroenterol Hepatol 2003; 15:885.
- Yoshihara M, Hiyama T, Yoshida S, et al. Reduction in gastric cancer mortality by screening based on serum pepsinogen concentration: a case-control study. Scand J Gastroenterol 2007; 42:760.
- Aikou S, Ohmoto Y, Gunji T, et al. Tests for serum levels of trefoil factor family proteins can improve gastric cancer screening. Gastroenterology 2011; 141:837.
- Kaise M, Miwa J, Tashiro J, et al. The combination of serum trefoil factor 3 and pepsinogen testing is a valid non-endoscopic biomarker for predicting the presence of gastric cancer: a new marker for gastric cancer risk. J Gastroenterol 2011; 46:736.
- Cui L, Zhang X, Ye G, et al. Gastric juice MicroRNAs as potential biomarkers for the screening of gastric cancer. Cancer 2013; 119:1618.
- Zhou H, Guo JM, Lou YR, et al. Detection of circulating tumor cells in peripheral blood from patients with gastric cancer using microRNA as a marker. J Mol Med (Berl) 2010; 88:709.
- Su ZX, Zhao J, Rong ZH, et al. Diagnostic and prognostic value of circulating miR-18a in the plasma of patients with gastric cancer. Tumour Biol 2014; 35:12119.
- Wang R, Wen H, Xu Y, et al. Circulating microRNAs as a novel class of diagnostic biomarkers in gastrointestinal tumors detection: a meta-analysis based on 42 articles. PLoS One 2014; 9:e113401.
- Mizoue T, Yoshimura T, Tokui N, et al. Prospective study of screening for stomach cancer in Japan. Int J Cancer 2003; 106:103.
- Llorens P. Gastric cancer mass survey in Chile. Semin Surg Oncol 1991; 7:339.
- Pisani P, Oliver WE, Parkin DM, et al. Case-control study of gastric cancer screening in Venezuela. Br J Cancer 1994; 69:1102.
- Hamashima C, Shibuya D, Yamazaki H, et al. The Japanese guidelines for gastric cancer screening. Jpn J Clin Oncol 2008; 38:259.
- Hamashima C, Saito H, Nakayama T, et al. The standardized development method of the Japanese guidelines for cancer screening. Jpn J Clin Oncol 2008; 38:288.
- Choi KS, Jun JK, Park EC, et al. Performance of different gastric cancer screening methods in Korea: a population-based study. PLoS One 2012; 7:e50041.
- Murakami R, Tsukuma H, Ubukata T, et al. Estimation of validity of mass screening program for gastric cancer in Osaka, Japan. Cancer 1990; 65:1255.
- Hisamichi S, Sugawara N, Fukao A. Effectiveness of gastric mass screening in Japan. Cancer Detect Prev 1988; 11:323.
- Fukao A, Tsubono Y, Tsuji I, et al. The evaluation of screening for gastric cancer in Miyagi Prefecture, Japan: a population-based case-control study. Int J Cancer 1995; 60:45.
- Oshima A, Hirata N, Ubukata T, et al. Evaluation of a mass screening program for stomach cancer with a case-control study design. Int J Cancer 1986; 38:829.
- Tsuji I, Fukao A, Sugawara N, et al. Cost-effectiveness analysis of screening for gastric cancer in Japan. Tohoku J Exp Med 1991; 164:279.
- Kunisaki C, Ishino J, Nakajima S, et al. Outcomes of mass screening for gastric carcinoma. Ann Surg Oncol 2006; 13:221.
- Inaba S, Hirayama H, Nagata C, et al. Evaluation of a screening program on reduction of gastric cancer mortality in Japan: preliminary results from a cohort study. Prev Med 1999; 29:102.
- Choi KS, Jun JK, Suh M, et al. Effect of endoscopy screening on stage at gastric cancer diagnosis: results of the National Cancer Screening Programme in Korea. Br J Cancer 2015; 112:608.
- Dan YY, So JB, Yeoh KG. Endoscopic screening for gastric cancer. Clin Gastroenterol Hepatol 2006; 4:709.
- Yeh JM, Hur C, Ward Z, et al. Gastric adenocarcinoma screening and prevention in the era of new biomarker and endoscopic technologies: a cost-effectiveness analysis. Gut 2016; 65:563.
- Choi IJ. Endoscopic gastric cancer screening and surveillance in high-risk groups. Clin Endosc 2014; 47:497.
- Hamashima C, Kim Y, Choi KS. Comparison of guidelines and management for gastric cancer screening between Korea and Japan. Value Health 2015; 18:A272.
- Yoo KY. Cancer control activities in the Republic of Korea. Jpn J Clin Oncol 2008; 38:327.
- Park HA, Nam SY, Lee SK, et al. The Korean guideline for gastric cancer screening. J Korean Med Assoc 2015; 58:373.
- Bae JM, Shin SY, Kim EH. Mean sojourn time of preclinical gastric cancer in Korean men: a retrospective observational study. J Prev Med Public Health 2014; 47:201.
- Nam JH, Choi IJ, Cho SJ, et al. Association of the interval between endoscopies with gastric cancer stage at diagnosis in a region of high prevalence. Cancer 2012; 118:4953.
- Park CH, Kim EH, Chung H, et al. The optimal endoscopic screening interval for detecting early gastric neoplasms. Gastrointest Endosc 2014; 80:253.
- Hamashima C, Ogoshi K, Okamoto M, et al. A community-based, case-control study evaluating mortality reduction from gastric cancer by endoscopic screening in Japan. PLoS One 2013; 8:e79088.
- Hirota WK, Zuckerman MJ, Adler DG, et al. ASGE guideline: the role of endoscopy in the surveillance of premalignant conditions of the upper GI tract. Gastrointest Endosc 2006; 63:570.
- Lundegårdh G, Adami HO, Helmick C, et al. Stomach cancer after partial gastrectomy for benign ulcer disease. N Engl J Med 1988; 319:195.
- Tersmette AC, Goodman SN, Offerhaus GJ, et al. Multivariate analysis of the risk of stomach cancer after ulcer surgery in an Amsterdam cohort of postgastrectomy patients. Am J Epidemiol 1991; 134:14.
- MING SC, GOLDMAN H. GASTRIC POLYPS; A HISTOGENETIC CLASSIFICATION AND ITS RELATION TO CARCINOMA. Cancer 1965; 18:721.
- Huang JQ, Sridhar S, Chen Y, Hunt RH. Meta-analysis of the relationship between Helicobacter pylori seropositivity and gastric cancer. Gastroenterology 1998; 114:1169.
- Ohata H, Kitauchi S, Yoshimura N, et al. Progression of chronic atrophic gastritis associated with Helicobacter pylori infection increases risk of gastric cancer. Int J Cancer 2004; 109:138.
- Kokkola A, Sjöblom SM, Haapiainen R, et al. The risk of gastric carcinoma and carcinoid tumours in patients with pernicious anaemia. A prospective follow-up study. Scand J Gastroenterol 1998; 33:88.
- Alexander JR, Andrews JM, Buchi KN, et al. High prevalence of adenomatous polyps of the duodenal papilla in familial adenomatous polyposis. Dig Dis Sci 1989; 34:167.
- Aarnio M, Salovaara R, Aaltonen LA, et al. Features of gastric cancer in hereditary non-polyposis colorectal cancer syndrome. Int J Cancer 1997; 74:551.
- Yatsuya H, Toyoshima H, Tamakoshi A, et al. Individual and joint impact of family history and Helicobacter pylori infection on the risk of stomach cancer: a nested case-control study. Br J Cancer 2004; 91:929.
- Chen MJ, Wu DC, Ko YC, Chiou YY. Personal history and family history as a predictor of gastric cardiac adenocarcinoma risk: a case-control study in Taiwan. Am J Gastroenterol 2004; 99:1250.
- Boeing H. Epidemiological research in stomach cancer: progress over the last ten years. J Cancer Res Clin Oncol 1991; 117:133.
- Ford AC, Forman D, Hunt RH, et al. Helicobacter pylori eradication therapy to prevent gastric cancer in healthy asymptomatic infected individuals: systematic review and meta-analysis of randomised controlled trials. BMJ 2014; 348:g3174.
- Uemura N, Mukai T, Okamoto S, et al. Effect of Helicobacter pylori eradication on subsequent development of cancer after endoscopic resection of early gastric cancer. Cancer Epidemiol Biomarkers Prev 1997; 6:639.
- Saito K, Arai K, Mori M, et al. Effect of Helicobacter pylori eradication on malignant transformation of gastric adenoma. Gastrointest Endosc 2000; 52:27.
- Wong BC, Lam SK, Wong WM, et al. Helicobacter pylori eradication to prevent gastric cancer in a high-risk region of China: a randomized controlled trial. JAMA 2004; 291:187.
- de Jong D, van Dijk WC, van der Hulst RW, et al. CagA+ H. pylori strains and gastric lymphoma. Gastroenterology 1997; 113:2022.
- Forbes GM, Warren JR, Glaser ME, et al. Long-term follow-up of gastric histology after Helicobacter pylori eradication. J Gastroenterol Hepatol 1996; 11:670.
- Annibale B, Aprile MR, D'ambra G, et al. Cure of Helicobacter pylori infection in atrophic body gastritis patients does not improve mucosal atrophy but reduces hypergastrinemia and its related effects on body ECL-cell hyperplasia. Aliment Pharmacol Ther 2000; 14:625.
- Correa P, Fontham ET, Bravo JC, et al. Chemoprevention of gastric dysplasia: randomized trial of antioxidant supplements and anti-helicobacter pylori therapy. J Natl Cancer Inst 2000; 92:1881.
- Ohkusa T, Fujiki K, Takashimizu I, et al. Improvement in atrophic gastritis and intestinal metaplasia in patients in whom Helicobacter pylori was eradicated. Ann Intern Med 2001; 134:380.
- Sung JJ, Lin SR, Ching JY, et al. Atrophy and intestinal metaplasia one year after cure of H. pylori infection: a prospective, randomized study. Gastroenterology 2000; 119:7.
- Kokkola A, Sipponen P, Rautelin H, et al. The effect of Helicobacter pylori eradication on the natural course of atrophic gastritis with dysplasia. Aliment Pharmacol Ther 2002; 16:515.
- Ito M, Haruma K, Kamada T, et al. Helicobacter pylori eradication therapy improves atrophic gastritis and intestinal metaplasia: a 5-year prospective study of patients with atrophic gastritis. Aliment Pharmacol Ther 2002; 16:1449.
- SCREENING MODALITIES
- Upper endoscopy
- Contrast radiography
- Other tests
- - Serum pepsinogen
- - Serum trefoil factor 3
- - MicroRNAs
- COMPARISON OF SCREENING METHODS
- Test performance
- SCREENING STRATEGIES
- Universal screening
- Selective screening of high-risk subgroups
- Helicobacter pylori eradication
- SUMMARY AND RECOMMENDATIONS