140 lines
64 KiB
Text
140 lines
64 KiB
Text
<!DOCTYPE html>
|
|
<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" class="no-js no-jr">
|
|
<head>
|
|
<!-- For pinger, set start time and add meta elements. -->
|
|
<script type="text/javascript">var ncbi_startTime = new Date();</script>
|
|
|
|
<!-- Logger begin -->
|
|
<meta name="ncbi_db" content="books">
|
|
<meta name="ncbi_pdid" content="book-part">
|
|
<meta name="ncbi_acc" content="NBK65730">
|
|
<meta name="ncbi_domain" content="pdqcis">
|
|
<meta name="ncbi_report" content="reader">
|
|
<meta name="ncbi_type" content="fulltext">
|
|
<meta name="ncbi_objectid" content="">
|
|
<meta name="ncbi_pcid" content="/NBK65730/?report=reader">
|
|
<meta name="ncbi_pagename" content="Stomach (Gastric) Cancer Screening (PDQ®) - PDQ Cancer Information Summaries - NCBI Bookshelf">
|
|
<meta name="ncbi_bookparttype" content="chapter">
|
|
<meta name="ncbi_app" content="bookshelf">
|
|
<!-- Logger end -->
|
|
|
|
<!--component id="Page" label="meta"/-->
|
|
<script type="text/javascript" src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.boots.min.js"> </script><title>Stomach (Gastric) Cancer Screening (PDQ®) - PDQ Cancer Information Summaries - NCBI Bookshelf</title>
|
|
<meta charset="utf-8">
|
|
<meta name="apple-mobile-web-app-capable" content="no">
|
|
<meta name="viewport" content="initial-scale=1,minimum-scale=1,maximum-scale=1,user-scalable=no">
|
|
<meta name="jr-col-layout" content="auto">
|
|
<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE">
|
|
<meta name="citation_inbook_title" content="PDQ Cancer Information Summaries [Internet]">
|
|
<meta name="citation_title" content="Stomach (Gastric) Cancer Screening (PDQ®)">
|
|
<meta name="citation_publisher" content="National Cancer Institute (US)">
|
|
<meta name="citation_date" content="2024/03/19">
|
|
<meta name="citation_author" content="PDQ Screening and Prevention Editorial Board">
|
|
<meta name="citation_pmid" content="26389174">
|
|
<meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK65730/">
|
|
<meta name="citation_keywords" content="gastric cancer">
|
|
<meta name="citation_keywords" content="disease screening">
|
|
<meta name="citation_keywords" content="disease screening">
|
|
<meta name="citation_keywords" content="gastric cancer">
|
|
<link rel="schema.DC" href="http://purl.org/DC/elements/1.0/">
|
|
<meta name="DC.Title" content="Stomach (Gastric) Cancer Screening (PDQ®)">
|
|
<meta name="DC.Type" content="Text">
|
|
<meta name="DC.Publisher" content="National Cancer Institute (US)">
|
|
<meta name="DC.Contributor" content="PDQ Screening and Prevention Editorial Board">
|
|
<meta name="DC.Date" content="2024/03/19">
|
|
<meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK65730/">
|
|
<meta name="description" content="For stomach (gastric) cancer, there is no standard or routine screening test for the general U.S. population. Review the evidence on the benefits and harms of screening for gastric cancer using barium-meal photofluorography, gastric endoscopy, or serum pepsinogen in this expert-reviewed summary.">
|
|
<meta name="og:title" content="Stomach (Gastric) Cancer Screening (PDQ®)">
|
|
<meta name="og:type" content="book">
|
|
<meta name="og:description" content="For stomach (gastric) cancer, there is no standard or routine screening test for the general U.S. population. Review the evidence on the benefits and harms of screening for gastric cancer using barium-meal photofluorography, gastric endoscopy, or serum pepsinogen in this expert-reviewed summary.">
|
|
<meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK65730/">
|
|
<meta name="og:site_name" content="NCBI Bookshelf">
|
|
<meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png">
|
|
<meta name="twitter:card" content="summary">
|
|
<meta name="twitter:site" content="@ncbibooks">
|
|
<meta name="bk-non-canon-loc" content="/books/n/pdqcis/CDR0000062757/?report=reader">
|
|
<link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK65730/">
|
|
<link href="https://fonts.googleapis.com/css?family=Archivo+Narrow:400,700,400italic,700italic&subset=latin" rel="stylesheet" type="text/css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/jatsreader/ptpmc_3.22/css/libs.min.css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/jatsreader/ptpmc_3.22/css/jr.min.css">
|
|
<meta name="format-detection" content="telephone=no">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css//books_print.min.css" type="text/css" media="print">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_reader.min.css" type="text/css">
|
|
<style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} .body-content h2, .body-content .h2 {border-bottom: 1px solid #97B0C8} .body-content h2.inline {border-bottom: none} a.page-toc-label , .jig-ncbismoothscroll a {text-decoration:none;border:0 !important} .temp-labeled-list .graphic {display:inline-block !important} .temp-labeled-list img{width:100%}</style>
|
|
|
|
<link rel="shortcut icon" href="//www.ncbi.nlm.nih.gov/favicon.ico">
|
|
<meta name="ncbi_phid" content="CE8B21167C930DE100000000012D00F7.m_5">
|
|
<meta name='referrer' content='origin-when-cross-origin'/><link type="text/css" rel="stylesheet" href="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/css/3852956/3849091.css"></head>
|
|
<body>
|
|
<!-- Book content! -->
|
|
|
|
|
|
<div id="jr" data-jr-path="/corehtml/pmc/jatsreader/ptpmc_3.22/"><div class="jr-unsupported"><table class="modal"><tr><td><span class="attn inline-block"></span><br />Your browser does not support the NLM PubReader view.<br />Go to <a href="/pmc/about/pr-browsers/">this page</a> to see a list of supported browsers<br />or return to the <br /><a href="/books/NBK65730/?report=classic">regular view</a>.</td></tr></table></div><div id="jr-ui" class="hidden"><nav id="jr-head"><div class="flexh tb"><div id="jr-tb1"><a id="jr-links-sw" class="hidden" title="Links"><svg xmlns="http://www.w3.org/2000/svg" version="1.1" x="0px" y="0px" viewBox="0 0 70.6 85.3" style="enable-background:new 0 0 70.6 85.3;vertical-align:middle" xml:space="preserve" width="24" height="24">
|
|
<style type="text/css">.st0{fill:#939598;}</style>
|
|
<g>
|
|
<path class="st0" d="M36,0C12.8,2.2-22.4,14.6,19.6,32.5C40.7,41.4-30.6,14,35.9,9.8"></path>
|
|
<path class="st0" d="M34.5,85.3c23.2-2.2,58.4-14.6,16.4-32.5c-21.1-8.9,50.2,18.5-16.3,22.7"></path>
|
|
<path class="st0" d="M34.7,37.1c66.5-4.2-4.8-31.6,16.3-22.7c42.1,17.9,6.9,30.3-16.4,32.5h1.7c-66.2,4.4,4.8,31.6-16.3,22.7 c-42.1-17.9-6.9-30.3,16.4-32.5"></path>
|
|
</g>
|
|
</svg> Books</a></div><div class="jr-rhead f1 flexh"><div class="head"></div><div class="body"><div class="t">Stomach (Gastric) Cancer Screening (PDQ®): Health Professional Version</div><div class="j">PDQ Cancer Information Summaries [Internet]</div></div><div class="tail"></div></div><div id="jr-tb2"><a id="jr-bkhelp-sw" class="btn wsprkl hidden" title="Help with NLM PubReader">?</a><a id="jr-help-sw" class="btn wsprkl hidden" title="Settings and typography in NLM PubReader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512" preserveAspectRatio="none"><path d="M462,283.742v-55.485l-29.981-10.662c-11.431-4.065-20.628-12.794-25.274-24.001 c-0.002-0.004-0.004-0.009-0.006-0.013c-4.659-11.235-4.333-23.918,0.889-34.903l13.653-28.724l-39.234-39.234l-28.72,13.652 c-10.979,5.219-23.68,5.546-34.908,0.889c-0.005-0.002-0.01-0.003-0.014-0.005c-11.215-4.65-19.933-13.834-24-25.273L283.741,50 h-55.484l-10.662,29.981c-4.065,11.431-12.794,20.627-24.001,25.274c-0.005,0.002-0.009,0.004-0.014,0.005 c-11.235,4.66-23.919,4.333-34.905-0.889l-28.723-13.653l-39.234,39.234l13.653,28.721c5.219,10.979,5.545,23.681,0.889,34.91 c-0.002,0.004-0.004,0.009-0.006,0.013c-4.649,11.214-13.834,19.931-25.271,23.998L50,228.257v55.485l29.98,10.661 c11.431,4.065,20.627,12.794,25.274,24c0.002,0.005,0.003,0.01,0.005,0.014c4.66,11.236,4.334,23.921-0.888,34.906l-13.654,28.723 l39.234,39.234l28.721-13.652c10.979-5.219,23.681-5.546,34.909-0.889c0.005,0.002,0.01,0.004,0.014,0.006 c11.214,4.649,19.93,13.833,23.998,25.271L228.257,462h55.484l10.595-29.79c4.103-11.538,12.908-20.824,24.216-25.525 c0.005-0.002,0.009-0.004,0.014-0.006c11.127-4.628,23.694-4.311,34.578,0.863l28.902,13.738l39.234-39.234l-13.66-28.737 c-5.214-10.969-5.539-23.659-0.886-34.877c0.002-0.005,0.004-0.009,0.006-0.014c4.654-11.225,13.848-19.949,25.297-24.021 L462,283.742z M256,331.546c-41.724,0-75.548-33.823-75.548-75.546s33.824-75.547,75.548-75.547 c41.723,0,75.546,33.824,75.546,75.547S297.723,331.546,256,331.546z"></path></svg></a><a id="jr-fip-sw" class="btn wsprkl hidden" title="Find"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 550 600" preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-cmap-sw" class="btn wsprkl hidden" title="Table of Contents"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M20,20h10v8H20V20zM36,20h44v8H36V20zM20,37.33h10v8H20V37.33zM36,37.33h44v8H36V37.33zM20,54.66h10v8H20V54.66zM36,54.66h44v8H36V54.66zM20,72h10v8 H20V72zM36,72h44v8H36V72z"></path></svg></a></div></div></nav><nav id="jr-dash" class="noselect"><nav id="jr-dash" class="noselect"><div id="jr-pi" class="hidden"><a id="jr-pi-prev" class="hidden" title="Previous page"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M75,30 c-80,60 -80,0 0,60 c-30,-60 -30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Prev</text></svg></a><div class="pginfo">Page <i class="jr-pg-pn">0</i> of <i class="jr-pg-lp">0</i></div><a id="jr-pi-next" class="hidden" title="Next page"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M25,30c80,60 80,0 0,60 c30,-60 30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Next</text></svg></a></div><div id="jr-is-tb"><a id="jr-is-sw" class="btn wsprkl hidden" title="Switch between Figures/Tables strip and Progress bar"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><rect x="10" y="40" width="20" height="20"></rect><rect x="40" y="40" width="20" height="20"></rect><rect x="70" y="40" width="20" height="20"></rect></svg></a></div><nav id="jr-istrip" class="istrip hidden"><a id="jr-is-prev" href="#" class="hidden" title="Previous"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M80,40 60,65 80,90 70,90 50,65 70,40z M50,40 30,65 50,90 40,90 20,65 40,40z"></path><text x="35" y="25" textLength="60" style="font-size:25px">Prev</text></svg></a><a id="jr-is-next" href="#" class="hidden" title="Next"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M20,40 40,65 20,90 30,90 50,65 30,40z M50,40 70,65 50,90 60,90 80,65 60,40z"></path><text x="15" y="25" textLength="60" style="font-size:25px">Next</text></svg></a></nav><nav id="jr-progress"></nav></nav></nav><aside id="jr-links-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">NCBI Bookshelf</div></div><div class="cnt lol f1"><a href="/books/">Home</a><a href="/books/browse/">Browse All Titles</a><a class="btn share" target="_blank" rel="noopener noreferrer" href="https://www.facebook.com/sharer/sharer.php?u=https://www.ncbi.nlm.nih.gov/books/NBK65730/"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 33 33" style="vertical-align:middle" width="24" height="24" preserveAspectRatio="none"><g><path d="M 17.996,32L 12,32 L 12,16 l-4,0 l0-5.514 l 4-0.002l-0.006-3.248C 11.993,2.737, 13.213,0, 18.512,0l 4.412,0 l0,5.515 l-2.757,0 c-2.063,0-2.163,0.77-2.163,2.209l-0.008,2.76l 4.959,0 l-0.585,5.514L 18,16L 17.996,32z"></path></g></svg> Share on Facebook</a><a class="btn share" target="_blank" rel="noopener noreferrer" href="https://twitter.com/intent/tweet?url=https://www.ncbi.nlm.nih.gov/books/NBK65730/&text=Stomach%20(Gastric)%20Cancer%20Screening%20(PDQ%AE)"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 33 33" style="vertical-align:middle" width="24" height="24"><g><path d="M 32,6.076c-1.177,0.522-2.443,0.875-3.771,1.034c 1.355-0.813, 2.396-2.099, 2.887-3.632 c-1.269,0.752-2.674,1.299-4.169,1.593c-1.198-1.276-2.904-2.073-4.792-2.073c-3.626,0-6.565,2.939-6.565,6.565 c0,0.515, 0.058,1.016, 0.17,1.496c-5.456-0.274-10.294-2.888-13.532-6.86c-0.565,0.97-0.889,2.097-0.889,3.301 c0,2.278, 1.159,4.287, 2.921,5.465c-1.076-0.034-2.088-0.329-2.974-0.821c-0.001,0.027-0.001,0.055-0.001,0.083 c0,3.181, 2.263,5.834, 5.266,6.438c-0.551,0.15-1.131,0.23-1.73,0.23c-0.423,0-0.834-0.041-1.235-0.118 c 0.836,2.608, 3.26,4.506, 6.133,4.559c-2.247,1.761-5.078,2.81-8.154,2.81c-0.53,0-1.052-0.031-1.566-0.092 c 2.905,1.863, 6.356,2.95, 10.064,2.95c 12.076,0, 18.679-10.004, 18.679-18.68c0-0.285-0.006-0.568-0.019-0.849 C 30.007,8.548, 31.12,7.392, 32,6.076z"></path></g></svg> Share on Twitter</a></div></aside><aside id="jr-cmap-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">In Page Navigation</div></div><div class="cnt lol f1"><a href="/books/n/pdqcis/?report=reader">Title Information</a><a href="/books/n/pdqcis/toc/?report=reader">Table of Contents Page</a><a href="#_NBK65730_">Stomach (Gastric) Cancer Screening (PDQ®): Health Professional Version</a></div></aside><aside id="jr-help-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">Settings</div></div><div class="cnt f1"><div id="jr-typo-p" class="typo"><div><a class="sf btn wsprkl">A-</a><a class="lf btn wsprkl">A+</a></div><div><a class="bcol-auto btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 200 100" preserveAspectRatio="none"><text x="10" y="70" style="font-size:60px;font-family: Trebuchet MS, ArialMT, Arial, sans-serif" textLength="180">AUTO</text></svg></a><a class="bcol-1 btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M15,25 85,25zM15,40 85,40zM15,55 85,55zM15,70 85,70z"></path></svg></a><a class="bcol-2 btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M5,25 45,25z M55,25 95,25zM5,40 45,40z M55,40 95,40zM5,55 45,55z M55,55 95,55zM5,70 45,70z M55,70 95,70z"></path></svg></a></div></div><div class="lol"><a class="" href="/books/NBK65730/?report=classic">Switch to classic view</a><a href="/books/NBK65730/?report=printable">Print View</a></div></div></aside><aside id="jr-bkhelp-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">Help</div></div><div class="cnt f1 lol"><a id="jr-helpobj-sw" data-path="/corehtml/pmc/jatsreader/ptpmc_3.22/" data-href="/corehtml/pmc/jatsreader/ptpmc_3.22/img/bookshelf/help.xml" href="">Help</a><a href="mailto:info@ncbi.nlm.nih.gov?subject=PubReader%20feedback%20%2F%20NBK65730%20%2F%20sid%3ACE8B5AF87C7FFCB1_0191SID%20%2F%20phid%3ACE8B21167C930DE100000000012D00F7.4">Send us feedback</a><a id="jr-about-sw" data-path="/corehtml/pmc/jatsreader/ptpmc_3.22/" data-href="/corehtml/pmc/jatsreader/ptpmc_3.22/img/bookshelf/about.xml" href="">About PubReader</a></div></aside><aside id="jr-objectbox" class="thidden hidden"><div class="jr-objectbox-close wsprkl">✘</div><div class="jr-objectbox-inner cnt"><div class="jr-objectbox-drawer"></div></div></aside><nav id="jr-pm-left" class="hidden"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 40 800" preserveAspectRatio="none"><text font-stretch="ultra-condensed" x="800" y="-15" text-anchor="end" transform="rotate(90)" font-size="18" letter-spacing=".1em">Previous Page</text></svg></nav><nav id="jr-pm-right" class="hidden"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 40 800" preserveAspectRatio="none"><text font-stretch="ultra-condensed" x="800" y="-15" text-anchor="end" transform="rotate(90)" font-size="18" letter-spacing=".1em">Next Page</text></svg></nav><nav id="jr-fip" class="hidden"><nav id="jr-fip-term-p"><input type="search" placeholder="search this page" id="jr-fip-term" autocorrect="off" autocomplete="off" /><a id="jr-fip-mg" class="wsprkl btn" title="Find"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 550 600" preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-fip-done" class="wsprkl btn" title="Dismiss find">✘</a></nav><nav id="jr-fip-info-p"><a id="jr-fip-prev" class="wsprkl btn" title="Jump to previuos match">◀</a><button id="jr-fip-matches">no matches yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><div class="fm-sec"><h1 id="_NBK65730_"><span class="title" itemprop="name">Stomach (Gastric) Cancer Screening (PDQ®)</span></h1><div class="subtitle whole_rhythm">Health Professional Version</div><p class="contribs">PDQ Screening and Prevention Editorial Board.</p><p class="fm-aai"><a href="#_NBK65730_pubdet_">Publication Details</a></p></div></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000062757__94">This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about stomach (gastric) cancer screening. It is intended as a resource to inform and assist clinicians in the care of their patients. It does not provide formal guidelines or recommendations for making health care decisions.</p><p id="CDR0000062757__95">This summary is reviewed regularly and updated as necessary by the PDQ Screening and Prevention Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).</p></div><div id="CDR0000062757__1"><h2 id="_CDR0000062757__1_"> Overview</h2><p id="CDR0000062757__2">Note: The Overview section summarizes the published evidence on this topic. The rest of the summary describes the evidence in more detail.</p><p id="CDR0000062757__119">Other PDQ summaries on <a href="/books/n/pdqcis/CDR0000062830/?report=reader">Stomach (Gastric) Cancer Prevention</a>; <a href="/books/n/pdqcis/CDR0000062911/?report=reader">Gastric Cancer
|
|
Treatment</a>; and <a href="/books/n/pdqcis/CDR0000304747/?report=reader">Levels of Evidence for Cancer Screening and Prevention Studies</a> are also available.</p><div id="CDR0000062757__22"><h3>Inadequate Evidence of Benefit Associated With Screening</h3><div id="CDR0000062757__96"><h4>Barium-meal gastric photofluorography and serum pepsinogen</h4><p id="CDR0000062757__97">Based on fair evidence, screening with barium-meal photofluorography or serum pepsinogen would not result in a decrease in mortality from gastric cancer in areas with relatively low incidence of the disease, such as the United States.[<a class="bibr" href="#CDR0000062757_rl_1_1" rid="CDR0000062757_rl_1_1">1</a>-<a class="bibr" href="#CDR0000062757_rl_1_4" rid="CDR0000062757_rl_1_4">4</a>]</p><p id="CDR0000062757__98"><b>Magnitude of Effect</b>: Fair evidence for no reduction in mortality.</p><ul id="CDR0000062757__99" class="simple-list"><li class="half_rhythm"><div><b>Study Design</b>: Evidence obtained from case-control and cohort studies, primarily from high-risk areas such as East Asia.</div></li><li class="half_rhythm"><div><b>Internal Validity</b>: Fair.</div></li><li class="half_rhythm"><div><b>Consistency</b>: Poor in prospective studies.[<a class="bibr" href="#CDR0000062757_rl_1_5" rid="CDR0000062757_rl_1_5">5</a>]</div></li><li class="half_rhythm"><div><b>External Validity</b>: Poor. Studies on populations in high-risk areas may not be applicable to low-risk areas such as the United States.</div></li></ul></div><div id="CDR0000062757__110"><h4>Gastric endoscopy</h4><p id="CDR0000062757__111"><b>Magnitude of Effect</b>: Inadequate evidence for mortality reduction.</p><ul id="CDR0000062757__112" class="simple-list"><li class="half_rhythm"><div><b>Study Design</b>: Evidence from case-control and cohort studies from East Asia are generally consistent with a substantial reduction in gastric cancer mortality associated with endoscopic screening.</div></li><li class="half_rhythm"><div><b>Internal Validity</b>: Fair to poor. All of the studies are observational and subject to selection bias on the basis of the individual who chooses to be screened.</div></li><li class="half_rhythm"><div><b>Consistency</b>: Good among the observational studies.</div></li><li class="half_rhythm"><div><b>External Validity</b>: Poor. Studies on populations in high-risk areas (East Asia) may not be applicable to low-risk areas such as the United States.</div></li></ul><div id="CDR0000062757__108"><h5>Harms</h5><p id="CDR0000062757__109">Based on solid evidence, screening would result in uncommon but serious side effects associated with endoscopy, which may include perforation, cardiopulmonary events, aspiration pneumonia, and bleeding requiring hospitalization.</p><p id="CDR0000062757__102"><b>Magnitude of Effect</b>: Solid evidence for rare but serious harms.</p><ul id="CDR0000062757__103" class="simple-list"><li class="half_rhythm"><div><b>Study Design</b>: Evidence obtained from screening programs and case series.</div></li><li class="half_rhythm"><div><b>Internal Validity</b>: Fair.</div></li><li class="half_rhythm"><div><b>Consistency</b>: Inadequate evidence.</div></li><li class="half_rhythm"><div><b>External Validity</b>: Poor.</div></li></ul></div></div></div><div id="CDR0000062757_rl_1"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062757_rl_1_1">Hirayama T, Hisamichi S, Fujimoto I, et al.: Screening for gastric cancer. In: Miller AB, ed.: Screening for Cancer. Academic Press, 1985, pp 367-376.</div></li><li><div class="bk_ref" id="CDR0000062757_rl_1_2">Tytgat GN, Mathus-Vliegen EM, Offerhaus J: Value of endoscopy in the surveillance of high-risk groups for gastrointestinal cancer. In: Sherlock P, Morson BC, Barbara L, et al., eds.: Precancerous Lesions of the Gastrointestinal Tract. Raven Press, 1983, pp 305-318.</div></li><li><div class="bk_ref" id="CDR0000062757_rl_1_3">Riecken B, Pfeiffer R, Ma JL, et al.: No impact of repeated endoscopic screens on gastric cancer mortality in a prospectively followed Chinese population at high risk. Prev Med 34 (1): 22-8, 2002. [<a href="https://pubmed.ncbi.nlm.nih.gov/11749093" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11749093</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062757_rl_1_4">Kitahara F, Kobayashi K, Sato T, et al.: Accuracy of screening for gastric cancer using serum pepsinogen concentrations. Gut 44 (5): 693-7, 1999. [<a href="/pmc/articles/PMC1727514/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1727514</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/10205207" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10205207</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062757_rl_1_5">Leung WK, Wu MS, Kakugawa Y, et al.: Screening for gastric cancer in Asia: current evidence and practice. Lancet Oncol 9 (3): 279-87, 2008. [<a href="https://pubmed.ncbi.nlm.nih.gov/18308253" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18308253</span></a>]</div></li></ol></div></div><div id="CDR0000062757__65"><h2 id="_CDR0000062757__65_">Incidence and Mortality</h2><p id="CDR0000062757__85">In 2024, it is estimated that 26,890 Americans will be diagnosed with
|
|
gastric cancer and 10,880 will die of it.[<a class="bibr" href="#CDR0000062757_rl_65_1" rid="CDR0000062757_rl_65_1">1</a>] Two-thirds of people diagnosed with gastric cancer are older than 66 years. Gastric cancer is the fourth most common cause of cancer mortality in the world. The disease is common in places such as East Asia, South-Central Asia,
|
|
South and Central America, and Eastern Europe. Gastric cancer is
|
|
a major cause of death worldwide.[<a class="bibr" href="#CDR0000062757_rl_65_2" rid="CDR0000062757_rl_65_2">2</a>]</p><p id="CDR0000062757__86">The
|
|
major type of gastric cancer is adenocarcinoma (95%). The remaining malignant tumors
|
|
include lymphomas, sarcomas, carcinoid tumors, and other rare types. Distinguishing the common adenocarcinoma from the uncommon lymphoma may sometimes be difficult, but it is important because of major differences in staging, treatment, and prognosis.[<a class="bibr" href="#CDR0000062757_rl_65_3" rid="CDR0000062757_rl_65_3">3</a>] Gastric adenocarcinomas
|
|
can be further categorized into an intestinal type and a diffuse type.[<a class="bibr" href="#CDR0000062757_rl_65_4" rid="CDR0000062757_rl_65_4">4</a>]
|
|
Intestinal-type lesions are frequently ulcerative and occur in the distal
|
|
stomach more often than the diffuse type. Diffuse-type lesions are associated with a
|
|
worse prognosis than the intestinal type. The intestinal type tends to
|
|
be predominant in geographic regions with a high incidence of gastric carcinoma.
|
|
The decline in the incidence of gastric cancer worldwide largely results from a
|
|
decrease in the number of intestinal-type lesions.[<a class="bibr" href="#CDR0000062757_rl_65_5" rid="CDR0000062757_rl_65_5">5</a>]</p><div id="CDR0000062757_rl_65"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062757_rl_65_1">American Cancer Society: Cancer Facts and Figures 2024. American Cancer Society, 2024. <a href="https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2024/2024-cancer-facts-and-figures-acs.pdf" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Available online</a>. Last accessed December 30, 2024.</div></li><li><div class="bk_ref" id="CDR0000062757_rl_65_2">Sung H, Ferlay J, Siegel RL, et al.: Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 71 (3): 209-249, 2021. [<a href="https://pubmed.ncbi.nlm.nih.gov/33538338" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33538338</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062757_rl_65_3">Pisters PWT, Kelsen DP, Tepper JE: Cancer of the stomach. In: DeVita VT Jr, Hellman S, Rosenberg SA, eds.: Cancer: Principles and Practice of Oncology. Vols. 1 & 2. 8th ed. Lippincott Williams & Wilkins, 2008, pp 1043-1079.</div></li><li><div class="bk_ref" id="CDR0000062757_rl_65_4">Lauren P: The two histological main types of gastric carcinoma: diffuse and so-called intestinal-type carcinoma: an attempt at a histo-clinical classification. Acta Pathol Microbiol Scand 64(1): 31-49, 1965. [<a href="https://pubmed.ncbi.nlm.nih.gov/14320675" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14320675</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062757_rl_65_5">Henson DE, Dittus C, Younes M, et al.: Differential trends in the intestinal and diffuse types of gastric carcinoma in the United States, 1973-2000: increase in the signet ring cell type. Arch Pathol Lab Med 128 (7): 765-70, 2004. [<a href="https://pubmed.ncbi.nlm.nih.gov/15214826" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15214826</span></a>]</div></li></ol></div></div><div id="CDR0000062757__9"><h2 id="_CDR0000062757__9_">Risk Factors</h2><p id="CDR0000062757__10">The incidence of gastric cancer in the United States has decreased fourfold since
|
|
1930, to approximately seven cases per 100,000 people.[<a class="bibr" href="#CDR0000062757_rl_9_1" rid="CDR0000062757_rl_9_1">1</a>] The reasons for this
|
|
striking decrease in incidence are not fully understood but are suspected to be related to
|
|
improved storage of food and changes in diet, such as decreased salt intake. Some populations of Americans are at elevated risk, including older patients with atrophic gastritis or pernicious anemia; patients with sporadic gastric adenomas,[<a class="bibr" href="#CDR0000062757_rl_9_2" rid="CDR0000062757_rl_9_2">2</a>] familial adenomatous polyposis,[<a class="bibr" href="#CDR0000062757_rl_9_3" rid="CDR0000062757_rl_9_3">3</a>] or hereditary nonpolyposis colon cancer;[<a class="bibr" href="#CDR0000062757_rl_9_4" rid="CDR0000062757_rl_9_4">4</a>] and immigrant ethnic populations from countries with high rates of gastric carcinoma.[<a class="bibr" href="#CDR0000062757_rl_9_5" rid="CDR0000062757_rl_9_5">5</a>,<a class="bibr" href="#CDR0000062757_rl_9_6" rid="CDR0000062757_rl_9_6">6</a>]</p><p id="CDR0000062757__68">
|
|
Risk factors for gastric cancer include the presence of precursor conditions
|
|
such as chronic atrophic gastritis and intestinal metaplasia, pernicious
|
|
anemia, and gastric adenomatous polyps. Genetic and environmental factors
|
|
include a family history of gastric cancer; low consumption of fruits and
|
|
vegetables; consumption of salted, smoked, or poorly preserved foods; and
|
|
cigarette smoking.[<a class="bibr" href="#CDR0000062757_rl_9_7" rid="CDR0000062757_rl_9_7">7</a>
|
|
,<a class="bibr" href="#CDR0000062757_rl_9_8" rid="CDR0000062757_rl_9_8">8</a>] There is consistent evidence that <i>Helicobacter pylori</i>
|
|
infection of the stomach is strongly associated with both the initiation and promotion
|
|
of carcinoma of the gastric body and antrum, and of gastric lymphoma.[<a class="bibr" href="#CDR0000062757_rl_9_9" rid="CDR0000062757_rl_9_9">9</a>-<a class="bibr" href="#CDR0000062757_rl_9_11" rid="CDR0000062757_rl_9_11">11</a>] The International Agency for Research on Cancer (IARC) classifies <i>H. pylori</i> infection as a cause of noncardia gastric carcinoma and low-grade B-cell mucosa-associated lymphatic tissue gastric lymphoma (i.e., a Group 1 human carcinogen).[<a class="bibr" href="#CDR0000062757_rl_9_12" rid="CDR0000062757_rl_9_12">12</a>,<a class="bibr" href="#CDR0000062757_rl_9_13" rid="CDR0000062757_rl_9_13">13</a>] Compared with the general population,
|
|
people with duodenal ulcer disease may have a lower risk of gastric cancer.[<a class="bibr" href="#CDR0000062757_rl_9_14" rid="CDR0000062757_rl_9_14">14</a>]
|
|
</p><div id="CDR0000062757_rl_9"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062757_rl_9_1">National Cancer Institute: SEER Stat Fact Sheets: Stomach Cancer. Bethesda, Md: National Cancer Institute. <a href="https://seer.cancer.gov/statfacts/html/stomach.html" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Available online</a>. Last accessed March 19, 2024.</div></li><li><div class="bk_ref" id="CDR0000062757_rl_9_2">MING SC, GOLDMAN H: Gastric polyps: a histogenetic classification and its relation to carcinoma. Cancer 18: 721-6, 1965. [<a href="https://pubmed.ncbi.nlm.nih.gov/14297468" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14297468</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062757_rl_9_3">Utsunomiya J, Maki T, Iwama T, et al.: Gastric lesion of familial polyposis coli. Cancer 34 (3): 745-54, 1974. [<a href="https://pubmed.ncbi.nlm.nih.gov/4852134" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 4852134</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062757_rl_9_4">Aarnio M, Salovaara R, Aaltonen LA, et al.: Features of gastric cancer in hereditary non-polyposis colorectal cancer syndrome. Int J Cancer 74 (5): 551-5, 1997. [<a href="https://pubmed.ncbi.nlm.nih.gov/9355980" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9355980</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062757_rl_9_5">Kurtz RC, Sherlock P: The diagnosis of gastric cancer. Semin Oncol 12 (1): 11-8, 1985. [<a href="https://pubmed.ncbi.nlm.nih.gov/3975641" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3975641</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062757_rl_9_6">Boeing H: Epidemiological research in stomach cancer: progress over the last ten years. J Cancer Res Clin Oncol 117 (2): 133-43, 1991. [<a href="https://pubmed.ncbi.nlm.nih.gov/2036128" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2036128</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062757_rl_9_7">Crew KD, Neugut AI: Epidemiology of gastric cancer. World J Gastroenterol 12 (3): 354-62, 2006. [<a href="/pmc/articles/PMC4066052/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4066052</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/16489633" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16489633</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062757_rl_9_8">Leung WK, Wu MS, Kakugawa Y, et al.: Screening for gastric cancer in Asia: current evidence and practice. Lancet Oncol 9 (3): 279-87, 2008. [<a href="https://pubmed.ncbi.nlm.nih.gov/18308253" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18308253</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062757_rl_9_9">Parsonnet J, Hansen S, Rodriguez L, et al.: Helicobacter pylori infection and gastric lymphoma. N Engl J Med 330 (18): 1267-71, 1994. [<a href="https://pubmed.ncbi.nlm.nih.gov/8145781" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8145781</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062757_rl_9_10">Ando T, Goto Y, Maeda O, et al.: Causal role of Helicobacter pylori infection in gastric cancer. World J Gastroenterol 12 (2): 181-6, 2006. [<a href="/pmc/articles/PMC4066024/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4066024</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/16482615" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16482615</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062757_rl_9_11">Aromaa A, Kosunen TU, Knekt P, et al.: Circulating anti-Helicobacter pylori immunoglobulin A antibodies and low serum pepsinogen I level are associated with increased risk of gastric cancer. Am J Epidemiol 144 (2): 142-9, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/8678045" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8678045</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062757_rl_9_12">IARC Working Group on the Evaluation of Carcinogenic Risks to Humans: A review of human carcinogens--Part B: biological agents. Volume 100. IARC Press, 2011.</div></li><li><div class="bk_ref" id="CDR0000062757_rl_9_13">Bouvard V, Baan R, Straif K, et al.: A review of human carcinogens--Part B: biological agents. Lancet Oncol 10 (4): 321-2, 2009. [<a href="https://pubmed.ncbi.nlm.nih.gov/19350698" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19350698</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062757_rl_9_14">Hansson LE, Nyrén O, Hsing AW, et al.: The risk of stomach cancer in patients with gastric or duodenal ulcer disease. N Engl J Med 335 (4): 242-9, 1996. [<a href="https://pubmed.ncbi.nlm.nih.gov/8657240" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8657240</span></a>]</div></li></ol></div></div><div id="CDR0000062757__69"><h2 id="_CDR0000062757__69_">Inadequate Evidence of Benefit Associated With Screening</h2><p id="CDR0000062757__70">Several screening techniques, including barium-meal photofluorography, gastric endoscopy, and serum pepsinogen, have been proposed as screening methods for the early detection of gastric cancer. No randomized trials evaluating the impact of screening on mortality from gastric cancer have been reported.[<a class="bibr" href="#CDR0000062757_rl_69_1" rid="CDR0000062757_rl_69_1">1</a>,<a class="bibr" href="#CDR0000062757_rl_69_2" rid="CDR0000062757_rl_69_2">2</a>] Even in very high-risk areas, the positive predictive value (PPV) of the screening tests may be very low. In a screening program of 17,647 men aged 40 to 60 years in Wakayama City, Japan, the PPV of combined serum pepsinogen and barium meal with digital radiography over the 7-year period was 0.85%.[<a class="bibr" href="#CDR0000062757_rl_69_3" rid="CDR0000062757_rl_69_3">3</a>] The positive test rates were 19.5% for serum pepsinogen and 22.5% for radiography, with a cancer detection rate of 0.28%. Over the 7-year period, there was no reduction in gastric cancer mortality compared with an age-matched surrounding population. </p><div id="CDR0000062757__71"><h3>Barium-Meal Gastric Photofluorography</h3><p id="CDR0000062757__72">A national program of population-based screening for gastric cancer using barium-meal photofluorography has been ongoing since the 1960s in Japan. Participation rates have been in the range of only 10% to 20%.[<a class="bibr" href="#CDR0000062757_rl_69_1" rid="CDR0000062757_rl_69_1">1</a>,<a class="bibr" href="#CDR0000062757_rl_69_3" rid="CDR0000062757_rl_69_3">3</a>] Although there has been a coincident decrease in mortality from gastric cancer in Japan, mortality rates have been decreasing in many developed countries without screening programs. Case-control studies from Japan show decreases in gastric mortality in people who have undergone screening, but results from prospective studies were not consistent.[<a class="bibr" href="#CDR0000062757_rl_69_1" rid="CDR0000062757_rl_69_1">1</a>,<a class="bibr" href="#CDR0000062757_rl_69_2" rid="CDR0000062757_rl_69_2">2</a>]</p><p id="CDR0000062757__73">A pilot study of community-based photofluorography was conducted in Costa Rica using the same techniques as those used in Japan’s national program (with consultation from Japanese experts).[<a class="bibr" href="#CDR0000062757_rl_69_4" rid="CDR0000062757_rl_69_4">4</a>] People were invited by letter from a population registry to attend two rounds of screening, and a total of 6,200 eligible screened participants (of a planned 12,000) were analyzed. Their gastric cancer mortality from 2 to 7 years after screening was compared with four control groups that had not been invited to be screened, and the relative risk was about 0.5 (no <i>P</i> value reported). The study was, however, prone to strong biases, including selection bias, and likely differential exclusion of people with previously diagnosed gastric cancer favoring the screened population. In addition, unlike the community controls, patients diagnosed with gastric cancer through the screening program were treated at a single referral center. The PPV of a suspicious fluorograph was 3%; the specificity in the two rounds was 67% and 80%; and the positivity rates were 34% and 20%. Despite the authors’ belief that their results provided substantial evidence that routine screening would decrease gastric cancer mortality, they concluded that the costs of screening with photofluorography would be far too high in their country.</p><p id="CDR0000062757__74">A screening study was begun in Venezuela in 1980, using radiographic fluorography.[<a class="bibr" href="#CDR0000062757_rl_69_5" rid="CDR0000062757_rl_69_5">5</a>] The efficacy of this program in reducing mortality from gastric cancer was evaluated by means of a case-control study. The study showed no detectable reduction in mortality from gastric cancer.</p></div><div id="CDR0000062757__75"><h3>Gastric Endoscopy</h3><p id="CDR0000062757__76">Endoscopy appears to be more sensitive than photofluorography for the detection of gastric cancer.[<a class="bibr" href="#CDR0000062757_rl_69_6" rid="CDR0000062757_rl_69_6">6</a>]</p><p id="CDR0000062757__77"> A meta-analysis of gastric cancer endoscopic screening studies in Asia identified ten relevant studies, all nonrandomized.[<a class="bibr" href="#CDR0000062757_rl_69_7" rid="CDR0000062757_rl_69_7">7</a>] These studies were conducted between 1989 and 2014 in South Korea, China, and Japan. Of the ten studies, a never-screened group was the comparator in six studies, a radiographic-screening group was the comparator in one study, and expected deaths based on population rates was the comparator in three studies. In some of the studies, the endoscopic screening was performed as part of a national screening program. The meta-analysis pooled risk ratio (RR) estimate of gastric cancer mortality associated with endoscopic screening was 0.60 (95% confidence interval [CI], 0.49–0.73), with all but one study showing an individual RR of 0.72 or lower. There was significant heterogeneity across studies (<i>P</i> = .001), which was because of the one study with an RR greater than 1 (1.01); removing that study resulted in no significant heterogeneity (<i>P</i> = .14). Pooled estimates for the four nested case-control studies and six cohort studies were 0.60 (95% CI, 0.47–0.76) and 0.57 (95% CI, 0.39–0.83), respectively. The pooled estimate for the six studies with the never-screened comparator group was 0.58 (95% CI, 0.48–0.70).</p></div><div id="CDR0000062757__78"><h3>Serum Pepsinogen</h3><p id="CDR0000062757__79">There are no studies evaluating the effect of screening with serum pepsinogen on gastric cancer mortality, and there are important limitations to its use as a screening test. Low serum pepsinogen levels indicate the presence of atrophic gastritis and are therefore applicable to the detection of presumed precursors for intestinal-type gastric cancer rather than the diffuse type.[<a class="bibr" href="#CDR0000062757_rl_69_3" rid="CDR0000062757_rl_69_3">3</a>] In addition, there are no standard cut-off values of abnormality.[<a class="bibr" href="#CDR0000062757_rl_69_1" rid="CDR0000062757_rl_69_1">1</a>,<a class="bibr" href="#CDR0000062757_rl_69_8" rid="CDR0000062757_rl_69_8">8</a>] Finally, eradication of <i>H. pylori</i> and use of proton pump inhibitors for the management of indigestion change pepsinogen levels, making interpretation of results difficult in the setting of widespread use of these interventions.[<a class="bibr" href="#CDR0000062757_rl_69_1" rid="CDR0000062757_rl_69_1">1</a>,<a class="bibr" href="#CDR0000062757_rl_69_3" rid="CDR0000062757_rl_69_3">3</a>]</p><p id="CDR0000062757__80">In Japan, one study measured serum pepsinogen levels I and II (PGI and PGII) in 5,113 patients who were also screened by endoscopy (13 gastric cancers detected). This study used cut-off points for identifying risk of gastric cancer, which were less than 70 ng/mL for PGI and less than 3 ng/mL for the PGI:PGII ratio. This combination provided a sensitivity of 84.6%, a specificity of 73.5%, a PPV of 0.81%, and a negative predictive value of 99.6%.[<a class="bibr" href="#CDR0000062757_rl_69_9" rid="CDR0000062757_rl_69_9">9</a>]</p></div><div id="CDR0000062757__81"><h3>Clinical Considerations for High-Risk Groups
|
|
</h3><p id="CDR0000062757__82">There may be justification for screening some populations of Americans at
|
|
higher risk, although there is considerable discussion about how much incidence
|
|
would make the examination worthwhile. Potential subgroups might include
|
|
older patients with atrophic gastritis or pernicious anemia; patients with partial
|
|
gastrectomy;[<a class="bibr" href="#CDR0000062757_rl_69_10" rid="CDR0000062757_rl_69_10">10</a>] patients with the diagnosis of sporadic adenomas,[<a class="bibr" href="#CDR0000062757_rl_69_11" rid="CDR0000062757_rl_69_11">11</a>]
|
|
familial adenomatous polyposis,[<a class="bibr" href="#CDR0000062757_rl_69_12" rid="CDR0000062757_rl_69_12">12</a>] or hereditary nonpolyposis colon cancer;[<a class="bibr" href="#CDR0000062757_rl_69_13" rid="CDR0000062757_rl_69_13">13</a>] and immigrant ethnic populations from countries with high
|
|
rates of gastric carcinoma.[<a class="bibr" href="#CDR0000062757_rl_69_14" rid="CDR0000062757_rl_69_14">14</a>,<a class="bibr" href="#CDR0000062757_rl_69_15" rid="CDR0000062757_rl_69_15">15</a>]</p></div><div id="CDR0000062757_rl_69"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062757_rl_69_1">Leung WK, Wu MS, Kakugawa Y, et al.: Screening for gastric cancer in Asia: current evidence and practice. Lancet Oncol 9 (3): 279-87, 2008. [<a href="https://pubmed.ncbi.nlm.nih.gov/18308253" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18308253</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062757_rl_69_2">Hamashima C, Shibuya D, Yamazaki H, et al.: The Japanese guidelines for gastric cancer screening. Jpn J Clin Oncol 38 (4): 259-67, 2008. [<a href="https://pubmed.ncbi.nlm.nih.gov/18344316" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18344316</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062757_rl_69_3">Ohata H, Oka M, Yanaoka K, et al.: Gastric cancer screening of a high-risk population in Japan using serum pepsinogen and barium digital radiography. Cancer Sci 96 (10): 713-20, 2005. [<a href="/pmc/articles/PMC11158591/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC11158591</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/16232204" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16232204</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062757_rl_69_4">Rosero-Bixby L, Sierra R: X-ray screening seems to reduce gastric cancer mortality by half in a community-controlled trial in Costa Rica. Br J Cancer 97 (7): 837-43, 2007. [<a href="/pmc/articles/PMC2360405/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2360405</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/17912238" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 17912238</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062757_rl_69_5">Pisani P, Oliver WE, Parkin DM, et al.: Case-control study of gastric cancer screening in Venezuela. Br J Cancer 69 (6): 1102-5, 1994. [<a href="/pmc/articles/PMC1969457/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1969457</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/8198977" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 8198977</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062757_rl_69_6">Tashiro A, Sano M, Kinameri K, et al.: Comparing mass screening techniques for gastric cancer in Japan. World J Gastroenterol 12 (30): 4873-4, 2006. [<a href="/pmc/articles/PMC4087623/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4087623</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/16937471" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16937471</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062757_rl_69_7">Zhang X, Li M, Chen S, et al.: Endoscopic Screening in Asian Countries Is Associated With Reduced Gastric Cancer Mortality: A Meta-analysis and Systematic Review. Gastroenterology 155 (2): 347-354.e9, 2018. [<a href="https://pubmed.ncbi.nlm.nih.gov/29723507" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29723507</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062757_rl_69_8">Yanaoka K, Oka M, Mukoubayashi C, et al.: Cancer high-risk subjects identified by serum pepsinogen tests: outcomes after 10-year follow-up in asymptomatic middle-aged males. Cancer Epidemiol Biomarkers Prev 17 (4): 838-45, 2008. [<a href="https://pubmed.ncbi.nlm.nih.gov/18398025" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18398025</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062757_rl_69_9">Kitahara F, Kobayashi K, Sato T, et al.: Accuracy of screening for gastric cancer using serum pepsinogen concentrations. Gut 44 (5): 693-7, 1999. [<a href="/pmc/articles/PMC1727514/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC1727514</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/10205207" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10205207</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062757_rl_69_10">Staël von Holstein C, Eriksson S, Huldt B, et al.: Endoscopic screening during 17 years for gastric stump carcinoma. A prospective clinical trial. Scand J Gastroenterol 26 (10): 1020-6, 1991. [<a href="https://pubmed.ncbi.nlm.nih.gov/1947767" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 1947767</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062757_rl_69_11">MING SC, GOLDMAN H: Gastric polyps: a histogenetic classification and its relation to carcinoma. Cancer 18: 721-6, 1965. [<a href="https://pubmed.ncbi.nlm.nih.gov/14297468" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14297468</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062757_rl_69_12">Utsunomiya J, Maki T, Iwama T, et al.: Gastric lesion of familial polyposis coli. Cancer 34 (3): 745-54, 1974. [<a href="https://pubmed.ncbi.nlm.nih.gov/4852134" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 4852134</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062757_rl_69_13">Aarnio M, Salovaara R, Aaltonen LA, et al.: Features of gastric cancer in hereditary non-polyposis colorectal cancer syndrome. Int J Cancer 74 (5): 551-5, 1997. [<a href="https://pubmed.ncbi.nlm.nih.gov/9355980" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 9355980</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062757_rl_69_14">Kurtz RC, Sherlock P: The diagnosis of gastric cancer. Semin Oncol 12 (1): 11-8, 1985. [<a href="https://pubmed.ncbi.nlm.nih.gov/3975641" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 3975641</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062757_rl_69_15">Boeing H: Epidemiological research in stomach cancer: progress over the last ten years. J Cancer Res Clin Oncol 117 (2): 133-43, 1991. [<a href="https://pubmed.ncbi.nlm.nih.gov/2036128" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 2036128</span></a>]</div></li></ol></div></div><div id="CDR0000062757__83"><h2 id="_CDR0000062757__83_">Evidence of Harm Associated With Screening</h2><p id="CDR0000062757__84">Harms of routine screening for gastric cancer are poorly quantitated or reported and derive chiefly from screening experiences in very high-risk areas such as Japan.[<a class="bibr" href="#CDR0000062757_rl_83_1" rid="CDR0000062757_rl_83_1">1</a>] The most frequent harm is the occurrence of false-positive tests.[<a class="bibr" href="#CDR0000062757_rl_83_2" rid="CDR0000062757_rl_83_2">2</a>] Exposure to the low doses of radiation (about 0.6 mSv in photofluorography) carries a theoretical but poorly quantified risk of carcinogenesis. Additional rare complications of screening may include adverse effects of premedication (used for endoscopy and sometimes photofluorography) and bleeding or perforation from endoscopy.[<a class="bibr" href="#CDR0000062757_rl_83_1" rid="CDR0000062757_rl_83_1">1</a>] As with any screening test, there is a possibility of overdiagnosis with attendant overtreatment. Since harms such as perforation and bleeding may vary with the experience of the screening center, the harms may be higher in populations at low risk for gastric cancer, such as the United States, than in mass screening programs in Japan.</p><div id="CDR0000062757_rl_83"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000062757_rl_83_1">Hamashima C, Shibuya D, Yamazaki H, et al.: The Japanese guidelines for gastric cancer screening. Jpn J Clin Oncol 38 (4): 259-67, 2008. [<a href="https://pubmed.ncbi.nlm.nih.gov/18344316" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18344316</span></a>]</div></li><li><div class="bk_ref" id="CDR0000062757_rl_83_2">Ohata H, Oka M, Yanaoka K, et al.: Gastric cancer screening of a high-risk population in Japan using serum pepsinogen and barium digital radiography. Cancer Sci 96 (10): 713-20, 2005. [<a href="/pmc/articles/PMC11158591/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC11158591</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/16232204" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16232204</span></a>]</div></li></ol></div></div><div id="CDR0000062757__15"><h2 id="_CDR0000062757__15_">Latest Updates to This Summary (03/19/2024)</h2><p id="CDR0000062757__17">The PDQ cancer information summaries are reviewed regularly and updated as
|
|
new information becomes available. This section describes the latest
|
|
changes made to this summary as of the date above.</p><p id="CDR0000062757__117">
|
|
<b>
|
|
<a href="#CDR0000062757__65">Incidence and Mortality</a>
|
|
</b>
|
|
</p><p id="CDR0000062757__118">Updated <a href="#CDR0000062757__85">statistics</a> with estimated new cases and deaths for 2024 (cited American Cancer Society as reference 1).</p><p id="CDR0000062757__disclaimerHP_3">This summary is written and maintained by the <a href="https://www.cancer.gov/publications/pdq/editorial-boards/screening-prevention" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Screening and Prevention Editorial Board</a>, which is
|
|
editorially independent of NCI. The summary reflects an independent review of
|
|
the literature and does not represent a policy statement of NCI or NIH. More
|
|
information about summary policies and the role of the PDQ Editorial Boards in
|
|
maintaining the PDQ summaries can be found on the <a href="#CDR0000062757__AboutThis_1">About This PDQ Summary</a> and <a href="https://www.cancer.gov/publications/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ® Cancer Information for Health Professionals</a> pages.
|
|
</p></div><div id="CDR0000062757__AboutThis_1"><h2 id="_CDR0000062757__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000062757__AboutThis_2"><h3>Purpose of This Summary</h3><p id="CDR0000062757__AboutThis_3">This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about stomach (gastric) cancer screening. It is intended as a resource to inform and assist clinicians in the care of their patients. It does not provide formal guidelines or recommendations for making health care decisions.</p></div><div id="CDR0000062757__AboutThis_4"><h3>Reviewers and Updates</h3><p id="CDR0000062757__AboutThis_5">This summary is reviewed regularly and updated as necessary by the <a href="https://www.cancer.gov/publications/pdq/editorial-boards/screening-prevention" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Screening and Prevention Editorial Board</a>, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).</p><p id="CDR0000062757__AboutThis_22"> Board members review recently published articles each month to determine whether an article should:</p><ul id="CDR0000062757__AboutThis_6"><li class="half_rhythm"><div>be discussed at a meeting,</div></li><li class="half_rhythm"><div>be cited with text, or</div></li><li class="half_rhythm"><div>replace or update an existing article that is already cited.</div></li></ul><p id="CDR0000062757__AboutThis_7">Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.</p><p id="CDR0000062757__AboutThis_9">Any comments or questions about the summary content should be submitted to Cancer.gov through the NCI website's <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Email Us</a>. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.</p></div><div id="CDR0000062757__AboutThis_10"><h3>Levels of Evidence</h3><p id="CDR0000062757__AboutThis_11">Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Screening and Prevention Editorial Board uses a <a href="/books/n/pdqcis/CDR0000304747/?report=reader">formal evidence ranking system</a> in developing its level-of-evidence designations.</p></div><div id="CDR0000062757__AboutThis_12"><h3>Permission to Use This Summary</h3><p id="CDR0000062757__AboutThis_13">PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary].”</p><p id="CDR0000062757__AboutThis_14">The preferred citation for this PDQ summary is:</p><p id="CDR0000062757__AboutThis_15">PDQ® Screening and Prevention Editorial Board. PDQ Stomach (Gastric) Cancer Screening. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: <a href="https://www.cancer.gov/types/stomach/hp/stomach-screening-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.cancer.gov/types/stomach/hp/stomach-screening-pdq</a>. Accessed <MM/DD/YYYY>. [PMID: 26389174]</p><p id="CDR0000062757__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in <a href="https://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>, a collection of over 2,000 scientific images.
|
|
</p></div><div id="CDR0000062757__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000062757__AboutThis_19">The information in these summaries should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the <a href="https://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000062757__AboutThis_20"><h3>Contact Us</h3><p id="CDR0000062757__AboutThis_21">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="https://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Email Us</a>.</p></div></div></div></div><div class="fm-sec"><h2 id="_NBK65730_pubdet_">Publication Details</h2><h3>Author Information and Affiliations</h3><p class="contrib-group"><h4>Authors</h4><span itemprop="author">PDQ Screening and Prevention Editorial Board</span>.</p><h3>Publication History</h3><p class="small">Published online: March 19, 2024.</p><h3>Version History</h3><ul class="simple-list" style="padding:0"><li><span class="bk_col_itm">NBK65730.11</span> March 19, 2024 (Displayed Version)</li><li><span class="bk_col_itm"><a href="/books/NBK65730.10/?report=reader">NBK65730.10</a></span> May 31, 2023</li><li><span class="bk_col_itm"><a href="/books/NBK65730.9/?report=reader">NBK65730.9</a></span> April 29, 2022</li><li><span class="bk_col_itm"><a href="/books/NBK65730.8/?report=reader">NBK65730.8</a></span> March 18, 2021</li><li><span class="bk_col_itm"><a href="/books/NBK65730.7/?report=reader">NBK65730.7</a></span> February 20, 2020</li><li><span class="bk_col_itm"><a href="/books/NBK65730.6/?report=reader">NBK65730.6</a></span> March 6, 2019</li><li><span class="bk_col_itm"><a href="/books/NBK65730.5/?report=reader">NBK65730.5</a></span> September 28, 2018</li><li><span class="bk_col_itm"><a href="/books/NBK65730.4/?report=reader">NBK65730.4</a></span> April 6, 2018</li><li><span class="bk_col_itm"><a href="/books/NBK65730.3/?report=reader">NBK65730.3</a></span> March 10, 2017</li><li><span class="bk_col_itm"><a href="/books/NBK65730.2/?report=reader">NBK65730.2</a></span> April 1, 2016</li><li><span class="bk_col_itm"><a href="/books/NBK65730.1/?report=reader">NBK65730.1</a></span> February 12, 2015</li></ul><h3>Copyright</h3><div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright Notice</a></div></div><h3>Publisher</h3><p><a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>, Bethesda (MD)</p><h3>NLM Citation</h3><p>PDQ Screening and Prevention Editorial Board. Stomach (Gastric) Cancer Screening (PDQ®): Health Professional Version. 2024 Mar 19. In: PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. <span class="bk_cite_avail"></span></p></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
|
|
|
|
|
|
|
|
|
|
<!-- Book content -->
|
|
|
|
<script type="text/javascript" src="/portal/portal3rc.fcgi/rlib/js/InstrumentNCBIBaseJS/InstrumentPageStarterJS.js"> </script>
|
|
|
|
|
|
<!-- CE8B5AF87C7FFCB1_0191SID /projects/books/PBooks@9.11 portal104 v4.1.r689238 Tue, Oct 22 2024 16:10:51 -->
|
|
<span id="portal-csrf-token" style="display:none" data-token="CE8B5AF87C7FFCB1_0191SID"></span>
|
|
|
|
<script type="text/javascript" src="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/js/3968615.js" snapshot="books"></script></body>
|
|
</html>
|