Effectiveness of Intensive Endoscopic Screening for Esophageal Cancer in China: A Community-Based Study

• Published in: American journal of epidemiology Vol. 188; no. 4; pp. 776 - 784
• Main Authors: Liu, Mengfei, He, Zhonghu, Guo, Chuanhai, Xu, Ruiping, Li, Fenglei, Ning, Tao, Pan, Yaqi, Li, Yong, Ding, Huirong, Zheng, Li, Zhou, Yue, Tian, Xiuyun, Yang, Wenjun, Wang, Xueqian, Lu, Fang, Zhang, Yanyan, Zhao, Yiqiang, Guo, Fangcen, Chen, Ke, Gao, Lei, Sun, Min, Liu, Ying, Liu, Fangfang, Hang, Dong, Shen, Na, Li, Jingjing, Xu, Zhongyao, Wang, Qiyan, Zhang, Chanyuan, Abliz, Amir, Deng, Qiuju, Li, Xiang, Liu, Zhen, Zhang, Chaoting, Yuan, Wenqing, Wang, Hui, Weiss, Noel S, Cai, Hong, Ke, Yang
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01.04.2019; Oxford Publishing Limited (England)
• Subjects: Adult; Age; Aged; Cancer; China - epidemiology; Confidence intervals; Early Detection of Cancer - methods; Early Detection of Cancer - statistics & numerical data; Endoscopy; Endoscopy, Gastrointestinal - statistics & numerical data; Esophageal cancer; Esophageal Neoplasms - epidemiology; Esophageal Neoplasms - prevention & control; Esophagus; Fatalities; Female; Gastrointestinal tract; Health risk assessment; Humans; Incidence; Male; Middle Aged; Mortality; Population-based studies; Screening; Squamous cell carcinoma; Standardization; China; esophageal squamous cell carcinoma; endoscopy; esophageal cancer; China; population-based endoscopic screening
• ISSN: 0002-9262; 1476-6256; 1476-6256
• DOI: 10.1093/aje/kwy291

Abstract Evidence is required to evaluate the effectiveness of population-level endoscopic screening for esophageal cancer (EC). In this study, 5,632 permanent residents aged 25–65 years from 6 villages in Hua County, Henan Province, China, were defined as the screening cohort and were offered intensive endoscopic screening. Residents of all 914 remaining villages in Hua County were included as the control cohort, and age-sex standardization was used to calculate the expected numbers of EC and upper gastrointestinal (GI) tract cancer cases and deaths in the screening cohort. The effectiveness of screening was assessed by comparing observed numbers of cases and deaths with expected numbers after 9-year follow-up of these screened subjects (2007–2016). In the screening cohort, 23 upper GI cancers (including 16 ECs) and 10 upper GI cancer deaths (including 5 EC deaths) were identified, and 47% (standardized incidence ratio = 0.53, 95% confidence interval (CI): 0.33, 0.87) and 66% (standardized mortality ratio = 0.34, 95% CI: 0.14, 0.81) reductions in cumulative EC incidence and mortality were found. For upper GI cancers, incidence and mortality were lowered by 43% (standardized incidence ratio = 0.57, 95% CI: 0.38, 0.86) and 53% (standardized mortality ratio = 0.47, 95% CI: 0.25, 0.88), respectively. This study showed that upper GI tract endoscopy is an effective population-level screening test for EC in high-risk regions.