A Community-Based, Case-Control Study Evaluating Mortality Reduction from Gastric Cancer by Endoscopic Screening in Japan

• Published in: PloS one Vol. 8; no. 11; p. e79088
• Main Authors: Hamashima, Chisato, Ogoshi, Kazuei, Okamoto, Mikizo, Shabana, Michiko, Kishimoto, Takuji, Fukao, Akira
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 13.11.2013; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Analysis; Cancer; Cancer research; Cancer screening; Case studies; Case-Control Studies; Communities; Confidence intervals; Diagnosis; Disease control; Early Detection of Cancer; Endoscopy, Gastrointestinal; Female; Gastric cancer; Health aspects; Health risk assessment; Humans; Japan - epidemiology; Male; Medical diagnosis; Middle Aged; Model matching; Mortality; Odds Ratio; Population studies; Regression analysis; Regression models; Screening; Statistical analysis; Stomach cancer; Stomach Neoplasms - diagnosis; Stomach Neoplasms - mortality; Studies; Womens health; Japan; Asia
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0079088

Although the incidence of gastric cancer has decreased in the last 3 decades, it remains the second leading cause of cancer death worldwide. In Asian countries, the burden of gastric cancer has remained, and cancer screening is normally expected to reduce gastric cancer death. We conducted a community-based, case-control study to evaluate the reduction of mortality from gastric cancer by endoscopic screening. Case subjects were defined as individuals who had died of gastric cancer between 2003 and 2006 in 4 cities in Tottori Prefecture, and between 2006 and 2010 in Niigata City, Japan. Up to 6 control subjects were matched by sex, birth year (±3 years), and the residence of each corresponding case subject from the population lists in the study areas. Control subjects were required to be disease-free at the time when the corresponding case subjects were diagnosed as having gastric cancer. The odds ratios (ORs) were calculated for those who had participated in endoscopic or radiographic screening before the reference date when the case subjects were diagnosed as having gastric cancer, compared with subjects who had never participated in any screening. Conditional logistic-regression models for matched sets were used to estimate the ORs and 95% confidence intervals (CIs). The case subjects consisted of 288 men and 122 women for case subjects, with 2,292 matched control subjects. Compared with those who had never been screened before the date of diagnosis of gastric cancer in the case subjects, the ORs within 36 months from the date of diagnosis were 0.695 (95% CI: 0.489-0.986) for endoscopic screening and 0.865 (95% CI : 0.631-1.185) for radiographic screening. The results suggest a 30% reduction in gastric cancer mortality by endoscopic screening compared with no screening within 36 months before the date of diagnosis of gastric cancer.