No Impact of Repeated Endoscopic Screens on Gastric Cancer Mortality in a Prospectively Followed Chinese Population at High Risk

Background. Gastric cancer (GC) is the leading cause of cancer deaths in China. Our study prospectively evaluated the impact of repeated endoscopic screens on GC mortality in a high-risk population in China. Methods. Between 1989 and 1999, a population-based gastroscopic screening was conducted in 4,394 residents of Linqu County, China, a region with the highest rates of GC worldwide. Residents ages 35 to 64 years received initial gastroscopies with biopsies in 1989. Repeated endoscopies were performed in 1994 and 1999. Cancer occurrences and deaths were actively monitored throughout the entire period until July 2000. Mortality from GC was compared with expected values based on mortality rates obtained for Linqu in the 1990–1992 Chinese Cancer Mortality Survey. Results. Between March 1989 and July 2000, 39,303 person-years were accumulated; 85 new GCs occurred, 29 (34.5%) were in early stage. Fifty-eight cases (68%) were identified at one of the screens. The number of observed deaths from GC (37) was close to the expected (36.8). The standardized mortality ratio was 1.01 (95% CI 0.72–1.37) for the entire cohort, 1.13 (95% CI 0.77–1.57) for males, and 0.65 (95% CI 0.26–1.32) for females. Conclusions. Despite high population coverage with repeated screens, no reduction in GC mortality was observed in this high-risk population in China.