The Relationship between a Cohort Endoscopic Screening of 15,000 Subjects and the Death of Patients with Esophageal and Gastric Cancers in High-Risk Areas

• Published in: Cancer biology & medicine 2009-08, Vol.6 (4), p.271-276
• Main Authors: Chen, Zhifeng, Song, Guohui, Hou, Jun, Guo, Cuilan, Jin, Guoliang, Meng, Fanshu, Bai, Wenlong
• Format: Article
• Language: English
• Subjects: endoscopic screening; esophageal cancer; gastric cancer; Medicine; Medicine & Public Health; mortality; Oncology; 内窥镜; 食道癌; 高分风险
• ISSN: 1674-5361; 2095-3941; 1868-324X
• DOI: 10.1007/s11805-009-0271-z

OBJECTIVE Ci-xian County is located in the north of China and is a high-risk area for esophageal cancer （EC）. In 2004, the incidence rate of EC in the county was 127/100,000 and 93/100,000 in the male and female population, respectively, and that of gastric cancer （GC） was 72/100,000 and 36/100,000. Since 2001 a cohort screening, supported by a special national fund, utilizing endoscopic examination with iodine staining for the target population at the age ranging from 40 to 69 years was carried out, so as to reduce the incidence and mortality rates in the high-risk areas of EC. METHODS In October 2001, 4 townships in the Ci-xian County, Hebei, China were selected, with 22,016 cases in the intervention group （IVG） and 33,410 in the control group （CG）. The total population coverage reached 55,000. There were 3257 males and 3339 females in the IVG with the age ranging from 40 to 69 years, and 4299 males and 4430 females in the CG with the same range of the age. Endoscopic screening with iodine staining was used in the IVG, with a screening rate of 53.2%. During the screening by endoscopic examination, 97 cases were found to have esophageal squamous epithelium, carcinoma-in-situ at the cardiac glandular epithelium or intra-mucosal carcinoma. Additionally, 102 cases were identified to have severe atypical hyperplasia in the esophagus and gastric cardia. The natural incidence rate of cancer and the mortality were observed in the CG. The ICD-0 version was used in the tumor incidence and death registration coding. During a period from June to September 2008, based on the information of the tumor registration database of the incidence and mortality in the Ci-xian County, the cohort groups were studied and followed. RESULTS There were 133 patients with untreatable EC and 48 with GC in the IVG, while there were 259 and 37 patients in the CG who died of esophageal and gastric cancer, respectively. The relative risk （RR） of death was 0.76 in the male patients with EC, 95%CI （0.59-0.98）, P = 0.038, and in the female patients the RR was 0.51, 95%CI （0.35-0.75）, P = 0.000. The RR of death in the GC patients was 2.45, （1.40-4.29） in the male, P = 0.01, and 0.99, （0.47-1.99）, in the female cases, P = 0.906. CONCLUSION Six years after a cohort screening of a large population by endoscopic examination with iodine staining in areas at high risk for EC, the death risk in the male and female patients with EC has decreased compared with that in the control group. The difference