Note: The Overview section summarizes the published evidence on this topic. The rest of the summary describes the evidence in more detail.
Other PDQ summaries on
Inadequate Evidence of Benefit Associated With Screening
Barium-meal gastric photofluorography and serum pepsinogen
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.[
Magnitude of Effect: Fair evidence for no reduction in mortality.
Study Design: Evidence obtained from case-control and cohort studies, primarily from high-risk areas such as East Asia. |
Internal Validity: Fair. |
Consistency: Poor in prospective studies.[ |
External Validity: Poor. Studies on populations in high-risk areas may not be applicable to low-risk areas such as the United States. |
Gastric endoscopy
Magnitude of Effect: Inadequate evidence for mortality reduction.
Study Design: 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. |
Internal Validity: 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. |
Consistency: Good among the observational studies. |
External Validity: Poor. Studies on populations in high-risk areas (East Asia) may not be applicable to low-risk areas such as the United States. |
Harms
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.
Magnitude of Effect: Solid evidence for rare but serious harms.
Study Design: Evidence obtained from screening programs and case series. |
Internal Validity: Fair. |
Consistency: Inadequate evidence. |
External Validity: Poor. |
References:
In 2024, it is estimated that 26,890 Americans will be diagnosed with gastric cancer and 10,880 will die of it.[
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.[
References:
The incidence of gastric cancer in the United States has decreased fourfold since 1930, to approximately seven cases per 100,000 people.[
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.[
References:
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.[
Barium-Meal Gastric Photofluorography
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 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 screening study was begun in Venezuela in 1980, using radiographic fluorography.[
Gastric Endoscopy
Endoscopy appears to be more sensitive than photofluorography for the detection of gastric cancer.[
A meta-analysis of gastric cancer endoscopic screening studies in Asia identified ten relevant studies, all nonrandomized.[
Serum Pepsinogen
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.[
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%.[
Clinical Considerations for High-Risk Groups
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;[
References:
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.[
References:
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.
Updated
This summary is written and maintained by the
Purpose of This Summary
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.
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This summary is reviewed regularly and updated as necessary by the
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The preferred citation for this PDQ summary is:
PDQ® Screening and Prevention Editorial Board. PDQ Stomach (Gastric) Cancer Screening. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at:
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Last Revised: 2024-03-19
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