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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 28, 2016; 22(28): 6385-6392
Published online Jul 28, 2016. doi: 10.3748/wjg.v22.i28.6385
Benefits and harms of endoscopic screening for gastric cancer
Chisato Hamashima
Chisato Hamashima, Division of Cancer Screening Assessment and Management, Center for Public Health Science, National Cancer Center, Tokyo 104-0045, Japan
Author contributions: Hamashima C designed and performed the recently published research studies cited in this review, and wrote this article.
Supported by the National Cancer Center, Tokyo, Japan, No. 26-A-30.
Conflict-of-interest statement: The author have no conflict of interest to report; the funder had no role in the conceptualization of the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Chisato Hamashima, MD, Division of Cancer Screening Assessment and Management, Center for Public Health Science, National Cancer Center, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan. chamashi@ncc.go.jp
Telephone: +81-3-3547-5305 Fax: +81-3-3547-8587
Received: March 28, 2016
Peer-review started: April 1, 2016
First decision: May 12, 2016
Revised: May 18, 2016
Accepted: June 13, 2016
Article in press: June 13, 2016
Published online: July 28, 2016
Processing time: 115 Days and 20.2 Hours
Abstract

Gastric cancer has remained a serious burden worldwide, particularly in East Asian countries. However, nationwide prevention and screening programs for gastric cancer have not yet been established in most countries except in South Korea and Japan. Although evidence regarding the effectiveness of endoscopic screening for gastric cancer has been increasingly accumulated, such evidence remains weak because it is based on results from studies other than randomized controlled trials. Specifically, evidence was mostly based on the results of cohort and case-control studies mainly conducted in South Korea and Japan. However, the consistent positive results from these studies suggest promising evidence of mortality reduction from gastric cancer by endoscopic screening. The major harms of endoscopic screening include infection, adverse effects, false-positive results, and overdiagnosis. Despite the possible harms of endoscopic screening, information regarding these harms remains insufficient. To provide appropriate cancer screening, a balance of benefits and harms should always be considered when cancer screening is introduced as a public policy. Quality assurance is very important for the implementation of cancer screening to provide high-quality and safe screening and minimize harms. Endoscopic screening for gastric cancer has shown promising results, and thus deserves further evaluation to reliably establish its effectiveness and optimal use.

Keywords: Gastric cancer; Cancer screening; Upper gastrointestinal endoscopy; Mortality reduction; Cohort study; Case-control study; Harms

Core tip: Although evidence regarding the effectiveness of endoscopic screening for gastric cancer has been increasingly accumulated based on consistent results, such evidence remains weak because it is based on the results of cohort and case-control studies mainly from South Korea and Japan. However, the consistent positive results suggest promising evidence of mortality reduction from gastric cancer by endoscopic screening. Despite the major harms of endoscopic screening, namely infection, adverse effects, false-positive results, and overdiagnosis, information regarding these harms remains insufficient. To provide appropriate cancer screening, a balance of benefits and harms should always be considered.