Upper gastrointestinal endoscopic screening serves as a primary prevention approach by reducing modifiable risk factors

doi:10.4251/wjgo.v18.i4.116949

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World Journal of Gastrointestinal Oncology

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World J Gastrointest Oncol. Apr 15, 2026; 18(4): 116949
Published online Apr 15, 2026. doi: 10.4251/wjgo.v18.i4.116949

Upper gastrointestinal endoscopic screening serves as a primary prevention approach by reducing modifiable risk factors

Xiang-Wen Cheng, Zhen Liu, Chuan-Hai Guo, Feng-Lei Li, Ya-Qi Pan, Ying Liu, Fang-Fang Liu, Huan-Yu Chen, Wen-Lei Yang, Hong-Rui Tian, Chao Shi, Zhong-Hu He, Meng-Fei Liu, Yang Ke

Xiang-Wen Cheng, Zhen Liu, Chuan-Hai Guo, Ya-Qi Pan, Ying Liu, Fang-Fang Liu, Huan-Yu Chen, Wen-Lei Yang, Hong-Rui Tian, Zhong-Hu He, Meng-Fei Liu, Yang Ke, Department of Genetics, Peking University Cancer Hospital, Beijing 100142, China

Feng-Lei Li, Hua County People’s Hospital, Anyang 456483, Henan Province, China

Chao Shi, Ningxia Clinical Research Institute, People’s Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan 750001, Ningxia Hui Autonomous Region, China

Co-first authors: Xiang-Wen Cheng and Zhen Liu.

Co-corresponding authors: Zhong-Hu He and Meng-Fei Liu.

Author contributions: Cheng XW was responsible for drafting of the manuscript; Cheng XW and Liu Z were responsible for statistical analysis as co-first authors; Cheng XW, Liu Z, He ZH, Liu MF, and Ke Y were responsible for analysis and interpretation of the data; Cheng XW, Liu Z, Guo CH, Li FL, Pan YQ, Liu Y, Liu FF, Chen HY, Yang WL, Tian HR, Shi C, He ZH, and Liu MF were responsible for acquisition of data; He ZH and Liu MF have played important and indispensable roles in the experimental design as co-corresponding authors; He ZH, Liu MF, and Ke Y were responsible for study concept and design, study supervision and critical revision of the article; all authors had access to the study data and reviewed and approved the final manuscript.

Supported by Key R&D Program of Ningxia Hui Autonomous Region, No. 2025BEG01011; and Science and Technology Plan of Tibet Autonomous Region, No. XZ202501JD0021.

Institutional review board statement: The study protocol was reviewed and approved by the Institutional Review Board of the Peking University School of Oncology, Beijing, China (No. 2011101110).

Clinical trial registration statement: The manuscript has been registered in ClinicalTrials.gov, No. NCT01688908.

Informed consent statement: All participants provided written informed consent.

Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.

CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.

Data sharing statement: All data generated or analyzed during this study are included in this published article and its Supplementary material.

Corresponding author: Meng-Fei Liu, PhD, Professor, Department of Genetics, Peking University Cancer Hospital, No. 52 Fucheng Road, Haidian District, Beijing 100142, China. liumengfei1205@foxmail.com

Received: November 26, 2025
Revised: January 14, 2026
Accepted: February 9, 2026
Published online: April 15, 2026
Processing time: 134 Days and 4.2 Hours

Abstract

BACKGROUND

Screening can play a role in primary prevention by mitigating modifiable risk factors. However, whether upper gastrointestinal (UGI) endoscopic screening can reduce the burden of modifiable risk factors is unknown.

AIM

To evaluate the effect of UGI endoscopic screening on modifiable risk factors for cancer and its potential role in primary prevention.

METHODS

We collected data from 11842 participants in the screening arm (received standard UGI endoscopy) and 12793 participants in the control arm (received abdominal B-ultrasound examination) of a randomized controlled trial. The participants completed questionnaires before and after screening (median interval: 6.55 years). Data on three modifiable risk factors including cigarette smoking, alcohol drinking, and unhealthy dietary habits, at both time-points were collected. Logistic regression was applied to assess the effect of UGI endoscopic screening on the cessation and incidence of these three modifiable risk factors.

RESULTS

UGI endoscopic screening significantly increased the cessation rate of cigarette smoking, alcohol drinking and unhealthy dietary habits [odds ratio (OR)_smoking = 1.20 (1.06-1.36), OR_drinking = 1.33 (1.19-1.50) and OR_{unhealthy dietary habits} = 1.07 (1.02-1.13)]. Subgroup analysis showed that the cessation effects were dominant among subjects who completed UGI endoscopy, while no significant effects were observed among those who declined endoscopy. Females and individuals aged > 60 years were more prone to changes in behavior. Analysis of the incidence of the three modifiable risk factors showed that only the incidence of unhealthy dietary habits was significantly decreased by UGI endoscopic screening [OR = 0.85 (0.80-0.91)].

CONCLUSION

UGI endoscopic screening increased the cessation of modifiable risk factors; thus, contributing to primary prevention of cancers. Females and individuals aged > 60 years in rural China were more prone to changes in behavior.

Keywords: Upper gastrointestinal tract cancer; Endoscopic screening; Risk factors; Primary prevention; Health promotion

Core Tip: This study provides novel evidence that upper gastrointestinal (UGI) endoscopic screening contributes to primary cancer prevention by reducing modifiable risk factors. Based on a population-based randomized controlled trial, we showed that UGI screening significantly promoted the reduction of cigarette smoking, alcohol drinking, and unhealthy dietary habits, particularly among women and older adults. These findings highlight the potential of UGI endoscopic screening to modify behavioral risk factors at the population level, underscoring its broader preventive value in cancer control strategies. Integrating health education into UGI screening programs may further enhance its effectiveness in reducing the cancer burden.