Shi J, Shi YD, Chen YH. Reframing endoscopic screening in upper gastrointestinal cancers: From early detection to precision primary prevention. World J Gastrointest Oncol 2026; 18(6): 120263 [DOI: 10.4251/wjgo.v18.i6.120263]
Corresponding Author of This Article
Yun-Dong Shi, MD, Professor, Department of Nephropathy, Jilin People’s Hospital, Jilin City Hospital, Zhongxing Street, Jilin City 132000, Jilin Province, China. drshiyundong@163.com
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Gastroenterology & Hepatology
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review-article
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Shi J, Shi YD, Chen YH. Reframing endoscopic screening in upper gastrointestinal cancers: From early detection to precision primary prevention. World J Gastrointest Oncol 2026; 18(6): 120263 [DOI: 10.4251/wjgo.v18.i6.120263]
World J Gastrointest Oncol. Jun 15, 2026; 18(6): 120263 Published online Jun 15, 2026. doi: 10.4251/wjgo.v18.i6.120263
Reframing endoscopic screening in upper gastrointestinal cancers: From early detection to precision primary prevention
Jing Shi, Yun-Dong Shi, Ying-Hui Chen
Jing Shi, Department of Third Operation Room, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
Yun-Dong Shi, Department of Nephropathy, Jilin People’s Hospital, Jilin City Hospital, Jilin City 132000, Jilin Province, China
Ying-Hui Chen, Department of General Surgery, Jiutai People’s Hospital, Changchun 130500, Jilin Province, China
Co-corresponding authors: Yun-Dong Shi and Ying-Hui Chen.
Author contributions: Shi J conceived and designed the study, performed the literature review, and drafted the initial manuscript; Shi YD contributed to conceptual development, critical revision of the manuscript, and supervision of the study; Chen YH participated in literature screening, manuscript revision, and final approval of the version to be published; Shi YD and Chen YH are co-corresponding authors and contributed equally to the supervision of the study and correspondence of the manuscript; all authors have read and approved the final manuscript.
AI contribution statement: ChatGPT was used only for language polishing and writing assistance at the level of grammar and expression improvement. It was not used for data analysis or scientific content generation. The main text content was independently written by us, and no AI was used in study design. All figures and tables were created by ourselves.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Corresponding author: Yun-Dong Shi, MD, Professor, Department of Nephropathy, Jilin People’s Hospital, Jilin City Hospital, Zhongxing Street, Jilin City 132000, Jilin Province, China. drshiyundong@163.com
Received: February 24, 2026 Revised: March 2, 2026 Accepted: March 24, 2026 Published online: June 15, 2026 Processing time: 107 Days and 21.6 Hours
Abstract
Upper gastrointestinal (UGI) cancers remain a major global health burden, particularly in high-incidence regions. Traditionally, endoscopic screening has been positioned as a secondary prevention strategy aimed at detecting premalignant lesions and early-stage cancers. However, emerging evidence suggests that the role of endoscopic screening may extend beyond early diagnosis and into the realm of primary cancer prevention. Recent prospective data suggest that participation in UGI endoscopic screening programs may be associated with reductions in modifiable behavioral risk factors, including cigarette smoking, alcohol consumption, and unhealthy dietary habits. These findings challenge the conventional paradigm that screening solely identifies disease and instead support the concept that screening encounters may serve as critical behavioral intervention windows (i.e., brief, clinician-delivered risk communication and counseling opportunities during and after screening). From an oncologic perspective, this raises important questions regarding how screening programs can be optimized to function as structured risk-modification platforms. This review examines the evolving concept of endoscopy as a catalyst for primary prevention, integrating behavioral science, risk stratification models, and population-based cancer control strategies. We discuss how screening-triggered health education, individualized risk communication, and integration with molecular and epidemiologic risk profiling could transform UGI cancer prevention frameworks. Furthermore, we explore the implications of redefining screening programs as multidimensional interventions rather than purely diagnostic tools. As precision oncology advances, cancer prevention must evolve accordingly. Reframing UGI endoscopic screening from a detection-centered approach to a precision prevention platform may conceptually enhance long-term cancer control, reduce population-level risk exposure, and improve cost-effectiveness in high-risk regions. Future implementation research is warranted to validate sustainable models that integrate behavioral modification into structured screening pathways.
Core Tip: Endoscopic screening for upper gastrointestinal cancers has traditionally been regarded as a secondary prevention tool focused on early detection. Emerging evidence suggests that screening participation may facilitate behavioral risk modification and enhanced risk awareness, suggesting a potential paradigm shift toward precision primary prevention. By integrating behavioral intervention, risk stratification, and digital follow-up into structured screening pathways, endoscopic programs can evolve into multidimensional prevention platforms that reduce long-term cancer risk and improve population-level cancer control.
