Reframing endoscopic screening in upper gastrointestinal cancers: From early detection to precision primary prevention

Table 1 Transformation of endoscopic screening from early detection to precision primary prevention in upper gastrointestinal cancers

Dimension	Traditional detection-centered screening	Precision primary prevention-oriented screening
Core objective	Early detection of premalignant lesions and early-stage cancers	Reduction of long-term cancer risk through integrated prevention
Prevention level	Secondary prevention	Integrated primary and secondary prevention
Conceptual framework	Diagnostic and surveillance tool	Multidimensional prevention and intervention platform
Target focus	Lesion identification and staging	Risk factor modification and individualized risk management
Role of patients	Passive recipients of diagnostic procedures	Active participants in behavioral change and risk reduction
Behavioral intervention	Rarely incorporated into screening workflow	Structured lifestyle counseling embedded in screening encounters
Risk perception	Limited to diagnostic results	Enhanced through visualization, communication, and personalized feedback
Risk stratification	Mainly age and epidemiology-based	Multidimensional (epidemiology, lifestyle, biomarker-informed risk stratification, and digital profiling)
Clinical pathway	Screening-diagnosis-treatment	Screening-risk assessment-behavioral intervention-long-term prevention
Health education	Optional or minimal	Structured and standardized component of screening programs
Follow-up strategy	Periodic surveillance only	Continuous digital follow-up and behavior monitoring
Technological integration	Conventional endoscopy	AI-assisted endoscopy, digital health tools, and precision risk models
Evaluation metrics	Detection rate and stage distribution	Behavioral modification, risk reduction, cost-effectiveness, and population health outcomes
Population impact	Mortality reduction through early diagnosis	Comprehensive cancer control through prevention and early intervention
Oncologic significance	Improves survival after disease onset	Potentially reduces incidence and carcinogenic exposure

AI: Artificial intelligence.