title: Acceptance of repeat esophagogastroduodenoscopy to detect gastric cancer in a Chinese immigrant cohort.
abstract: OBJECTIVE
  To study the feasibility of using repeat esophagogastroduodenoscopy (EGD) to screen for Helicobacter pylori infection and gastric cancer in an Asian immigrant cohort.
  
  
  BACKGROUND
  Immigrants in the United States (US) from countries with high per capita rates of gastric cancer remain at higher risk for gastric cancer. The existence of the possibly modifiable risk factor of H. pylori infection and the poor outcomes associated with late-stage disease make screening higher-risk groups with EGD an appealing possibility. It is unknown whether Asian immigrants in the US would accept an EGD-based strategy for gastric cancer screening.
  
  
  METHODS
  Cross-sectional study of adult Chinese immigrants in New York City with dyspepsia who underwent EGD in an earlier gastric cancer detection study, who were offered a second EGD four years later. Our main outcome measure was acceptance or refusal of repeat EGD.
  
  
  RESULTS
  Seventy-three of the 115 Chinese participants in the earlier study were successfully contacted for this current study. Twenty-three of 73 (32%) underwent repeat EGD. Leading reasons given for declining were lack of symptoms and lack of time. Significantly associated with acceptance of repeat EGD was the belief that EGD will find stomach cancer "nearly always" in someone who has it (P=0.0054; odds ratio=14.0, 2.1 to 94.2 95% confidence interval).
  
  
  CONCLUSIONS
  Acceptance of repeat EGD for gastric cancer detection in a cohort of Chinese immigrants was relatively low despite the mitigation of cost and language factors, 2 major barriers to healthcare access. Relocation seemed to be a factor as well. In this population, perceptions of the benefits of EGD may influence acceptance of testing for cancer detection purposes.
authors.affiliation: Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC, USA. alex.cho@duke.edu
authors.forename: Alex
authors.initials: A
authors.lastname: Cho
authors.forename: Amina
authors.initials: A
authors.lastname: Chaudhry
authors.forename: Lisa
authors.initials: L
authors.lastname: Minsky-Primus
authors.forename: Alan
authors.initials: A
authors.lastname: Tso
authors.forename: Guillermo
authors.initials: G
authors.lastname: Perez-Perez
authors.forename: David
authors.initials: D
authors.lastname: Diehl
authors.forename: Stuart G
authors.initials: SG
authors.lastname: Marcus
authors.forename: Francesca M
authors.initials: FM
authors.lastname: Gany
mesh_terms: D000368:Aged; D001213:Asian / Q000523:psychology*; D002681:China / Q000208:ethnology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004641:Emigration and Immigration; D016145:Endoscopy, Digestive System / Q000706:statistics & numerical data*; D005260:Female; D006302:Health Services Research; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000208:ethnology; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009519:New York City; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D019233:Retreatment; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000208:ethnology