title: Gastric Cancers Missed During Endoscopy in England.
abstract: OBJECTIVE
  Single-center studies have estimated that 4.6% to 25.8% of gastric cancers are missed at endoscopy. We performed a population-based study to make a more precise estimate of factors associated with missed lesions in England.
  
  
  METHODS
  We performed a retrospective population-based observational cohort study of 2727 patients diagnosed with gastric cancer from April 2011 through March 2012 in England, using linked records from 3 national data sets. The primary outcome was the proportion of patients who had undergone endoscopy in the 3 to 36 months before a diagnosis of gastric cancer. We determined this proportion for the entire cohort and for subgroups.
  
  
  RESULTS
  Of the 2727 patients in the cohort, 8.3% (95% confidence interval, 7.2%-9.3%) underwent endoscopic evaluation in the 3 to 36 months before their diagnosis of gastric cancer. An endoscopy within 3 to 36 months of diagnosis was associated with a diagnosis of early stage cancer (stages 0 or 1, 11.5%; stage 2, 7.9%; stages 3 or 4, 6.9%; P = .01 for stage 0 or 1 vs stage 2 or greater), younger age at diagnosis (<55 y, 13.3% vs ≥55 y, 7.8%; P = .03), and female sex (10% of women vs 7.3% of men; P = .01). Gastric ulcers were detected in 15% of endoscopies performed at any time in the 3 years before cancer diagnosis, and in 64% of endoscopies performed 3 to 6 months before a diagnosis of gastric cancer.
  
  
  CONCLUSIONS
  Based on a retrospective analysis of medical records in England, in 8.3% of patients with gastric cancer, their cancer was missed at endoscopy within the 3 previous years. A previous endoscopy detected benign gastric ulcers more frequently than any other lesion in patients who later were diagnosed with gastric cancer.
authors: Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, United Kingdom; Department of Surgery and Cancer, Imperial College, London, United Kingdom. Electronic address: gchadwick@rcseng.ac.uk.
authors: Georgina
authors: G
authors: Chadwick
authors: Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, United Kingdom; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors: Oliver
authors: O
authors: Groene
authors: Department of Gastroenterology, Northern General Hospital, Sheffield, United Kingdom.
authors: Stuart
authors: S
authors: Riley
authors: Department of Surgery, Addenbrookes Hospital, Cambridge, United Kingdom.
authors: Richard
authors: R
authors: Hardwick
authors: Velindre Cancer Centre, Cardiff, Wales.
authors: Tom
authors: T
authors: Crosby
authors: Department of Gastroenterology, St Marys Hospital, London, United Kingdom.
authors: Jonathan
authors: J
authors: Hoare
authors: Department of Surgery and Cancer, Imperial College, London, United Kingdom.
authors: George B
authors: GB
authors: Hanna
authors: Health and Social Care Information Centre, Leeds, United Kingdom.
authors: Kimberley
authors: K
authors: Greenaway
authors: Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, United Kingdom; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors: David A
authors: DA
authors: Cromwell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis*
keywords: Database Analysis; Early Detection; Screening; Stomach Cancer