Long-Term Follow-Up of a Community Assignment, One-Time Endoscopic Screening Study of Esophageal Cancer in China.
OBJECTIVE
There are no global screening recommendations for esophageal squamous cell carcinoma (ESCC). Endoscopic screening has been investigated in areas of high incidence in China since the 1970s. This study aimed to evaluate whether an endoscopic screening and intervention program could reduce mortality caused by ESCC.


METHODS
Residents age 40 to 69 years were recruited from communities with high rates of ESCC. Fourteen villages were selected as the intervention communities. Ten villages not geographically adjacent to intervention villages were selected for comparison. Participants in the intervention group were screened once by endoscopy with Lugol's iodine staining, and those with dysplasia or occult cancer were treated. All intervention participants and a sample consisting of one tenth of the control group completed questionnaires. We compared cumulative ESCC incidence and mortality between the two groups.


RESULTS
Three thousand three hundred nineteen volunteers (48.62%) from an eligible population of 6,827 were screened in the intervention group. Seven hundred ninety-seven volunteers from an eligible population of 6,200 in the control group were interviewed. Six hundred fifty-two incident and 542 fatal ESCCs were identified during the 10-year follow-up. A reduction in cumulative mortality in the intervention group versus the control group was apparent (3.35% v 5.05%, respectively; P < .001). Furthermore, the intervention group had a significantly lower cumulative incidence of ESCC versus the control group (4.17% v 5.92%, respectively; P < .001).


CONCLUSIONS
We showed that endoscopic screening and intervention significantly reduced mortality caused by esophageal cancer. Detection and treatment of preneoplastic lesions also led to a reduction in the incidence of this highly fatal cancer.
Wen-Qiang Wei, Hao Feng, Dong-Mei Lin, Xin-Qing Li, Guo-Qing Wang, Zhi-Wei Dong, and You-Lin Qiao, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing; Zhi-Feng Chen, Yu-Tong He, and Jun Hou, Cancer Institute of Hebei Province, Shijiazhuang; Cui-Lan Guo, Shao-Sen Li, Cancer Institute/Hospital of Ci County, Handan, China; and Christian C. Abnet, National Cancer Institute, Bethesda, MD.
Wen-Qiang
WQ
Wei
Wen-Qiang Wei, Hao Feng, Dong-Mei Lin, Xin-Qing Li, Guo-Qing Wang, Zhi-Wei Dong, and You-Lin Qiao, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing; Zhi-Feng Chen, Yu-Tong He, and Jun Hou, Cancer Institute of Hebei Province, Shijiazhuang; Cui-Lan Guo, Shao-Sen Li, Cancer Institute/Hospital of Ci County, Handan, China; and Christian C. Abnet, National Cancer Institute, Bethesda, MD.
Zhi-Feng
ZF
Chen
Wen-Qiang Wei, Hao Feng, Dong-Mei Lin, Xin-Qing Li, Guo-Qing Wang, Zhi-Wei Dong, and You-Lin Qiao, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing; Zhi-Feng Chen, Yu-Tong He, and Jun Hou, Cancer Institute of Hebei Province, Shijiazhuang; Cui-Lan Guo, Shao-Sen Li, Cancer Institute/Hospital of Ci County, Handan, China; and Christian C. Abnet, National Cancer Institute, Bethesda, MD.
Yu-Tong
YT
He
Wen-Qiang Wei, Hao Feng, Dong-Mei Lin, Xin-Qing Li, Guo-Qing Wang, Zhi-Wei Dong, and You-Lin Qiao, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing; Zhi-Feng Chen, Yu-Tong He, and Jun Hou, Cancer Institute of Hebei Province, Shijiazhuang; Cui-Lan Guo, Shao-Sen Li, Cancer Institute/Hospital of Ci County, Handan, China; and Christian C. Abnet, National Cancer Institute, Bethesda, MD.
Hao
H
Feng
Wen-Qiang Wei, Hao Feng, Dong-Mei Lin, Xin-Qing Li, Guo-Qing Wang, Zhi-Wei Dong, and You-Lin Qiao, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing; Zhi-Feng Chen, Yu-Tong He, and Jun Hou, Cancer Institute of Hebei Province, Shijiazhuang; Cui-Lan Guo, Shao-Sen Li, Cancer Institute/Hospital of Ci County, Handan, China; and Christian C. Abnet, National Cancer Institute, Bethesda, MD.
Jun
J
Hou
Wen-Qiang Wei, Hao Feng, Dong-Mei Lin, Xin-Qing Li, Guo-Qing Wang, Zhi-Wei Dong, and You-Lin Qiao, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing; Zhi-Feng Chen, Yu-Tong He, and Jun Hou, Cancer Institute of Hebei Province, Shijiazhuang; Cui-Lan Guo, Shao-Sen Li, Cancer Institute/Hospital of Ci County, Handan, China; and Christian C. Abnet, National Cancer Institute, Bethesda, MD.
Dong-Mei
DM
Lin
Wen-Qiang Wei, Hao Feng, Dong-Mei Lin, Xin-Qing Li, Guo-Qing Wang, Zhi-Wei Dong, and You-Lin Qiao, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing; Zhi-Feng Chen, Yu-Tong He, and Jun Hou, Cancer Institute of Hebei Province, Shijiazhuang; Cui-Lan Guo, Shao-Sen Li, Cancer Institute/Hospital of Ci County, Handan, China; and Christian C. Abnet, National Cancer Institute, Bethesda, MD.
Xin-Qing
XQ
Li
Wen-Qiang Wei, Hao Feng, Dong-Mei Lin, Xin-Qing Li, Guo-Qing Wang, Zhi-Wei Dong, and You-Lin Qiao, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing; Zhi-Feng Chen, Yu-Tong He, and Jun Hou, Cancer Institute of Hebei Province, Shijiazhuang; Cui-Lan Guo, Shao-Sen Li, Cancer Institute/Hospital of Ci County, Handan, China; and Christian C. Abnet, National Cancer Institute, Bethesda, MD.
Cui-Lan
CL
Guo
Wen-Qiang Wei, Hao Feng, Dong-Mei Lin, Xin-Qing Li, Guo-Qing Wang, Zhi-Wei Dong, and You-Lin Qiao, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing; Zhi-Feng Chen, Yu-Tong He, and Jun Hou, Cancer Institute of Hebei Province, Shijiazhuang; Cui-Lan Guo, Shao-Sen Li, Cancer Institute/Hospital of Ci County, Handan, China; and Christian C. Abnet, National Cancer Institute, Bethesda, MD.
Shao-Sen
SS
Li
Wen-Qiang Wei, Hao Feng, Dong-Mei Lin, Xin-Qing Li, Guo-Qing Wang, Zhi-Wei Dong, and You-Lin Qiao, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing; Zhi-Feng Chen, Yu-Tong He, and Jun Hou, Cancer Institute of Hebei Province, Shijiazhuang; Cui-Lan Guo, Shao-Sen Li, Cancer Institute/Hospital of Ci County, Handan, China; and Christian C. Abnet, National Cancer Institute, Bethesda, MD.
Guo-Qing
GQ
Wang
Wen-Qiang Wei, Hao Feng, Dong-Mei Lin, Xin-Qing Li, Guo-Qing Wang, Zhi-Wei Dong, and You-Lin Qiao, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing; Zhi-Feng Chen, Yu-Tong He, and Jun Hou, Cancer Institute of Hebei Province, Shijiazhuang; Cui-Lan Guo, Shao-Sen Li, Cancer Institute/Hospital of Ci County, Handan, China; and Christian C. Abnet, National Cancer Institute, Bethesda, MD.
Zhi-Wei
ZW
Dong
Wen-Qiang Wei, Hao Feng, Dong-Mei Lin, Xin-Qing Li, Guo-Qing Wang, Zhi-Wei Dong, and You-Lin Qiao, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing; Zhi-Feng Chen, Yu-Tong He, and Jun Hou, Cancer Institute of Hebei Province, Shijiazhuang; Cui-Lan Guo, Shao-Sen Li, Cancer Institute/Hospital of Ci County, Handan, China; and Christian C. Abnet, National Cancer Institute, Bethesda, MD.
Christian C
CC
Abnet
Wen-Qiang Wei, Hao Feng, Dong-Mei Lin, Xin-Qing Li, Guo-Qing Wang, Zhi-Wei Dong, and You-Lin Qiao, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing; Zhi-Feng Chen, Yu-Tong He, and Jun Hou, Cancer Institute of Hebei Province, Shijiazhuang; Cui-Lan Guo, Shao-Sen Li, Cancer Institute/Hospital of Ci County, Handan, China; and Christian C. Abnet, National Cancer Institute, Bethesda, MD. qiaoy@cicams.ac.cn.
You-Lin
YL
Qiao
D000328:Adult; D000368:Aged; D044466:Asian People / Q000706:statistics & numerical data*; D002681:China / Q000453:epidemiology; D055088:Early Detection of Cancer / Q000379:methods*; D004938:Esophageal Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology*; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging; D012111:Residence Characteristics; D013997:Time Factors