Effectiveness of the Korean National Cancer Screening Program in Reducing Gastric Cancer Mortality.
It is not clear whether screening for gastric cancer by upper endoscopy or upper gastrointestinal (UGI) series examinations (looking at the upper and middle sections of the gastrointestinal tract by imaging techniques) reduces mortality. Nevertheless, the Korean National Cancer Screening Program for gastric cancer was launched in 1999 to screen individuals 40 years and older for gastric cancer using these techniques. We evaluated the effectiveness of these techniques in gastric cancer detection and compared their effects on mortality in the Korean population.



We performed a nested case-control study using data from the Korean National Cancer Screening Program for gastric cancer since 2002. A total of 16,584,283 Korean men and women, aged 40 years and older, comprised the cancer-free cohort. Case subjects (n = 54,418) were defined as individuals newly diagnosed with gastric cancer from January 2004 through December 2009 and who died before December 2012. Cases were matched with controls (subjects who were alive on the date of death of the corresponding case subject, n = 217,672) for year of entry into the study cohort, age, sex, and socioeconomic status. Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained via conditional logistic regression analysis.



Compared with subjects who had never been screened, the overall OR for dying from gastric cancer among ever-screened subjects was 0.79 (95% CI, 0.77-0.81). According to screening modality, the ORs of death from gastric cancer were 0.53 (95% CI, 0.51-0.56) for upper endoscopy and 0.98 (95% CI, 0.95-1.01) for UGI series. As the number of endoscopic screening tests performed per subject increased, the ORs of death from gastric cancer decreased: 0.60 (95% CI, 0.57-0.63), 0.32 (95% CI, 0.28-0.37), and 0.19 (95% CI, 0.14-0.26) for once, twice, and 3 or more times, respectively.



Within the Korean National Cancer Screening Program, patients who received an upper endoscopy were less likely to die from gastric cancer; no associations were found for UGI series.
National Cancer Control Institute, National Cancer Center Hospital, National Cancer Center, Goyang, Gyeonggi, Republic of Korea; Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Gyeonggi, Republic of Korea.
Jae Kwan
JK
Jun
National Cancer Control Institute, National Cancer Center Hospital, National Cancer Center, Goyang, Gyeonggi, Republic of Korea; Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Gyeonggi, Republic of Korea. Electronic address: kschoi@ncc.re.kr.
Kui Son
KS
Choi
Department of Social Medicine, College of Medicine, Dankook University, Cheonan, Chungnam, Republic of Korea.
Hoo-Yeon
HY
Lee
National Cancer Control Institute, National Cancer Center Hospital, National Cancer Center, Goyang, Gyeonggi, Republic of Korea.
Mina
M
Suh
National Cancer Control Institute, National Cancer Center Hospital, National Cancer Center, Goyang, Gyeonggi, Republic of Korea; Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Gyeonggi, Republic of Korea.
Boyoung
B
Park
National Cancer Control Institute, National Cancer Center Hospital, National Cancer Center, Goyang, Gyeonggi, Republic of Korea.
Seung Hoon
SH
Song
National Cancer Control Institute, National Cancer Center Hospital, National Cancer Center, Goyang, Gyeonggi, Republic of Korea.
Kyu Won
KW
Jung
Center for Cancer Prevention and Detection, National Cancer Center Hospital, National Cancer Center, Goyang, Gyeonggi, Republic of Korea.
Chan Wha
CW
Lee
Center for Gastric Cancer, National Cancer Center Hospital, National Cancer Center, Goyang, Gyeonggi, Republic of Korea.
Il Ju
IJ
Choi
Department of Preventive Medicine, Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, Republic of Korea. Electronic address: ecpark@yuhs.ac.
Eun-Cheol
EC
Park
National Cancer Control Institute, National Cancer Center Hospital, National Cancer Center, Goyang, Gyeonggi, Republic of Korea; Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Gyeonggi, Republic of Korea.
Dukhyoung
D
Lee
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D055088:Early Detection of Cancer / Q000379:methods* / Q000706:statistics & numerical data*; D016099:Endoscopy, Gastrointestinal / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011859:Radiography / Q000706:statistics & numerical data; D056910:Republic of Korea; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality*
Endoscopy; Mass Screening; Photofluorography; Stomach Neoplasms