Gastric cancer is a global public health burden, nearly one million new cases are diagnosed per year worldwide, of which 44% of cases occur in China. The prognosis of gastric cancer varies remarkably by the stage of c...Gastric cancer is a global public health burden, nearly one million new cases are diagnosed per year worldwide, of which 44% of cases occur in China. The prognosis of gastric cancer varies remarkably by the stage of cancer, and most of the patients in China are diagnosed at advanced stages, resulting in poor prognoses. Effective strategies to reduce the burden of gastric cancer include primary prevention through testing and treatment of Helicobacter pylori(H. pylori) and secondary prevention by screening and early detection. Although many countries have issued management guidelines and consensus reports concerning these strategies, the limited availability of healthcare resources often precludes their widespread implementation. Therefore, assessing the costs, benefits, and harms of population-based intervention measures through health economic evaluation is necessary for informed health policy decisions. Accordingly, we synthesize management approaches from different countries on H. pylori eradication and endoscopic screening, and also summarize recent advancements in health economic evaluations on population-based preventive strategies. The goal of the review is to provide empirical evidence supporting optimal resource allocation, maximizing benefits for the population, and ultimately reducing the burden of gastric cancer.展开更多
Background:Risk-stratified endoscopic screening(RSES),which offers endoscopy to those with a high risk of esophageal cancer,has the potential to increase effectiveness and reduce endoscopic demands compared with the u...Background:Risk-stratified endoscopic screening(RSES),which offers endoscopy to those with a high risk of esophageal cancer,has the potential to increase effectiveness and reduce endoscopic demands compared with the universal screening strategy(i.e.,endoscopic screening for all targets without risk prediction).Evidence of RSES in high-risk areas of China is limited.This study aimed to estimate whether RSES based on a 22-score esophageal squamous cell carcinoma(ESCC)risk prediction model could optimize the universal endoscopic screening strategy for ESCC screening in high-risk areas of China.Methods:Eight epidemiological variables in the ESCC risk prediction model were collected retrospectively from 26,618 individuals aged 40-69 from three high-risk areas of China who underwent endoscopic screening betweenMay 2015 and July 2017.The model’s performance was estimated using the area under the curve(AUC).Participants were categorized into a high-risk group and a low-risk group with a cutoff score having sensitivities of both ESCC and severe dysplasia and above(SDA)at more than 90.0%.Results:The ESCC risk prediction model had an AUC of 0.80(95% confidence interval:0.75-0.84)in this external population.We found that a score of 8(ranging from 0 to 22)had a sensitivity of 94.2% for ESCC and 92.5% for SDA.The RSES strategy using this threshold score would allow 50.6% of endoscopies to be avoided and save approximately US$0.59 million compared to universal endoscopic screening among 26,618 participants.In addition,a higher prevalence of SDA(1.7%vs.0.9%),a lower number need to screen(60 vs.111),and a lower average cost per detected SDA(US$3.22 thousand vs.US$5.45 thousand)could have been obtained by the RSES strategy.Conclusions:The RSES strategy based on individual risk has the potential to optimize the universal endoscopic screening strategy in ESCC high-risk areas of China.展开更多
In this narrative review, we highlight the disparities in the incidence and mortality of gastric cancer across various racial and ethnic populations in the United States (US). Despite the low and decreasing trend in t...In this narrative review, we highlight the disparities in the incidence and mortality of gastric cancer across various racial and ethnic populations in the United States (US). Despite the low and decreasing trend in the incidence of gastric cancer in the US, the incidence remains significantly high among Asian and Hispanic Americans, showing a striking racial and ethnic disparity. The low survival rate of gastric cancer further accentuates the magnitude of this disparity. In addition, there is a marked funding disparity among different cancers in the US, reflecting the significantly lower level of support for cancers, such as gastric cancer, which are more prevalent in minority populations, compared to the cancers more prevalent among non-Hispanic Whites (NHW). Moreover, the economic burden from health disparities remains high. Although studies from the US and Asia suggest that screening for stomach cancer may be cost-effective, there is no currently available guideline for scree-ning high-risk populations in the US. A multidimensional framework involving the community, physicians, and policymakers is proposed to tackle these gastric cancer disparities and to develop population-based screening and surveillance programs to reduce the burden of gastric cancer.展开更多
基金supported in part by the Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support (No. ZLRK202325)a grant from National Key R&D Program of China (No. 2018YFC 1313105)。
文摘Gastric cancer is a global public health burden, nearly one million new cases are diagnosed per year worldwide, of which 44% of cases occur in China. The prognosis of gastric cancer varies remarkably by the stage of cancer, and most of the patients in China are diagnosed at advanced stages, resulting in poor prognoses. Effective strategies to reduce the burden of gastric cancer include primary prevention through testing and treatment of Helicobacter pylori(H. pylori) and secondary prevention by screening and early detection. Although many countries have issued management guidelines and consensus reports concerning these strategies, the limited availability of healthcare resources often precludes their widespread implementation. Therefore, assessing the costs, benefits, and harms of population-based intervention measures through health economic evaluation is necessary for informed health policy decisions. Accordingly, we synthesize management approaches from different countries on H. pylori eradication and endoscopic screening, and also summarize recent advancements in health economic evaluations on population-based preventive strategies. The goal of the review is to provide empirical evidence supporting optimal resource allocation, maximizing benefits for the population, and ultimately reducing the burden of gastric cancer.
基金National Key R&D Program of China,Grant/Award Number:2018YFC1313100Special Project of Beijing-Tianjin-Hebei Basic Research Cooperation,Grant/Award Number:J200017+2 种基金Sanming Project of Medicine in Shenzhen,Grant/Award Number:SZSM201911015Special Fund for Health Research in the Public Interest,Grant/Award Number:201502001Major State Basic Innovation Program of the Chinese Academy of Medical Sciences,Grant/Award Numbers:2016-12M-2-004,2019-I2M-2-004。
文摘Background:Risk-stratified endoscopic screening(RSES),which offers endoscopy to those with a high risk of esophageal cancer,has the potential to increase effectiveness and reduce endoscopic demands compared with the universal screening strategy(i.e.,endoscopic screening for all targets without risk prediction).Evidence of RSES in high-risk areas of China is limited.This study aimed to estimate whether RSES based on a 22-score esophageal squamous cell carcinoma(ESCC)risk prediction model could optimize the universal endoscopic screening strategy for ESCC screening in high-risk areas of China.Methods:Eight epidemiological variables in the ESCC risk prediction model were collected retrospectively from 26,618 individuals aged 40-69 from three high-risk areas of China who underwent endoscopic screening betweenMay 2015 and July 2017.The model’s performance was estimated using the area under the curve(AUC).Participants were categorized into a high-risk group and a low-risk group with a cutoff score having sensitivities of both ESCC and severe dysplasia and above(SDA)at more than 90.0%.Results:The ESCC risk prediction model had an AUC of 0.80(95% confidence interval:0.75-0.84)in this external population.We found that a score of 8(ranging from 0 to 22)had a sensitivity of 94.2% for ESCC and 92.5% for SDA.The RSES strategy using this threshold score would allow 50.6% of endoscopies to be avoided and save approximately US$0.59 million compared to universal endoscopic screening among 26,618 participants.In addition,a higher prevalence of SDA(1.7%vs.0.9%),a lower number need to screen(60 vs.111),and a lower average cost per detected SDA(US$3.22 thousand vs.US$5.45 thousand)could have been obtained by the RSES strategy.Conclusions:The RSES strategy based on individual risk has the potential to optimize the universal endoscopic screening strategy in ESCC high-risk areas of China.
文摘In this narrative review, we highlight the disparities in the incidence and mortality of gastric cancer across various racial and ethnic populations in the United States (US). Despite the low and decreasing trend in the incidence of gastric cancer in the US, the incidence remains significantly high among Asian and Hispanic Americans, showing a striking racial and ethnic disparity. The low survival rate of gastric cancer further accentuates the magnitude of this disparity. In addition, there is a marked funding disparity among different cancers in the US, reflecting the significantly lower level of support for cancers, such as gastric cancer, which are more prevalent in minority populations, compared to the cancers more prevalent among non-Hispanic Whites (NHW). Moreover, the economic burden from health disparities remains high. Although studies from the US and Asia suggest that screening for stomach cancer may be cost-effective, there is no currently available guideline for scree-ning high-risk populations in the US. A multidimensional framework involving the community, physicians, and policymakers is proposed to tackle these gastric cancer disparities and to develop population-based screening and surveillance programs to reduce the burden of gastric cancer.
