Performance of Different Gastric Cancer Screening Methods in Korea: A Population-Based Study

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Abstract

Background

There is a lack of agreement on which gastric cancer screening method is the most effective in the general population. The present study compared the relative performance of upper-gastrointestinal series (UGIS) and endoscopy screening for gastric cancer.

Methods

A population-based study was conducted using the National Cancer Screening Program (NCSP) database. We analyzed data on 2,690,731 men and women in Korea who underwent either UGIS or endoscopy screening for gastric cancer between January 1, 2002 and December 31, 2005. Final gastric cancer diagnosis was ascertained through linkage with the Korean Central Cancer Registry. We calculated positivity rate, gastric cancer detection rate, interval cancer rate, sensitivity, specificity, and positive predictive value of UGIS and endoscopy screening.

Results

The positivity rates for UGIS and endoscopy screening were 39.7 and 42.1 per 1,000 screenings, respectively. Gastric cancer detection rates were 0.68 and 2.61 per 1,000 screenings, respectively. In total, 2,067 interval cancers occurred within 1 year of a negative UGIS screening result (rate, 1.17/1,000) and 1,083 after a negative endoscopy screening result (rate, 1.17/1,000). The sensitivity of UGIS and endoscopy screening to detect gastric cancer was 36.7 and 69.0%, respectively, and specificity was 96.1 and 96.0%. The sensitivity of endoscopy screening to detect localized gastric cancer was 65.7%, which was statistically significantly higher than that of UGIS screening.

Conclusion

Overall, endoscopy performed better than UGIS in the NCSP for gastric cancer. Further evaluation of the impact of these screening methods should take into account the corresponding costs and reduction in mortality.

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Most cited references 30

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Global cancer statistics

DM Parkin, P Pisani, J Ferlay … (2011)

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Combining independent studies of a diagnostic test into a summary ROC curve: data-analytic approaches and some additional considerations.

L E Moses, D. Shapiro, B Littenberg (1993)

We consider how to combine several independent studies of the same diagnostic test, where each study reports an estimated false positive rate (FPR) and an estimated true positive rate (TPR). We propose constructing a summary receiver operating characteristic (ROC) curve by the following steps. (i) Convert each FPR to its logistic transform U and each TPR to its logistic transform V after increasing each observed frequency by adding 1/2. (ii) For each study calculate D = V - U, which is the log odds ratio of TPR and FPR, and S = V + U, an implied function of test threshold; then plot each study's point (Si, Di). (iii) Fit a robust-resistant regression line to these points (or an equally weighted least-squares regression line), with V - U as the dependent variable. (iv) Back-transform the line to ROC space. To avoid model-dependent extrapolation from irrelevant regions of ROC space we propose defining a priori a value of FPR so large that the test simply would not be used at that FPR, and a value of TPR so low that the test would not be used at that TPR. Then (a) only data points lying in the thus defined north-west rectangle of the unit square are used in the data analysis, and (b) the estimated summary ROC is depicted only within that subregion of the unit square. We illustrate the methods using simulated and real data sets, and we point to ways of comparing different tests and of taking into account the effects of covariates.

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Endoscopic resection of early gastric cancer.

Takuji Gotoda (2007)

The purpose of this review is to examine recent advances in the techniques and technologies of endoscopic resection of early gastric cancer (EGC). Endoscopic mucosal resection (EMR) of EGC, with negligible risk of lymph node metastasis, is a standard technique in Japan and is increasingly becoming accepted and regularly used in Western countries. EMR is a minimally invasive technique which is safe, convenient, and efficacious; however, it is insufficient when treating larger lesions. The evidence suggests that difficulties with the correct assessment of depth of tumor invasion lead to an increase in local recurrence with standard EMR when lesions are larger than 15 mm. A major factor contributing to this increase in local recurrence relates to lesions being excised piecemeal due to the technical limitations of standard EMR. A new development in endoscopic techniques is to dissect directly along the submucosal layer -- a procedure called endoscopic submucosal dissection (ESD). This allows the en-bloc resection of larger lesions. ESD is not necessarily limited by lesion size and it is predicted to replace conventional surgery in dealing with certain stages of ECG. However, it still has a higher complication rate when compared to standard EMR, and it requires high levels of endoscopic skill and experience. Endoscopic techniques, indications, pathological assessment, and methods of endoscopic resection of EGC need to be established for carrying out appropriate treatment and for the collation of long-term outcome data.

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Author and article information

Contributors

Xiao-Ping Miao: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, USA )

ISSN (Electronic): 1932-6203

Publication date Collection: 2012

Publication date (Electronic): 29 November 2012

Volume: 7

Issue: 11

Electronic Location Identifier: e50041

Affiliations

[1 ]National Cancer Control Institute, National Cancer Center, Goyang, Korea

[2 ]Department of Preventive Medicine & Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, Korea

[3 ]Department of Epidemiology and Health Promotion, Graduate school of Public Health, Yonsei University, Seoul, Korea

[4 ]Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Korea

[5 ]Gastric Cancer Branch, Research Institute and Hospital, National Cancer Center, Goyang, Korea

[6 ]Department of Social Medicine, College of Medicine, Dankook University, Chungnam, Korea

MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, China

Author notes

* E-mail: hylee@ 123456dankook.ac.kr

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: KSC JKJ HYL ECP. Performed the experiments: KSC JKJ HYL MAH SP KWJ. Analyzed the data: KSC JKJ. Contributed reagents/materials/analysis tools: KSC JKJ. Wrote the paper: KSC JKJ HYL IJC.

Article

Publisher ID: PONE-D-12-15058

DOI: 10.1371/journal.pone.0050041

PMC ID: 3510189

PubMed ID: 23209638

SO-VID: 38db7d1c-dda2-4f01-915c-78d6e6764dd7

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 25 May 2012

Date accepted : 15 October 2012

Page count

Pages: 8

Funding

This study was supported by a Grant-in-Aid for Cancer Research and Control from the National Cancer Center, Korea (grant number 1010200). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Performance of Different Gastric Cancer Screening Methods in Korea: A Population-Based Study

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Abstract

Background

Methods

Results

Conclusion

Related collections

PLOS Climate

Most cited references 30

Global cancer statistics

Combining independent studies of a diagnostic test into a summary ROC curve: data-analytic approaches and some additional considerations.

Endoscopic resection of early gastric cancer.

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