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Am J Epidemiol. 2019 Jan 4. doi: 10.1093/aje/kwy291. [Epub ahead of print]

Effectiveness of Intensive Endoscopic Screening for Esophageal Cancer in China: A Community-Based Study.

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Key laboratory of Carcinogenesis and Translational Research.
Anyang Cancer Hospital, Anyang, Henan Province, China.
Hua County People's Hospital, Anyang, Henan Province, China.
Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington.


Evidence is required to evaluate the effectiveness of population-level endoscopic screening for esophageal cancer (EC). In this study, 5,632 permanent residents aged 25-65 years from 6 villages of Hua County, Henan Province of China, were defined as the screening cohort and offered intensive endoscopic screening. Residents of all 914 remaining villages in Hua County were included as the control cohort, and age-gender standardization was used to calculate the expected number of EC and upper gastrointestinal cancer cases and deaths in the screening cohort. The effectiveness of screening was assessed by comparing observed numbers versus numbers expected after 9-year follow-up of these screened subjects. In the screening cohort, 23 upper gastrointestinal cancers (including 16 ECs) and 10 upper gastrointestinal cancer deaths (including 5 ECs) were identified, and a 47% (Standardized incidence ratio = 0.53, 95% confidence interval (CI): 0.33, 0.87) and 66% (Standardized mortality ratio = 0.34, 95% CI: 0.14, 0.81) reduction in cumulative incidence and mortality of EC was found. For upper gastrointestinal cancers, incidence and mortality were lowered by 43% (Standardized incidence ratio = 0.57, 95% CI: 0.38, 0.86) and 53% (Standardized mortality ratio = 0.47, 95% CI: 0.25, 0.88). This study showed upper gastrointestinal endoscopy is an effective population-level screening test for EC in high-risk regions.


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