An initial screening strategy based on epidemiologic information in esophageal cancer screening: a prospective evaluation in a community-based cancer screening cohort in rural China - 19/11/20

Doi : 10.1016/j.gie.2020.05.052

Wanqing Chen, PhD ^1,^⁎^{^{∗
Drs Chen and Li contributed equally to this article.}}, He Li, BCh ^1,^{^{∗
Drs Chen and Li contributed equally to this article.}}, Rongshou Zheng, MPH ², Jiansong Ren, PhD ¹, Jufang Shi, PhD ¹, Maomao Cao, BCh ¹, Dianqin Sun, BCh ¹, Xibin Sun, BCh ³, Xiaoqin Cao, PhD ³, Jinyi Zhou, MPH ⁴, Pengfei Luo, MPH ⁴, Jialin Wang, BCh ⁵, Hengmin Ma, MPH ⁵, Tiantang Shao, BCh ⁶, Chunling Zhao, BCh ⁶, Shilin He, BCh ⁷, Daokuan Sun, BCh ⁷, Yuluan Xu, BCh ⁸, Pengli Wu, BCh ⁸, Hongmei Zeng, PhD ², Jiang Li, PhD ¹, Jie He, MD ^9,^⁎
¹ Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
² Office of Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
³ Department of Cancer Epidemiology, Henan Office for Cancer Control and Research, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450000, China
⁴ Institute of Chronic Non-communicable Diseases Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China
⁵ Department of Public Health, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, 250117, China
⁶ Office of Chronic Non-communicable Diseases Prevention and Control, Xiping Center for Disease Control and Prevention, Zhu Madian, 463900, China
⁷ Office of Chronic Non-communicable Diseases Prevention and Control, Jinhu Center for Disease Control and Prevention, Huai’an, 211600, China
⁸ Office of Chronic Non-communicable Diseases Prevention and Control, Tengzhou Center for Disease Control and Prevention, Tengzhou, 277599, China
⁹ Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China

^∗Reprint requests: Prof. Wanqing Chen, Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.Office of Cancer ScreeningNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing100021China^∗∗Prof. Jie He, Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No.17 Pan-jia-yuan South Lane, Chaoyang District, Beijing 100021, China.Department of Thoracic SurgeryNational Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Science and Peking Union Medical CollegeNo.17 Pan-jia-yuan South LaneChaoyang DistrictBeijing100021China

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 19 November 2020

Abstract

Background and Aims

In China, regional organized esophageal cancer screening programs have been implemented since 2005. However, the implementation of these screening programs is still facing some urgent challenges, especially concerning identifying high-risk individuals. This study aimed to evaluate the risk stratification potential of the current initial assessment strategy used in a mass esophageal squamous cell carcinoma (ESCC) screening program in China.

Methods

A total of 43,875 participants without a previous cancer history enrolled in a mass ESCC screening program in China from 2007 to 2010 who had initial assessment results were included in this study and were followed until December 31, 2015. Eight potential risk factors for ESCC were evaluated in the initial assessment strategy. A comprehensive evaluation of the association of the initial assessment results with ESCC risk was performed by propensity score matching and Cox regression analysis.

Results

During a median follow-up of 5.5 years, 272 individuals developed ESCC. The high-risk population assessed at baseline had a higher risk of ESCC than the non-high-risk population, with a hazard ratio (HR) of 3.11 (95% confidence interval (CI), 2.33-4.14) after adjustment for sex, age, education level, income level, and body mass index. In addition, the initial assessment results of the high-risk population were significantly associated with the risk of all esophageal cancers (HR, 3.30; 95% CI, 2.51-4.33) and upper gastrointestinal cancers (HR, 3.03; 95% CI, 2.43-3.76).

Conclusions

The initial screening tool in a mass ESCC screening program in China, consisting of 8 accessible variables in epidemiologic surveys, could be helpful for the selection of asymptomatic individuals for priority ESCC screening.

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Abbreviations : BMI, CI, EAC, ESCC, ESLCSP, HR, PSM, SDA, UGI

Plan

Introduction

Methods

Study design and study population

Data collection and definition of the high-risk population

Follow-up and outcome definition

Statistical analysis

Results

Demographic characteristics of the analysis cohort

Cumulative incidence by initial assessment results

Sensitivity analysis

Discussion

Conclusions

	If you would like to chat with an author of this article, you may contact Dr Chen at chenwq@cicams.ac.cn or Dr He at hejie@cicams.ac.cn.
	DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.