Missed Opportunities for Screening or Surveillance Among Patients with Newly Diagnosed Non-cardia Gastric Adenocarcinoma

Dig Dis Sci. 2023 Mar;68(3):761-769. doi: 10.1007/s10620-022-07587-5. Epub 2022 Jun 11.

Abstract

Background: Screening for gastric cancer is not recommended despite rising rates in certain U.S.

Populations: We determined possible missed opportunities for the detection and surveillance of preneoplastic lesions among gastric cancer patients in a VA hospital.

Methods: This retrospective cohort study included consecutive, newly diagnosed non-cardia gastric adenocarcinoma patients from 11/2007 to 10/2018 at the Houston VA Hospital. We identified missed opportunities for screening based on risk factors (non-White race, smoking, alcohol, Helicobacter pylori infection, gastric ulcers, family history of gastric cancer). We additionally determined missed opportunities for surveillance of known high-risk lesions. Associations between receipt of prior endoscopy for screening or surveillance and cancer-related outcomes (stage, treatment, survival) were determined using logistic regression models.

Results: Among 91 gastric cancer patients, 95.6% were men, 51.6% were black, 12.1% were Hispanic, with mean age of 68.0 years (standard deviation 10.8 years). The most common risk factors included non-white race (68.1%), smoking (76.9%), alcohol use (59.3%) and prior H. pylori (12.1%). Most patients had ≥ 1 risk factor for gastric cancer (92.6%), and 76.9% had ≥ 2 risk factors. Only 25 patients (27.5%) had undergone endoscopy prior to cancer diagnosis. Of 14 with known high-risk lesions (i.e., gastric intestinal metaplasia, dysplasia, ulcer), only 2 (14.3%) underwent surveillance endoscopy. Receipt of prior endoscopy was not associated with differences in cancer outcomes.

Conclusions: Most patients with newly diagnosed gastric cancer had ≥ 2 known risk factors for gastric cancer but never received prior screening endoscopy. Among the few with known prior preneoplastic lesions, endoscopic surveillance was not consistently performed.

Keywords: Atrophic gastritis; Cancer screening; Epidemiology; Gastric cancer; Gastric intestinal metaplasia; Helicobacter pylori.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adenocarcinoma* / complications
  • Adenocarcinoma* / diagnosis
  • Adenocarcinoma* / epidemiology
  • Aged
  • Female
  • Helicobacter Infections* / complications
  • Helicobacter Infections* / diagnosis
  • Helicobacter Infections* / epidemiology
  • Helicobacter pylori*
  • Humans
  • Male
  • Metaplasia / complications
  • Retrospective Studies
  • Risk Factors
  • Stomach Neoplasms* / diagnosis
  • Stomach Neoplasms* / epidemiology
  • Stomach Neoplasms* / pathology