Endoscopic Findings in a Mass Screening Program for Gastric Cancer in a High Risk Region - Guilan Province of Iran

Background &
Objectives: Gastric cancer is a leading cause of cancer-related deaths in both sexes in Iran. Thisstudy was designed to assess upper GI endoscopic findings among people > 50 years targeted in a mass screeningprogram in a hot-point region.
Methods: Based on the pilot results in Guilan Cancer Registry study (GCRS),one of the high point regions for GC –Lashtenesha- was selected. The target population was called mainly usingtwo methods: in rural regions, by house-house direct referral and in urban areas using public media. Upper GIendoscopy was performed by trained endoscopists. All participants underwent biopsies for rapid urea test (RUT)from the antrum and also further biopsies from five defined points of stomach for detection of precancerouslesions. In cases of visible gross lesions, more diagnostic biopsies were taken and submitted for histopathologicevaluation.
Results: Of 1,394 initial participants, finally 1,382 persons (702 women, 680 men) with a mean age of61.7±9.0 years (range: 50-87 years) underwent upper GI endoscopy. H. pylori infection based on the RUT waspositive in 66.6%. Gastric adenocarcinoma and squamous cell carcinoma of esophagus were detected in seven(0.5%) and one (0.07%) persons, respectively. A remarkable proportion of studied participants were found tohave esophageal hiatal hernia (38.4%). Asymptomatic gastric masses found in 1.1% (15) of cases which weremostly located in antrum (33.3%), cardia (20.0%) and prepyloric area (20.0%). Gastric and duodenal ulcerswere found in 5.9% (82) and 6.9% (96) of the screened population.
Conclusion: Upper endoscopy screening is aneffective technique for early detection of GC especially in high risk populations. Further studies are required toevaluate cost effectiveness, cost benefit and mortality and morbidity of this method among high and moderaterisk population before recommending this method for the GC surveillance program at the national level.