BackgroundEven though mass gastric cancer screening is controversial in Western countries, diverse strategies have been proposed in intermediate-risk to high-risk areas.AimThe aim of this study was to determine the long-term accuracy of the pepsinogen test (PG) for early diagnosis of gastric cancer.Participants and methodsA cohort of inhabitants from the Northern part of Portugal, aged between 40 and 74 years (n=5913), subjected to the PG test (PGI≤70 ng/ml and PGI/PGII≤3), were followed up between November 2006 and December 2015. The diagnosis of gastric cancer was determined through linkage to the population-based registry of cancer [North Region Cancer Registry of Portugal (RORENO)].ResultsTwenty-six gastric cancers were diagnosed (0.4%): nine (4%) among individuals ‘positive’ for the PG test (n=225) and 15 (0.3%) among those who were ‘negative’ (n=5688) [hazard ratio=12.7; 95% confidence interval (CI): 5.6–28.6]. Individuals with a ‘negative PG test’ had a 3-year risk of gastric cancer of 0.1%, representing a sensitivity of 35% (95% CI: 17–56%), globally, and of 58% (95% CI: 28–85%) at 3 years follow-up. The median survival rate in both groups was over 24 months.ConclusionThe PG test was found to be suboptimal as a screening test and, if used (before upper gastrointestinal endoscopy), it is mandatory to repeat it after 3 years.
European Journal of Gastroenterology & Hepatology – Wolters Kluwer Health
Published: Mar 1, 2018
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