Personalized starting age of gastric cancer screening based on individuals' risk profiles: a population-based prospective study
Menée en Chine à partir de données portant sur 59 771 personnes (âge : 40-69 ans ; durée médiane de suivi : 6 ans), cette étude multicentrique estime, en fonction de 3 niveaux de risque de développer un cancer de l'estomac (faible, moyen, élevé), l'âge d'entrée dans un programme de dépistage de la maladie puis présente un calculateur en ligne, basé sur 8 facteurs de risque, permettant de déterminer cet âge
The current recommended starting age for gastric cancer (GC) lacks unified guideline and individualized criteria. We aimed to determine risk-stratified starting age for GC screening in China based on individuals’ risk profiles, and develop an online calculator for clinical application. In this multi-center population-based prospective study, we divided participants enrolled during 2015-2017 (n = 59,771, aged 40-69) into screened and unscreened groups and observed them for primary endpoints–GC occurrence, all-cause and GC-specific deaths. The median follow-up was 6.07 years. To determine the reference starting age, the effectiveness of GC screening was assessed by age-groups after propensity-score-matching. Further, we categorized the calculated individual risk scores (using well-established risk factors) by quantiles. Subsequently, we used age-specific 10-year cumulative risk curves to estimate the risk-stratified starting age—when the individual’s risk level matches reference starting age risk threshold.During follow-up, 475 GC cases, 182 GC deaths and 1,860 all-cause deaths occurred. All-cause and GC-specific mortality decreased among screened individuals aged ≥45 and 50-59 years, respectively. Thus, the average population (reference) starting age was set as 50 years. The 10-year cumulative risk of GC in average population aged 50 was 1.147%. We stratified the starting age using eight risk factors, and categorized participants as low-, medium-, and high-risk individuals, whose risk-stratified starting age was 58, 50, and 46, respectively.While high-risk individuals warrant 3-5 years earlier GC screening than average population (age 50), low-risk individuals can tolerate delayed screening. Our online, personalized starting-age calculator will help risk-adapted GC screening (https://web.consultech.com.cn/gastric/#/).
Journal of the National Cancer Institute , résumé, 2023