Gastric cancer endoscopic screening (East Asia)

Korea's National Cancer Screening Programme has offered biennial upper endoscopy (or barium X-ray) to everyone aged 40 and over since 1999, and Japan added endoscopy to its national guideline in 2016 for people aged 50 and over every two to three years. A Korean nested case-control study (Gastroenterology 2017) found that endoscopic screening was associated with a 47% reduction in gastric cancer mortality, and over half of Korean gastric cancers are now diagnosed at stage I, many treated by endoscopic submucosal dissection rather than gastrectomy. No randomised trial exists; the evidence is observational, and the strategy is cost-effective only where incidence is high. In low-incidence countries the equivalent strategy is Helicobacter pylori test-and-treat, which prevents rather than detects cancer. China is expanding endoscopic screening in high-risk regions.