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Abstract

Introduction: Gastric cancer (GC) is mostly related to Helicobacter pylori (Hp) infection, and risk-stratified screening (RS) for GC has been adopted in some cities. We aimed to investigate the efficacy of RS as compared with barium X-ray screening (XR) recommended by Japan for GC.

Methods: Repeated cross-sectional study from the data of Yokosuka Public Health Center. The GC screening participants were >40 years old from 2002 to 2018. RS was classified by pepsinogen test screening (PG) and Helicobacter pylori (Hp) tests into low and high-risk groups. The primary endpoints were detection rates of all GC and early GC (TNM T1). Secondary endpoints were participation rate and GC detection cost. For GC detection, the odds ratios were calculated by logistic regression models adjusted for age, sex, and first visit or revisit.

Results: A total of 448,244 participants’ data were included. In multivariable analyses, the odds ratios of PG and RS vs XR were 2.26 and 3.73 for GC detection, and 4.64 and 10.63 for early GC detection, respectively (p<.00001). The citizens’ participation rate increased significantly from 3.9% in XR to 22.2% in RS, and 23.1% in RS. Hp eradication was successful in 83.9% of the high-risk groups. GC detection cost by RS was 29.99 and 1.60 times lower as compared with XR and PG, respectively (p<0.0001).

Conclusion: RS was more effective than XR for detecting GC and the detection cost was lower. RS might contribute to citizens’ future survival by the improved early GC detection, participation, and Hp eradication system.