Long-Term Follow-Up Study Of The Optimal Starting Age Of Endoscopic Screening Program And Its Effect On Mortality Of Esophageal Cancer In High Risk Population In China

Wenqiang WEI, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, China
SONG G. 2 , FENG H. 1 , BAI W. 3 , LI X. 1 , MENG F. 2 , WANG G. 1 , DONG Z. 1 , ABNET C. 4 , QIAO Y. 1

1 Department of Cancer Epidemiology, Cancer Institute/Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
2 Department of Epidemiology, Cancer Institute/Hospital of Ci county, Handan, China
3 Department of Endoscopy, Cancer Institute/Hospital of Ci county, Handan, China
4 Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland

Purpose
There are no global screening recommendations for esophageal squamous cell carcinoma (ESCC). We previously reported the effectiveness of endoscopic screening in reducing mortality and incidence caused by ESCC in an endoscopic screening cohort. This study is aim to evaluate effects of endoscopic screening in different age groups and further confirm the optimum starting age for ESCC screening.
Methods
Based on the previous endoscopic screening cohort study, 6825 residents aged 40-69 years in the intervention communities were recruited as the subjects. Subjects were assigned to either the screening group of underwent baseline screening by endoscopy with Lugol’s iodine staining and biopsies of the unstained lesions or the control group received usual medical care. The primary analysis compared ESCC mortality rates in the screening group and the control group of different starting age groups.
Results
The 14-year risks of ESCC fatality were 1 in 55, 1 in 17 and 1 in 9 for a person in the starting age group of 40-, 50- and 60- year. The screening groups had significantly lower cumulative mortalities of ESCC versus control groups in starting age 40 years group (1.42% vs 2.38%, p=0.0331) and 50 years group (4.18% vs 7.13%, p=0.0053).The relative risks for subjects underwent screening were 0.60 (95% CI 0.37-0.97) and 0.59 (95% CI 0.40-0.86) for the starting age groups of 40- year and 50- year. The numbers needed to invited for screening to save 1 life were 104 (95% CI 51-1520) and 34 (95% CI 20-114) for subjects aged 40 to 49 years and 50 to 59 years respectively.
Conclusions
Considering overall conditions of high risk regions of ESCC, we recommend high risk population should have screening once at their 50 years. 40 years will be preferable defined as the starting age to screening in the developed areas with sufficient health resources.
Funding source
This study was supported by grants (2006BAI02A15, and 81241091) from the Ministry of Science and Technology of PRC.