Endoscopy Every Three Years Cuts Gastric Cancer Death Risk: Cohort Study
South Korea: The question of how often screening endoscopy should be performed to effectively reduce gastric cancer (GC) deaths has remained uncertain. A new large-scale Korean cohort study, published in Gastrointestinal Endoscopy, offers clarity, suggesting that undergoing endoscopic screening every three years or sooner is associated with a markedly lower risk of dying from gastric cancer.
Researchers utilized data from the Korean National Health Insurance claims registry to evaluate all patients newly diagnosed with gastric cancer in 2010. A total of 26,199 individuals were included in the analysis. To understand the effect of prior screening, patients were grouped based on the time interval between their most recent screening endoscopy and their diagnostic procedure for gastric cancer. The intervals assessed were ≤1 year, ≤2 years, ≤3 years, ≤4 years, ≤5 years, >5 years, and a never-screened group.
The findings revealed a clear survival benefit among those who underwent screening compared with individuals who had never been screened. Specifically, the study reported:
- Undergoing screening endoscopy within one to three years before diagnosis significantly reduced gastric cancer mortality, with hazard ratios of 0.47 for ≤1 year, 0.34 for ≤2 years, and 0.35 for ≤3 years compared with never-screened individuals.
- Patients screened within three years had a 28–29% lower risk of gastric cancer–specific death than those whose last screening was more than three years prior.
- After propensity score matching, the survival benefit remained consistent, with an adjusted hazard ratio of 0.71 (95% CI, 0.62–0.80) for the ≤3-year group.
- The benefit of screening diminished with longer intervals, as patients screened more than five years before diagnosis had outcomes similar to the never-screened group.
- Screening was well tolerated, with no additional safety concerns reported among screened individuals.
- A three-year screening interval appears optimal, balancing effectiveness and practicality, especially in high-risk regions.
Interestingly, the benefit diminished with longer screening intervals. Patients who had been screened more than five years before diagnosis had outcomes closer to the never-screened group, highlighting the importance of maintaining a timely screening schedule.
The study authors emphasized that a three-year interval appears to strike the right balance between effectiveness and practicality, particularly in regions with a high burden of gastric cancer. “Screening at intervals of three years or less provides a significant mortality benefit, while longer intervals reduce its effectiveness,” the team noted.
Gastric cancer continues to be one of the leading causes of cancer-related deaths worldwide, particularly in East Asian countries such as Korea and Japan, where incidence remains high. Endoscopic screening programs have been adopted in these regions to enable early detection, which is crucial for improving outcomes. The present findings lend strong support to policy recommendations favoring three-year screening intervals in high-risk populations.
"The nationwide cohort study highlights that regular endoscopic screening every three years or sooner can substantially lower the risk of death from gastric cancer. For countries grappling with a high incidence of the disease, implementing such intervals could serve as an effective public health strategy to save lives," the authors concluded.
Reference: https://www.giejournal.org/article/S0016-5107(25)01916-9/abstract
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