At 45 or older, if you live in an area with a high rate of stomach or esophageal cancer, have a family history, or test positive for Helicobacter pylori, get a gastroscopy screening

Cost

An ordinary gastroscopy costs a few hundred CNY, a painless (sedated) one costs a few hundred more, and prices vary by place. You go on an empty stomach and it takes half a day, before and after. If you choose the painless kind, someone has to go with you. The unpleasant part is the few minutes when the tube passes the throat.

What you get

The National Health Commission's (国家卫健委) 2024 program defines high-risk people this way. First you must be 45 or older, and meet any one of the following. One, you live in a county with a high rate of stomach or esophageal cancer: for stomach cancer, an age-standardized incidence above 20 per 100,000 people, and for esophageal cancer, above 15. Two, a parent, child or sibling has had that cancer. Three, a positive Helicobacter pylori test, which counts for stomach cancer only. Four, smoking, heavy drinking, eating very salty food or a lot of pickled food, and for esophageal cancer also liking very hot food. Five, a history of atrophic gastritis, stomach ulcer, stomach polyps, Barrett's esophagus or reflux esophagitis. Screening ages are generally 45 to 74, gastroscopy is the first choice, and in principle it is done once every 5 years. The 2022 national guideline explicitly does not advise stomach cancer screening for people outside the high-risk groups. A study in 6 high-rate areas of China followed about 637,500 (63.75万) people aged 40 to 69. Compared with people not invited, those who had one gastroscopy had about 57% lower risk of dying from upper digestive tract cancer. As reported: RR 0.43, 95% CI 0.40 to 0.47. Incidence of upper digestive tract cancer was about 23% lower (RR 0.77). Only 33.53% of those invited actually went. Counting everyone invited, deaths were about 31% lower (RR 0.69, 95% CI 0.66 to 0.72). Another study was done in villages with a high rate of esophageal cancer, without random assignment, and followed for 10 years. Cumulative deaths from esophageal squamous cell cancer were 3.35% in the screening group and 5.05% in the control group. In South Korea's national screening program, people who had a gastroscopy were about 47% less likely to die of stomach cancer. As reported: OR 0.53, 95% CI 0.51 to 0.56. For barium meal X-rays no difference was seen (OR 0.98). The more gastroscopies, the lower the risk. Pooling 10 studies from Asia, people who had a gastroscopy had about 40% lower stomach cancer deaths. As reported: RR 0.60, 95% CI 0.49 to 0.73. No change was seen in the number who got stomach cancer. In northern China there was a trial that randomized by village, enrolling 33,800 (3.38万) people aged 45 to 69 and following them for 9 years. People assigned to screening had about 18% lower esophageal cancer deaths (HR 0.82, 95% CI 0.53 to 1.26), still within the margin of error. Incidence was about 19% lower (HR 0.81, 95% CI 0.60 to 1.09), likewise not significant. A 2023 meta-analysis corrected for the bias that “people who choose to get checked are healthier to begin with.” For people who actually had a gastroscopy, stomach cancer deaths were about 48% lower (RR 0.52, plausible range 0.39 to 0.79). Calculated over the whole screening program, only RR 0.94 was left (plausible range 0.71 to 1.28), with no visible effect (China / South Korea / Asia)

Notes

Dispute. Most of the evidence that gastroscopy lowers deaths comes from comparing people who chose to be checked with people who did not. People who get checked already look after their health more, so the benefit is overstated. The 2023 meta-analysis rated the risk of bias in these studies as moderate to serious. In the village-randomized esophageal cancer trial, the difference in deaths at 9 years is still within the margin of error. The harms listed in the 2022 guideline are: overdiagnosis, meaning finding a cancer that would never have caused trouble in your lifetime; false positives; missed diagnoses; and bleeding, perforation, heart and lung accidents, aspiration pneumonia and infection. For people who cannot tolerate an ordinary gastroscopy, the program states it can be done under anesthesia or sedation. People 45 and older who test positive for Helicobacter pylori already count as at high risk of stomach cancer. For eradication see §1.23 (test for Helicobacter pylori, and eradicate it if positive), but eradication does not replace gastroscopy; you need both. Barium meal X-rays, pepsinogen alone, tumor marker tests and PET scans are all not recommended for screening by the program. For tumor marker packages see §6.7 (whole-body PET-CT and tumor marker packages). People found to have atrophic gastritis, intestinal metaplasia or intraepithelial neoplasia should be rechecked more often, as the doctor says. To find out whether your county counts as a high-rate area, ask the local Center for Disease Control or the county hospital. If you already have trouble swallowing, vomiting blood or black stools, that is seeing a doctor, not screening; see §34.6 (trouble swallowing, vomiting blood or black stools: go straight to the hospital). For people who like hot tea, see §2.30 (let hot drinks cool a bit before you drink). The beneficiary is mainly you, and also your parents.

Evidence grade

A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.

Sources

1. 国家卫生健康委办公厅 (2024). 关于印发食管癌筛查与早诊早治方案（2024年版）和胃癌筛查与早诊早治方案（2024年版）的通知（国卫办医急函〔2024〕200号）. https://www.nhc.gov.cn/wjw/c100378/202406/7008ffe1c77d4457ac73361be75760c7.shtml（附件全文转载：广东省疾病预防控制中心 https://cdcp.gd.gov.cn/jkjy/jkzt/mxfcrxjbfz/content/mpost_4444507.html）
2. 赫捷, 陈万青, 李兆申, 等 (2022). 中国胃癌筛查与早诊早治指南（2022，北京）. 中国肿瘤, 31(7), 488-527（临床问题 7、13）. https://doi.org/10.11735/j.issn.1004-0242.2022.07.A002（同文刊于中华肿瘤杂志, 44(7), 634-666. https://doi.org/10.3760/cma.j.cn112152-20220617-00430）
3. Chen R, Liu Y, Song G, et al. (2021). Effectiveness of one-time endoscopic screening programme in prevention of upper gastrointestinal cancer in China: a multicentre population-based cohort study. Gut, 70(2), 251-260. https://doi.org/10.1136/gutjnl-2019-320200
4. Wei WQ, Chen ZF, He YT, et al. (2015). Long-Term Follow-Up of a Community Assignment, One-Time Endoscopic Screening Study of Esophageal Cancer in China. Journal of Clinical Oncology, 33(17), 1951-1957. https://doi.org/10.1200/JCO.2014.58.0423
5. Jun JK, Choi KS, Lee HY, et al. (2017). Effectiveness of the Korean National Cancer Screening Program in Reducing Gastric Cancer Mortality. Gastroenterology, 152(6), 1319-1328.e7. https://doi.org/10.1053/j.gastro.2017.01.029
6. Zhang X, Li M, Chen S, et al. (2018). Endoscopic Screening in Asian Countries Is Associated With Reduced Gastric Cancer Mortality: A Meta-analysis and Systematic Review. Gastroenterology, 155(2), 347-354.e9. https://doi.org/10.1053/j.gastro.2018.04.026
7. Liu M, Yang W, Guo C, et al. (2024). Effectiveness of Endoscopic Screening on Esophageal Cancer Incidence and Mortality: A 9-Year Report of the Endoscopic Screening for Esophageal Cancer in China (ESECC) Randomized Trial. Journal of Clinical Oncology, 42(14), 1655-1664. https://doi.org/10.1200/JCO.23.01284
8. Hibino M, Hamashima C, Iwata M, Terasawa T. (2023). Radiographic and endoscopic screening to reduce gastric cancer mortality: a systematic review and meta-analysis. The Lancet Regional Health – Western Pacific, 35, 100741. https://doi.org/10.1016/j.lanwpc.2023.100741

Translated from the Chinese original. Original book, section 1, tip 47. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer