Is stomach cancer screening on your mind? If so, you need to find out more about the benefits and the risks of being tested.
It is true that if you looked at a population of people without symptoms and investigated them, a certain percentage would have the disease.
Well, at this point you would probably say GREAT lets do it! But wait, is this really the right thing to be doing?
First of all you need to consider the tests that you need to make a diagnosis and the risks of having that test. So....
Probably the most common test that would be recommended to you is an endoscopy or flexible camera examination of your upper gastrointestinal tract.
To do this you need to:
Now don't get me wrong, an endoscopy is a safe test if carried out by a qualified endoscopist.
However, even the best endoscopist in the world will have complications in a small number of procedures (you can read more about that in the diagnosis section).
So you need to take this in to account. You also need to take in to account the cost to either yourself, depending on whether you pay for the procedure or the cost to the government of your country.
In the UK, an average cost of a diagnostic endoscopy in the private sector is around £900.
For a government, using public health services such as the NHS, the cost is lower although still substantial and currently not available in most countries.
There's also the cost of taking away money or resources from other health areas if using this form of screening test.
And at what age do you have your endoscopy? Well, we know the risk increases with age and is rare under the age of 40 years.
So, if you were to have a test it would seem sensible to have it when over the age of 40 years.
So, what about other tests you might ask?
Well, you could consider a barium meal. This is a test that involves swallowing a contrast dye that shows up on x-ray.
However, there are risks involved with this too which you can read about in the diagnosis section.
An endoscopy is more likely to pick up smaller cancers than a barium meal test.
Also, if you have a suspicious test, you will be advised to have an endoscopy in most cases!
What about CT scanning as a way of testing? After all, this is a comfortable easy test to do.
Well, the issue here is giving radiation to an otherwise healthy person and differentiating a benign from a cancerous lesion.
It is okay for picking up advanced gastric cancer, but not early one's that we all want to pick up so that it can be successfully treated.
Again, with both CT and Barium testing there is a resource issue too.
When you look at the current evidence for stomach cancer screening there is very little good evidence to show benefit.
This is because the studies have either been very small or larger scale studies have not found benefit.
Yes, if you look for it and pick it up early survival odds are very good. However, you have to do a lot of tests to pick up 1 cancer.
So for now, in the USA and UK the likelihood is for continued "opportunistic" testing in those requesting it.
Some countries such as Japan and Korea are doing stomach cancer screening, but their populations seem to have higher rates than the US and UK.
People are looking at defining high risk groups and investigating that population.
This would seem sensible as it is condensing a group that are at high risk rather than looking at mass population screening.
Use of other tests that may indicate increased risk such as testing for H.pylori infection, Serum Pepsinogen I/II ratio's, previous diagnosis of gastric atrophy and genetic tendency may be the step forward as well as other tests in the future.