Annual screening program led to one of world’s highest survival rates for gastric cancer, but doctors say not all screening is beneficial
In South Korea, the relative survival rate for patients diagnosed with stomach cancer has risen to nearly 80 percent, more than double that of the United States.
This success story is largely attributed to a nationwide early detection campaign that encourages citizens in high-risk groups to undergo annual endoscopy screenings, along with a well-established public health care system.
But South Korea is now considering easing its approach, recommending screenings every two years instead of annually.
The change, announced Tuesday by the state-affiliated cancer institute, is the first revision in a decade and only the second since the guideline was first introduced in 2001.
The new advice also places an age limit on screening. It will now be recommended for people aged 40 to 74, the oldest age at which screening has been confirmed to lower the fatality rate, according to the National Cancer Center. There was previously no upper age limit.
The report by the NCC pointed out that there was not enough evidence to conclude that the benefits of regular gastric cancer screening outweighed the harms for those aged between 75 and 84. The screening is not recommended for those older than 85, since comparison with the control group showed that the procedure actually increases the mortality rate.
Screening comes with potential side effects, and can yield false results that lead to unnecessary treatment, at the same time, the likelihood that treatment will be beneficial also worsens with age.
Contrast radiography, which uses barium to highlight the stomach in X-ray images, is now recommended only for cases where it was deemed medically essential, such as when gastroscopy was not an option. The previous advisory stated “conditional recommendation” after consultation with a physician.
The NCC said that the new recommendation was based on the Grading of Recommendations Assessment, Development, and Evaluation approach, a framework for assessing certainty in evidence and the strengths of recommendations in health care. It was subject to professional and public input at a Sept. 1 public hearing.
Nationwide push for early detection pays off
Yang Han-kwang, the president of the NCC, said this recommendation shows the advancement of Korea’s medical system, and is based on the existing gastric cancer screening system.
Research suggest that East Asian countries are particularly susceptible to gastric cancer, and South Korea ranked fifth in the world in terms of new cases of stomach cancer in 2022, according to the data from the World Cancer Research Fund.
South Korea in 2001 employed a recommendation for the citizens aged 40 and above to be regularly checked for stomach cancer, which had consistently increased the five-year survival rate for gastric cancer patients.
According to the Ministry of Health and Welfare in December, Koreans diagnosed with gastric cancer between 2016 and 2020 had a 78 percent five year relative survival rate, which refers to the survival rate compared to the general population in that time frame. In other words, people with stomach cancer were 22 percent less likely to be alive five years after their diagnosis than the overal population. This was a significant increase from 58 percent 15 years earlier.
The five-year relative survival rate was 37.9 percent in the US for patients diagnosed between 2015 and 2021, according to the US National Cancer Institute.
As of 2021, the mortality rate from stomach cancer in South Korea was reduced to one-fifth of the rate in 1999, decreasing from 23.9 deaths to just 5.9 deaths per 100,000 people.
minsikyoon@heraldcorp.com
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