An Opportunistic Screening Strategy for Gastric Cancer Based on Questionnaire and Sequential Serology - Hospital-Based Cross-Sectional Study (SIGES)

Sep 30, 2026

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Objectives: develop and validate a candidate selection strategy for opportunistic endoscopic screening (OES) to enable early detection of gastric cancer where massive screening programs are absent. Methods: a hospital-based cross-sectional study enrolled health check-up controls and gastric cancer patients; data combined a questionnaire (demography, comorbidities, family history) and serology (hemoglobin, CEA, CA19-9). Sequential risk-stratification scoring systems were built and cost-effectiveness was evaluated. Results: 58,218 participants were analyzed, including 619 gastric cancer patients (1.1%); male, age >40, family history, upper digestive tract benign diseases, anemia, and elevated CEA and/or CA19-9 independently increased risk. OES was recommended for age ≥50, family history, and/or comorbid UDTBDs, otherwise selected anemia/CEA/CA19-9 in specific subgroups. Conclusions: questionnaire plus sequential serology identifies high-risk candidates with comparable detection and superior cost-effectiveness; further tailored screening and surveillance studies are needed.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages15

Reading Time38 min

AccessFree to download

Introduction

Opportunistic endoscopic screening rationale

Burden of massive screening in China

Abstract

Objectives

Methods

Results

Conclusions

Article An Opportunistic Screening Strategy for Gastric Cancer Based on Questionnaire and Sequential Serology: A Hospital-Based Cross-Sectional Study (SIGES) Wen Xiang 1,2,†, Zhuo-Yu Li 1,†, Yan Huang 3,* and Xin-Zu Chen 1,4,5, *,‡ on behalf of the SIGES Research Group Academic Editors: Tania Triantafyllou, Milo Frattini and Maximos Frountzas Received: 17 November 2025 Revised: 12 December 2025 Accepted: 16 December 2025 Published: 19 December 2025 Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Gastric Cancer Laboratory, Gastric Cancer Center, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, China 2 Department of Thyroid and Breast Surgery, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu 611137, China 3 Health Management Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu 610041, China 4 Ya’an Cancer Prevention and Control Center, Ya’an People’s Hospital—West China Ya’an Hospital, Sichuan University, Ya’an 625000, China 5 Ya’an Key Laboratory for High Altitude Medicine, Ya’an People’s Hospital—West China Ya’an Hospital, Sichuan University, Ya’an 625000, China * [Correspondence: yanhuang@wchscu.edu.cn](Correspondence: yanhuang@wchscu.edu.cn) (Y.H.); [chenxinzu@scu.edu.cn](chenxinzu@scu.edu.cn) (X.-Z.C.)† These authors contributed equally to this work. ‡ Membership of the SIGES Research Group is provided in the Acknowledgments. Abstract Objectives: In the absence of massive screening programs, it is imperative to develop and validate a candidate selection strategy for opportunistic endoscopic screening (OES) targeting the early detection of gastric cancer. Methods: A hospital-based cross-sectional study was conducted, enrolling both health check-up controls and gastric cancer patients. Data collection included two components: (1) a questionnaire including demography, self-reported comorbidities, and family history of cancers; (2) serology including hemoglobin, carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9 (CA19-9). Associations between potential variables and gastric cancer risk were assessed and the predictive efficacy of these risk factors was quantified. Sequentially, risk stratification scoring systems were constructed and their cost-effectiveness profiles were evaluated. Results: A total of 58,218 participants were included in the analysis, among whom 619 (1.1%) were gastric cancer patients. Multivariate analyses identified male, age >40 years, family history of gastric cancer, comorbidities of upper digestive tract benign diseases (UDTBDs), anemia, and elevated serum CEA and/or CA19-9 as independent risk factors of increasing gastric cancer risk. Cost-effectiveness analysis demonstrated that individuals, especially those symptomatic, presenting any of following conditions should be recommended for OES: (1) age ≥50 years, (2) family history of gastric cancer, and/or (3) comorbid UDTBDs. Elsewise, unclear anemia and/or elevated serum CEA and/or CA19-9 presenting among males and/or persons 41–50 years of age should be considered for OES. Notably, this selection strategy achieved a detection rate comparable to that of alternative protocols while yielding superior cost-effectiveness outcomes. Conclusions: The integrated strategy combining questionnaire and sequential serology represents an effective and cost-effective approach to identifying high-risk candidates for gastric cancer OES. Further investigations are warranted to develop more precise and tailored screening and surveillance protocols, with the aim of optimizing both detection rates and cost-effectiveness in clinical practice. Keywords: gastric cancer; screening; end

FAQs

What is the purpose of the opportunistic endoscopic screening (OES) strategy in this study?

The study aims to develop and validate a candidate selection strategy for OES to support early detection of gastric cancer when massive screening programs are not available.

What data sources were used to build the risk-selection strategy?

Risk factors were collected from a questionnaire covering demographics, self-reported comorbidities, and family history, and from serology measuring hemoglobin, CEA, and CA19-9.

Which conditions were recommended for OES based on the cost-effectiveness results?

For symptomatic individuals, OES should be recommended when age is ≥50 years, there is a family history of gastric cancer, and/or comorbid upper digestive tract benign diseases are present.

Sep 30, 2026

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