X-ray
Screening Reduces
Gastric Cancer Mortality
in Costa Rica
X-ray screening is
associated with a
halving of gastric
cancer mortality in a
community in Costa Rica,
according to a report in
the October 2nd issue of
the British Journal of
Cancer.
"Mortality from gastric
cancer can be
substantially reduced
with a good,
well-designed screening
intervention," Dr. Luis
Rosero-Bixby from
Universidad de Costa
Rica, San José, said.
But this does not come
cheap and it is not easy
to do.
Dr. Rosero-Bixby and Dr.
R. Sierra evaluated the
impact of a two-wave
mass-screening program
for gastric cancer
carried out in Costa
Rica from 1996 to 2000.
X-ray detected gastric
pathologies meriting
endoscopy in 34 per cent
of participants in the
first wave of the study
and 20 per cent of
participants in the
second wave, resulting
ultimately in the
diagnosis of 59 gastric
cancers in the first
wave and 28 in the
second wave.
Most cancers (55 per
cent in the first wave,
80 per cent in the
second wave) were at an
early stage, the report
indicates.
Sensitivity of X-ray
screening for detecting
gastric cancer was
around 90 per cent
overall, but the
positive predictive
value was only 3 per
cent. The mortality rate
during the 2 to 7 years
after screening was
considerably lower than
the rates in the control
groups, the
investigators say,
ranging from 41 per cent
to 52 per cent of the
control rates.
Five-year survival among
screened patients found
to have gastric cancer
was 95 per cent for
early cases and 77 per
cent for late cancer
stage at diagnosis,
significantly higher
than in the control
groups.
Based on a cost of
us$1,000 per
examination, the
researchers estimate the
pilot program to be
around $300,000 per
saved life.
"In any scenario, the
costs of the screening
program seem far too
high in a country like
Costa Rica where yearly
health expenditures are
in the order of us$300
per capita," the authors
write.
"The public health
system in Costa Rica
currently limits X-ray
screening to the highest
risk area in the
country," Dr. Rosero-Bixby
explained. "A danger
with this approach may
be that individuals who
feel themselves healthy
will not go for the
screening." For a
successful program, much
parallel education will
be needed to motivate
individuals to attend
screenings.
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