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The Effect of Nationwide Organized Cancer Screening Programs on Gastric Cancer Mortality: a Synthetic Control Study.

Gastroenterology 2023 November 24
BACKGROUND & AIMS: Nationwide organized gastric cancer (GC) screening programs have been running for decades in South Korea and Japan. This study aimed to conduct a quasi-experimental analysis to assess the population impact of these programs on GC mortality.

METHODS: We used the flexible synthetic control method (SCM) to estimate the effect of the screening programs on age-standardized GC mortality and other upper gastrointestinal (UGI) diseases (esophageal cancer and peptic ulcer) among people aged 40 years or above. World Health Organization mortality data and country-level covariates from the World Bank and the Global Burden of Diseases study were used for the analyses. We compared post-intervention trends in outcome with the counterfactual trend of the synthetic control, and estimated average post-intervention rate ratios (RRs) with associated 95% confidence intervals (CIs). A series of sensitivity analyses were conducted.

RESULTS: The pre-intervention fits were acceptable for the analyses of South Korea and Japan's GC mortality but poor for Japan's other UGI disease mortality. The average post-intervention RRs are 0.83 (95% CI 0.71-0.96) for GC mortality and 0.72 (0.57-0.90) for other UGI disease mortality in South Korea. The RR reached 0.59 by the 15th year after the initiation of nationwide screening. For Japan, the average RRs were 0.97 (0.88-1.07) for GC mortality and 0.93 (0.68-1.28) for other UGI disease mortality. Sensitivity analysis reveals the result for Japan may potentially be biased.

CONCLUSION: South Korea's nationwide GC screening has apparent benefits while the Japanese program's effectiveness is uncertain. The experiences of South Korea and Japan could serve as a reference for other countries.

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