The optimal starting age of endoscopic screening for esophageal squamous cell cancer in high prevalence areas in China

Abstract

Background and Aim This study aimed to evaluate effects of endoscopic screening method in different starting age groups and further confirm the optimum starting age for ESCC screening. Methods This study received IRB approval, and 6,825 residents aged 40 to 69 years in high prevalence communities were assigned to the screening group or the control (non‐screening) group from Hebei province, China. Cumulative mortalities during the 14‐year period, relative risks (RR) for participants underwent screening, numbers needed to invite for screening (NNS) to save one life were compared between the screening group and the control group of different starting age groups at 14‐year follow‐up. Results The 14‐year risks of ESCC mortality were one in 55, one in 17 and one in 9 for a person screened in the starting age group of 40, 50 and 60 years old. The cumulative mortalities of ESCC in screening groups were significantly lower than control groups in starting age groups of 40 years (1.42% vs 2.38%, p=0.0331) and 50 years (4.18% vs 7.13%, p=0.0053). RR for participants underwent screening were 0.60 and 0.59 for the starting age groups of 40 years and 50 years. NNS to save one life were 104 and 34 for participants aged in 40 years old group and 50 years old group, respectively. Conclusions In conclusion, people in high prevalence area of ESCC should have endoscopy screening once at their 50 years. 40 years will be preferable defined as the starting age for screening in areas with sufficient health resources.