Liu M, Yang W, Guo C, et al. Effectiveness of Endoscopic Screening on Esophageal Cancer Incidence and Mortality: A 9-Year Report of the Endoscopic Screening for Esophageal Cancer in China (ESECC) Randomized Trial. J Clin Oncol. 2024 Mar 8:JCO2301284. doi: 10.1200/JCO.23.01284. (Original study)

PURPOSE: To evaluate the effectiveness of endoscopic screening against incidence of and mortality from esophageal squamous cell carcinoma (ESCC).

METHODS: From January 2012 to September 2016, we conducted a community-based cluster randomized controlled trial involving permanent residents age 45-69 years in a high-risk region for ESCC in northern China. A total of 668 targeted villages were randomly assigned in a 1:1 ratio to the screening group (offered Lugol's chromoendoscopy) or control group (no screening). Intention-to-treat and per-protocol analyses were performed to compare esophageal cancer (EC) incidence and mortality between the two groups. The per-protocol analysis adjusted for nonadherence to the screening procedure.

RESULTS: A total of 33,847 participants were included in the analysis: 17,104 in the screening group, 15,165 (88.7%) of whom underwent screening, and 16,743 in the control group. During a maximum follow-up of 9 years, EC incidence in the screening and control groups were 60.9 and 72.5 per 100,000 person-years, respectively; mortality in the screening and control groups were 29.7 and 32.4 per 100,000 person-years, respectively. Compared with the control group, the incidence and mortality of the screening group reduced by 19% (adjusted hazard ratio [aHR], 0.81 [95% CI, 0.60 to 1.09]) and 18% (aHR, 0.82 [95% CI, 0.53 to 1.26]), respectively, in the intention-to-treat analysis; and by 22% (aHR, 0.78 [95% CI, 0.56 to 1.10]) and 21% (aHR, 0.79 [95% CI, 0.49 to 1.30]), respectively, in the per-protocol analysis.

CONCLUSION: With a 9-year follow-up, our trial suggests that chromoendoscopic screening induces modest reductions in EC incidence and mortality. A more efficient strategy for EC screening and subsequent patient management should be established to guarantee the effectiveness of endoscopic screening.

Discipline Area Score
Family Medicine (FM)/General Practice (GP) 6 / 7
General Internal Medicine-Primary Care(US) 6 / 7
Public Health 6 / 7
Oncology - Gastrointestinal 6 / 7
Gastroenterology 4 / 7
Comments from MORE raters

Family Medicine (FM)/General Practice (GP) rater

The study results show no statistical significance. There are some limitations including the non-randomized assignment, inconsistent recruitment criteria between groups, and lack of blinding for outcome assessment. These limitations might reduce the effectiveness of endoscopic screening.

Oncology - Gastrointestinal rater

So far, screening for EAC hasn't been successful. This study shows screening can have an impact if implemented large scale.

Public Health rater

A valuable study of a significant condition. The results suggest that screening protocols still need to be refined as the positive benefit of the approach detailed, whilst evident, is not as great as one might hope. Clinicians were clearly aware of EC and seeking to minimise its occurrence, yet a significant cohort in the screened population still succumbed to the disease.
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