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Epidemiology

Effect of risk-based screening for upper gastrointestinal cancers: a multi-center real-world study

British Journal of Cancer volume 133, pages 1038–1045 (2025)Cite this article

Subjects

Abstract

Background

To evaluate the feasibility, effectiveness, and cost-effectiveness of risk-based sequential screening for upper gastrointestinal (UGI) cancer via questionnaire-based quantitative models.

Methods

We applied the risk-based screening strategy to the ongoing government-administered screening project in two areas (Longde and Litong) of Ningxia Hui Autonomous Region, China. Through epidemiological investigation, participants assessed as high-risk were invited for endoscopic screening.

Results

A total of 9492 participants were enroled and completed questionnaire-based assessment, and 2552 (26.89%) participants were evaluated as high-risk. Among the high-risk subjects, 1198 (46.94%) individuals further received endoscopic examination. The detection rate of risk-based screening was 2.28 times as high as that of historical data of universal screening (p = 0.002) (Longde: 2.15% vs. 0.99%; Litong: 1.18% vs. 0.38%), with a similar early detection rate of ~60–70%. The average cost for detecting one case and the average cost for detecting one early case were 30.76% lower (Longde: $12,919 vs. $16,783; Litong: $21,836 vs. $45,512) and 28.99% lower (Longde: $20,993 vs. $24,475; Litong: $30,570 vs. $75,854), respectively, than those for universal screening.

Conclusions

This real-world, multi-centre study demonstrates that risk-based sequential screening is feasible and cost-effective in detecting UGI cancers, and is expected to be applied in other areas.

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Fig. 1
Fig. 2: Detection rates of upper gastrointestinal cancers and average screening costs for detecting one case in risk-based sequential screening (2023) and universal screening (2018–2022).
Fig. 3: Endoscopic images, G-score, and E-score of one case with double primary upper gastrointestinal cancers in risk-based sequential screening (2023).

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Data availability

Data used in this study are available from the corresponding authors upon reasonable request.

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Acknowledgements

The authors gratefully acknowledge all the following experts, collaborators, and team members for their assistance in this study: Cheng Li and Hua Zheng from the Health Commission of Ningxia Hui Autonomous Region; Wenhe Kuai and Yi Yang from Ningxia Center for Disease Control and Prevention; Yang Bo, Shengjuan Hu, Miao Zhang, Na Zhang, Xiaobing Yu, Xianmei Chen, Jun Liu, and Linke Ma from People’s Hospital of Ningxia Hui Autonomous Region; Minqiang Li and Xiongjie Zhai from the Health Bureau of Longde; Zhihong Chen from the Health Commission of Wuzhong; Zhiping Li and Kaishi Wang from Wuzhong Center for Disease Control and Prevention; Chunbi Tao from Longde County People’s Hospital; Ying Wang from Wuzhong People’s Hospital; Zeyu Yan, Dongze Chen, Mengqiu Wu, Ji Ke, Zifan Qi, Wei He, Jing Qin, and Yi Huang from Peking University Cancer Hospital & Institute. The authors would also like to thank Tencent Healthcare, all the township leaders, village doctors, and participants in this study.

Funding

This work was supported by the Tencent Charity Foundation; the National Key R&D Program of China [grant number 2021YFC2500405]; and the Beijing Natural Science Foundation [grant number 7222243]. The funders of the study had no role in study design, collection, analysis, and interpretation of data, or writing of the report.

Author information

Author notes

  1. These authors contributed equally: Hongrui Tian, Mengfei Liu, Zhen Liu, Chao Shi, Lei Chen, Yine Zhang.

Authors and Affiliations

  1. Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Genetics, Peking University Cancer Hospital & Institute, Beijing, China

    Hongrui Tian, Mengfei Liu, Zhen Liu, Lei Chen, Hongchen Zheng, Wenlei Yang, Yaqi Pan & Huanyu Chen

  2. Ningxia Clinical Research Institute, People’s Hospital of Ningxia Hui Autonomous Region, Ningxia Medical University, Yinchuan, China

    Chao Shi

  3. Ningxia Center for Disease Control and Prevention, Yinchuan, China

    Yine Zhang & Mei Li

  4. Wuzhong Center for Disease Control and Prevention, Wuzhong, China

    Xiaoli Li & Xiaoming Ma

  5. Longde Center for Disease Control and Prevention, Guyuan, China

    Yincheng Ma & Yingying Liang

  6. Department of Gastroenterology, Wuzhong People’s Hospital, Wuzhong, China

    Ruichun Shi

  7. Endoscopy Center, Longde County People’s Hospital, Guyuan, China

    Hongli Liu

  8. Health Commission of Ningxia Hui Autonomous Region, Yinchuan, China

    Jinhan Lv

  9. State Key Laboratory of Molecular Oncology, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Genetics, Peking University Cancer Hospital & Institute, Beijing, China

    Zhonghu He & Yang Ke

Authors
  1. Hongrui Tian
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Contributions

Hongrui Tian: Formal analysis, Investigation, Writing – original draft, Writing – review & editing. Mengfei Liu: Formal analysis, Investigation, Writing – original draft, Writing – review & editing. Zhen Liu: Investigation, Writing – original draft. Chao Shi: Project administration, Investigation, Writing – original draft. Lei Chen: Formal analysis, Investigation, Writing – original draft, Writing – review & editing. Yine Zhang: Investigation, Writing – original draft. Mei Li: Investigation. Xiaoli Li: Investigation. Yincheng Ma: Investigation. Xiaoming Ma: Investigation. Yingying Liang: Investigation. Ruichun Shi: Investigation. Hongli Liu: Investigation. Hongchen Zheng: Investigation. Wenlei Yang: Investigation. Yaqi Pan: Investigation. Huanyu Chen: Investigation. Jinhan Lv: Conceptualisation. Zhonghu He: Conceptualisation, Formal analysis, Investigation, Writing – original draft, Writing – review & editing. Yang Ke: Conceptualisation, Writing – original draft, Writing – review & editing.

Corresponding authors

Correspondence to Zhonghu He or Yang Ke.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

This study was approved by the Institutional Review Board of the Peking University School of Oncology, China (No. 2022KT69), and performed in accordance with the Declaration of Helsinki. Informed consent was obtained from each participant.

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Tian, H., Liu, M., Liu, Z. et al. Effect of risk-based screening for upper gastrointestinal cancers: a multi-center real-world study. Br J Cancer 133, 1038–1045 (2025). https://doi.org/10.1038/s41416-025-03138-7

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