Should Asian Americans Be Routinely Screened for Gastric Cancer With Endoscopy?
Vanessa M. Shami, MD, FASGE, reviewing Shah SC, et al. Clin Gastroenterol Hepatol 2020 Jul 21.
There are no current guidelines in the United States for gastric cancer screening, even with a high population of immigrants from Asian-Pacific countries. Studies have suggested that these individuals retain their elevated risk of gastric cancer while residing in the United States, but there remains a lack of both insurance coverage and adequate screening measures. Here, the authors were able to generate a decision-analytic Markov model to simulate a cohort of 50-year-old Asian Americans with 3 strategies: (1) one-time upper endoscopy (EGD) at the screening colonoscopy; (2) EGD with screening colonoscopy and subsequent examinations every 2 years; and (3) no endoscopic screening. The study outcomes included incremental cost-effectiveness ratios (ICERs) with a willingness-to-pay threshold of $100,000 per quality-adjusted life-year (QALY).
For asymptomatic 50-year-old Asian Americans, the one-time EGD strategy was the most cost-effective strategy (ICER of $75,959/QALY) compared to the other two strategies. The lowest ICERs were among Chinese Americans ($68,256/QALY), Japanese Americans (males, $69,011/QALY; females, $73,748/QALY), and Korean Americans (males, $70,739/QALY; females, $70,236/QALY). Furthermore, the biennial EGD strategy was found to be less effective and more expensive.
COMMENTThis study demonstrates a much-needed focus that is lacking from our current gastric cancer screening guidelines for Asian Americans. We are hopeful that future research can translate modeling systems into clinical practice, as this population is estimated to double by 2060. There also needs to be a large push to ensure insurance coverage for screening EGDs regardless of additional gastric cancer risk factors, including family history of gastric cancer, tobacco use, or Helicobacter pylori infection.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Shah SC, Canakis A, Peek RM, Saumoy M. Endoscopy for gastric cancer screening is cost-effective for Asian Americans in the United States. Clin Gastroenterol Hepatol 2020 Jul 21. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2020.07.031)
