Upper Endoscopy Prioritized in National Gastric Cancer Screening... Guidelines Revised for the First Time in 10 Years

National Cancer Center: Screening for Those Aged 75 or Older Determined After Individual Consultation
Liver Cancer Screening Every Six Months for High-Risk Groups

For national gastric cancer screening, it is recommended to undergo an upper endoscopy every two years as the primary test. For liver cancer screening, individuals in high-risk groups, such as patients with liver cirrhosis and those at high risk for chronic hepatitis B or C, are advised to have an ultrasound and a serum alpha-fetoprotein (AFP) test every six months.

(ChatGPT Generated Image)

The National Cancer Center announced on the 24th that, together with relevant professional societies such as the Korean Academy of Family Medicine, the Korean Association of Internal Medicine, and the Korean Liver Cancer Association, it has revised the national gastric and liver cancer screening recommendations by applying the international standard GRADE methodology. This is the first revision in ten years since 2015.

The most significant change concerns the method for gastric cancer screening. Previously, the guidelines prioritized upper endoscopy while allowing for optional consideration of upper gastrointestinal series (UGIS). However, the new recommendations present biennial upper endoscopy as the sole first-line screening method.

According to an analysis of domestic studies by the National Cancer Center and the Multidisciplinary Gastric Cancer Screening Guideline Revision Committee, upper endoscopy was found to be superior to UGIS in terms of reducing gastric cancer mortality and diagnostic accuracy. As a result, UGIS is now only considered in special circumstances when upper endoscopy is not feasible, and in general cases, the guideline now conditionally advises against its use.

The screening age range remains unchanged at 40 to 74 years. The committee considered that, for those aged 75 and older, the potential risks from complications during the screening process may outweigh the benefits. Therefore, for individuals aged 75 or above, it is recommended to make an individualized decision regarding screening in consultation with medical professionals, taking into account health status and life expectancy.

The liver cancer screening guidelines have also been revised to reflect the latest research and changes in the domestic healthcare environment. The new recommendations continue to advise screening for high-risk groups, specifically patients with liver cirrhosis and those aged 40 or older with chronic hepatitis B or C. This is based on the extremely high risk of liver cancer onset from the time of cirrhosis diagnosis, as well as domestic statistics on hepatitis prevalence and liver cancer incidence, which indicate the necessity of screening for chronic hepatitis patients after the age of 40.

As before, the recommended screening method is an abdominal ultrasound and AFP test every six months. The committee evaluated recent evidence and determined that this approach is effective for early detection of liver cancer and reducing mortality. In contrast, screening for liver cancer using CT or MRI was placed on hold, as there is insufficient evidence to compare the benefits and risks of these tests.

The committee also considered whether to newly designate patients with nonalcoholic steatohepatitis (NASH), metabolic dysfunction-associated steatohepatitis (MASH), and liver fibrosis as high-risk groups. However, as there is not yet sufficient evidence to recommend screening for these populations, they were not included in the current guidelines.

The National Cancer Center explained that, in preparing the guidelines, it held a public hearing to gather input from experts and stakeholders and comprehensively reviewed cost-effectiveness, safety, and the domestic medical environment.

Sukkyoon Kang, Director of the Cancer Screening Division at the National Cancer Center, stated, "The gastric and liver cancer screening guidelines, revised for the first time in ten years, are evidence-based guidelines that reflect the latest medical research and the domestic healthcare environment. For gastric cancer, we clearly present the effectiveness of upper endoscopy screening, and for liver cancer, we expect the guidelines to contribute to early detection and improved treatment rates for high-risk groups."

The full text of the revised national guidelines for gastric and liver cancer screening can be found on the Cancer Information Center website.

This content was produced with the assistance of AI translation services.