BackgroundThe low uptake rate of upper gastrointestinal cancer (UGC) screening substantially reduces the benefits of endoscopic screening. This study aimed to obtain residents’ UGC screening preferences to optimize screening strategies and increase the participation rate.MethodsA discrete choice experiment (DCE) was conducted to assess UGC screening preferences of 1,000 rural residents aged 40 to 70 years from three countries (Linqu, Feicheng, and Dongchangfu) of Shandong province in China. The DCE questionnaire was developed from five attributes: out-of-pocket costs, screening interval, regular follow-up for precancerous lesions, mortality reduction, and screening technique. The data from the DCE were analyzed within the framework of random utility theory using a mixed logit model.ResultsIn total, 926 of 959 residents who responded were analyzed. The mean (SD) age was 57.32 (7.22) years. The five attributes all significantly affected residents’ preferences, and the painless endoscopy had the most important impact (β=2.927, P<0.01), followed by screening interval of every year (β = 1.184, P<0.01). Policy analyses indicated that switching the screening technique to painless endoscopy would increase the participation rate up to 89.84% (95%CI: 87.04%-92.63%). Residents aged 40–49, with a history of cancer, with a family income of more than ¥30,000 were more likely to participate in a screening.ConclusionsUGC screening implementation should consider residents’ preferences to maximize the screening participation rate. Resources permitting, we can carry out the optimal screening program with shorter screening intervals, lower out-of-pocket costs, less pain, follow-up, and higher UGC mortality reduction.
Purpose To evaluate the effectiveness of endoscopic screening in reducing esophageal cancer mortality within a high-incidence area.
Methods A nested case-control study was conducted based on the Upper Gastrointestinal Cancer Screening Program of Feicheng City. Based on the screening population cohort, individuals who were newly diagnosed with esophageal cancer from September 2006 to December 2016 and died of esophageal cancer before December 2018 as case subjects. Each case matched 4 controls (Subjects who were alive on the date of death of the corresponding case) based on age, gender and screening village. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated via conditional logistic analysis.
Results This study included 345 cases (270 men and 75 women) and 1380 matched controls (1,080 men and 300 women). Compared with individuals who were never screened, the total ORs was 0.52(CI 0.39-0.70) for participants, the OR of screened subjects 40 to 49 years old was 0.34 (CI 0.17-0.67), and the OR for dying from esophageal cancer among individuals who were diagnosed 2 to 4 years was 0.30 (CI 0.17-0.53).
Conclusions Participating in endoscopic screening could reduce the risk of death from esophageal cancer by 48%. The screening effect was related to the age of screening and the period from the screening to the date of diagnosis.
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