Challenges in evaluation of screening for gastric cancer among men based on nonrandomized design

Background: Objective was to quantify biases in screening for gastric cancer when comparing attenders to nonattenders using serum pepsinogen I (SPGI) level as primary test.Methods: In mid 1990s, all men aged 51-65 years from two Finnish cities were invited to SPGI screening. Mortality and premature mortality in attenders were compared to nonattenders. Efficacy of screening was studied by 15 years' follow-up of standardized mortality ratio (SMR) and potential years of life lost (PYLL) due to gastric cancer. Bias due to selective attendance was quantified using corrective coefficients based on total cancer incidence and mortality, and gastric cancer-specific incidence and mortality for total population and nonattenders.Results: In 1994-1996, men aged 51-65 years (16,872) were invited to SPGI assay and 12,175 men (72%) attended. SPGI was 25 microg/l or less in 610 (5%) men, indicating severe atrophic gastritis (AG). Post-screening gastroscopy was performed to 435 men with low SPGI. Of these, 168 men were referred for treatment due to abnormal focal lesions. Attributable proportions in reductions of SMR and PYLL from gastric cancer due to screening were 59% and 67%. After correcting for selective participation, attributable proportions were reduced to 23% and 39%.Conclusions: Biomarker screening by low SPGI among middle-aged men followed by upper gastrointestinal endoscopy decreased long-term and premature mortality due to gastric cancer. However, in spite of methodological corrections done, the results do not justify any firm conclusions or recommend general screening programs. Randomized trials are warranted for this purpose.Peer reviewe

Oesophageal cancer incidence in 20-year follow-up in a population-based sample of 12 000 middle-age men with or without Helicobacter pylori infection in Finland

Non peer reviewe

A cross-national comparison of physician utilization by the socioeconomic status groups

This study is a part of a three stage pursuit to examine and to comprehend the relationship between the resources available, the apparent utilization patterns of those resources by the population being served, and the selected characteristics of the populations utilizing and not utilizing the prevailing medical care system. The first stage of the research involves the examination of the existing patterns of medical care utilization by socioeconomic status groups. Cross-national Comparison of Physician Utilization by the Socioeconomic Status Groups is the pilot research for the first stage and both modifies and develops the methodology for this type of research and also examines the physician utilization patterns of a population in well defined basic measurements — in this case the socioeconomic status index, the diagnosed disease, and the number of physician contacts. The comparison of the physician utilization patterns of socioeconomic status groups in respect to the prevailing medical care delivery system necessarily involves cross-area studies at least at regional level, but most likely cross-national comparisons as well. This study used already collected data, nevertheless, primary data, which had been collected and partly analysed in the World Health Organization/International Collaborative Study of Medical Care Utilization. The data came from twelve geographical areas, altogether from seven countries, and provided documented research material on the surveyed respondents' social characteristics, standard diagnostic procedures, and standard definitions of the interactions between the users and the prevailing medical care delivery systems. The social characteristics were used separately, but in a standardized way, in order to derive socioeconomic status groups in each area; the diseases distributions were examined in relationship to the socioeconomic status groups, and the physician utilization patterns were related to the socioeconomic status groups while controlling for the distributions of selected diseases, after which the study areas were compared to each other in terms of the exhibited relationships between the physician utilization and the socioeconomic status groups. The physician utilization patterns were found to vary only little from one area to another, however, consistently, to warrant the use of derived information for the second stage of the research. Physician utilizations were very weakly correlated to the socioeconomic status and these correlations were not substantially effected by the selection of the controlling disease, i.e., they were consistent.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat

Enne­nai­kaisten kuolemien aiheuttamat elinvuosien menetykset pohjoisen ulottuvuuden kumppa­nuus­maissa 2003–13

Lähtö­kohdat: Täs­sä tutki­muk­sessa tarkas­tellaan ehkäis­tä­vissä olevien enne­nai­kaisten kuo­lemien ta­kia mene­tet­tyjä elin­vuosia Suo­messa ja seitse­mässä muus­sa poh­joisen ulot­tu­vuuden kumppa­nuus­maassa. Mene­telmät: Enne­nai­kai­seksi kuole­maksi määri­teltiin en­nen 70 ikä­vuotta tapah­tunut kuo­lema. Mene­tetyt elin­vuodet las­kettiin ikä­va­kioi­dusti 100 000 hen­kilöä koh­ti vuo­sina 2003, 2009 ja 2013. Tu­lokset: Eniten elin­vuosia mene­tettiin vuon­na 2013 Valko-Ve­nä­jällä, 9 851/100 000, ja vä­hiten Ruot­sissa, 2 511/100 000. Suo­messa me­netys oli 3 115/100 000 eli yh­teensä noin 170 000 elin­vuotta. Nais­ten mene­tetyt elin­vuodet olivat Suo­messa sa­malla ta­solla kuin Ruot­sissa, mut­ta mie­hillä mene­tykset olivat suu­remmat. Eniten mene­tet­tyjä elin­vuosia aiheut­tivat ul­koiset syyt, toi­seksi eniten syö­vät ja kolman­neksi eniten veren­kier­toe­linten sai­raudet. Alko­ho­li­kuo­lemien ta­kia mene­te­tyissä elin­vuo­sissa oli suurim­millaan yli 10-ker­tainen ero; Suo­mi si­joittui kes­kiarvon huonom­malle puo­lelle. Enne­nai­kai­sesti mene­tet­tyjen elin­vuosien mää­rä vä­heni kai­kissa tutki­mukseen osal­lis­tu­neissa mais­sa vuo­desta 2003 vuo­teen 2013. Pää­telmät: Vertai­lussa Suo­mi si­joittuu hy­vin syö­pien ja sy­dän- ja veri­suo­ni­tautien aiheut­taman enne­nai­kaisen kuollei­suuden ehkäi­syssä, mut­ta itse­murhien ehkäi­syssä ja eri­tyi­sesti alko­holin aiheut­tamien kuo­lemien ­vä­hen­tä­mi­sessä hei­kommin. Mies­ten ja nais­ten enne­nai­kaisen kuollei­suuden ta­kia mene­te­tyissä elin­vuo­sissa on Suo­messa huomat­tavan suu­ri ero

Risk of gastric cancer in Helicobacter pylori infection in a 15-year follow-up

Objective: We investigated the risk of gastric cancer among men with Helicobacter pylori (H. pylori) infection or atrophic gastritis (AG) in a 15-year follow-up. Materials and methods: Study population consists of 12,016 men aged 50–65 years at the beginning of the follow-up in 1994–1996. Serum levels of pepsinogen I (SPGI) and antibodies (IgG) to H. pylori (HpAb) were assayed from serums collected in 1994–1996. Incidence of gastric cancer in the study population was assessed in follow-up from 1994 to 2011 by data from the nationwide cancer registry. Based on SPGI and HpAb values, standardized incidence ratios (SIRs) of gastric cancer were calculated in three subgroups, that is, in those with a healthy stomach, those with H. pylori infection but without AG and those with AG. Risk ratios (RR) of gastric cancer were calculated using SIR of subgroups. Results: During 15 years, seven gastric cancers appeared per 79,928 person years among men with healthy stomachs, 50 cancers per 92,533 person years in men with H. pylori infection but without AG, and 8 per 8658 person years in men with AG. Risk ratio (RR) of stomach cancer in men with H. pylori infection was 5.8 (95%CI: 2.7–15.3) compared to men with healthy stomachs, and 9.1 (95%CI: 2.9–30.0) in men with AG. There were no differences in cancer risk between cardia and distal stomach. Conclusions: Risk of gastric cancer is low in men with healthy stomachs. It is significantly increased in those with H. pylori infection and more in those with AG.This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any wa