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. 2022 Oct 1;13(10):e00530.
doi: 10.14309/ctg.0000000000000530.

Reevaluation of Gastric Cancer Screening by Levin's Equation

Naoki Ishii  1 , Yasutoshi Shiratori  2 , Takahiko Yano  1 , Mimoe Konai  1 , Yuki Arai  1 , Jun Hamada  1 , Hisato Maekawa  1 , Fumio Omata  3
Affiliations

Reevaluation of Gastric Cancer Screening by Levin's Equation

Naoki Ishii et al. Clin Transl Gastroenterol. .

Abstract

Introduction: This study aimed to reevaluate the effectiveness of fluoroscopy and endoscopy in reducing gastric cancer mortality at the population level.

Methods: Crude and age-adjusted mortality rates of gastric cancer and the introduction rates of gastric cancer screening were extracted from the Cancer Registry and Statistics database. The population-attributable risk (PAR) percent of no screening for gastric cancer mortality was calculated using Levin's equation. The PAR of each mortality rate in the no-screening group was estimated as follows: mortality × PAR%. The Jonckheere-Terpstra test for trends and linear regression were performed to compare the PAR of gastric cancer mortality rates among the decades.

Results: The PAR of crude and age-adjusted mortality rates in the no-screening group significantly decreased in the total population ( P for trend <0.001), as well as individually in the male ( P for trend <0.001) and female ( P for trend <0.001) populations. The PAR of the crude mortality rate in the female population significantly decreased in 2000-2009 and 2010-2019, compared with that in 1980-1989. There was no significant difference in the PAR of crude mortality rate in the male population among the decades. The PAR of the age-adjusted mortality rate significantly decreased in 2000-2009 and 2010-2019, compared with that in 1980-1989, in the male and female populations.

Discussion: PAR% and PAR of no screening for gastric cancer mortality could be estimated using Levin's equation, and the effectiveness of the present gastric cancer screenings with fluoroscopy and endoscopy has been decreasing, especially in the female population.

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Conflict of interest statement

Guarantor of the article: Naoki Ishii, MD, PhD, MPH.

Specific author contributions: All the authors have contributed significantly to and agree on the content of the manuscript. Each author's contribution to the manuscript is as follows: N.I.: designed and conducted the study and performed statistical analysis; N.I., Y.S., and F.O.: collected and interpreted the data; N.I.: drafted the article; Y.S., T.Y., M.K., Y.A., H.M., and F.O.: critically revised the manuscript. All authors read and approved the submitted version of the manuscript.

Financial support: None to report.

Potential competing interests: None to report.

Figures

Figure 1.
Figure 1.
Crude mortality and age-adjusted mortality rates from 1958 to 2019. The Jonckheere-Terpstra test for trends was performed for crude and age-adjusted mortality rates across decades. Crude and age-adjusted mortality significantly decreased in the total population (P for trend <0.001 and <0.001), in the male population (P for trend <0.001 and <0.001), and in the female population (P for trend <0.001 and <0.001). A 2-tailed P value of <0.05 was considered statistically significant.
Figure 2.
Figure 2.
Estimated PAR of crude and age-adjusted mortality rates of no screening from 1958 to 2019. The Jonckheere-Terpstra test for trends was performed for the PAR of crude and age-adjusted mortality rates of no screening. The PAR of crude and age-adjusted mortality rates for no screening significantly decreased in the total population (P for trend <0.001), in the male population (P for trend <0.001), and in the female population (P for trend <0.001), irrespective of the number of endoscopy screenings. A 2-tailed P value of <0.05 was considered statistically significant. PAR, population-attributable risk.
See this image and copyright information in PMC

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