Gastric cancer below the age of 55: implications for screening patients with uncomplicated dyspepsia

Abstract

Aims: To test the hypothesis that gastric cancer presenting with uncomplicated dyspepsia is rare below the age of 55.

Patients and methods: The area studied was the postcode defined catchment area of a district general hospital (Gloucestershire Royal) serving a population of 280,500. An open access endoscopy service has been available in this district for more than 17 years. All cases of gastric cancer during a seven year period (1986-92) were drawn from the local pathology database. The database of the neighbouring hospital and the South West Cancer Registry were searched for missed cases from the postcoded area. Hospital and general practitioner records were retrospectively reviewed with respect to duration of symptoms, and previous consultation and investigation for dyspepsia; and alarming symptoms and signs suggestive of underlying malignancy (unexplained recent weight loss, dysphagia, haematemesis or melaena, anaemia, previous gastric surgery, palpable mass, and perforation).

Results: Twenty five of 319 cases of gastric cancer detected during the seven year period were aged less than 55. Twenty four of these 25 patients presented with one or more suspicious symptoms or signs. Only one patient (4%) aged less than 55 presented with uncomplicated dyspepsia. In two patients there was a delay in diagnosis of more than six months after first presenting to the general practitioner. Both these patients had significant symptoms at presentation.

Conclusion: Gastric cancer is rare below the of 55 (7.8% of all cases) and, even in the presence of established open access endoscopy, presents with suspicious symptoms or signs in 96% of cases. The age limit for screening uncomplicated dyspepsia can be raised safely to 55.

Figure 1

: Incidence of gastric cancer in West Gloucestershire and in England and Wales.

Figure 2

: Frequency of suspicious symptoms or signs in patients aged less than 55 with gastric cancer.

Figure 3

: Pathological findings in patients aged over 55 with gastric cancer. (A) Type; (B) differentiation; (C) position; (D) H pylori status.