Esophageal cancer and gastric cancer are relatively common malignant tumors, which seriously threaten the health of mainland residents. Recently, the National Health Commission issued the "Esophageal Cancer Screening, Early Diagnosis and Early Treatment Program (2024 Edition)" and the "Gastric Cancer Screening, Early Diagnosis and Early Treatment Program (2024 Edition)". What are the key points of the two plans? How can esophageal and stomach cancer be prevented? How can I be diagnosed and treated early? Relevant experts have interpreted this.
People at high risk of esophageal cancer
Applicants must be ≥ 45 years old and meet any of the following:
(1) Living in areas with a high incidence of esophageal cancer (defined by county-level administrative districts, and the age-standardized incidence rate based on the structure of Chinese mouth in 2000 > 15/100,000).
(2) Parents, children, siblings and other first-degree relatives have a history of esophageal cancer.
(3) Bad eating habits and lifestyles such as hot food, high-salt diet, pickled food, smoking, and heavy drinking.
(4) Chronic esophagitis, Barrett's esophagus, esophageal diverticulum, achalasia, reflux esophagitis, benign esophageal strictures and other diseases.
(5) Have a history of diagnosis and treatment of precancerous lesions of the esophagus.
Excerpt from "Esophageal Cancer Screening, Early Diagnosis and Early Treatment Program (2024 Edition)"
People at high risk of stomach cancer
Applicants must be ≥ 45 years old and meet any of the following:
(1) Living in an area with a high incidence of gastric cancer (defined by county-level administrative districts, with an age-standardized incidence >rate of 20/100,000 based on the structure of Chinese population in 2000).
(2) Parents, children, siblings and other first-degree relatives have a history of gastric cancer.
(3) Urea breath test, serum Hp antibody, and fecal Hp antigen test are any positive.
(4) Bad lifestyles and eating habits such as smoking, heavy drinking, high-salt diets, and pickled foods.
(5) Suffering from chronic atrophic gastritis, gastric ulcer, gastric polyps, residual stomach after surgery, hypertrophic gastritis, pernicious anemia and other diseases.
Excerpt from "Gastric Cancer Screening, Early Diagnosis and Early Treatment Program (2024 Edition)"
Prefer to "eat hot" and beware of burning esophageal cancer
Esophageal cancer is one of the most common malignancies worldwide. According to the 2020 Global Cancer Statistics, the number of new cases of esophageal cancer reached 604,000 and the number of deaths reached 544,000. Although the incidence and mortality of esophageal cancer in China are declining, it is still one of the major malignant tumors that threaten the health of mainland residents.
"The esophagus is a tubular passage for food to enter the stomach through the mouth, and it is one of the most important digestive tract organs in the human body, and the malignant tumor that occurs in the esophageal mucosal epithelium is esophageal cancer, and the main histological type of esophageal cancer in mainland China is squamous cell carcinoma." According to Chai Huiping, chief physician of the Department of Thoracic Surgery of the First Affiliated Hospital of Anhui Medical University, the "Esophageal Cancer Screening, Early Diagnosis and Early Treatment Program (2024 Edition)" clearly points out that the main risk factors for esophageal cancer include specific dietary habits, unhealthy lifestyle, relevant medical history and genetic factors.
"For example, Chinese people prefer hot food in their diet, advocating 'eating while it's hot' and 'drinking it while it's hot'. Freshly boiled hot tea and freshly scalded hot pot may have a better flavor, but this 'heat' must be grasped well, because overheated tea and food can easily cause irritation and damage to the esophageal mucosa. Chai Huiping introduced that under normal circumstances, the esophageal mucosa will start self-repair after being damaged, but if the long-term diet is too hot, the mucosa will continue to circulate the process of "damage-repair", and in the long run, the esophageal mucosa may appear dysplasia, precancerous lesions, and increase the risk of cancer. Therefore, it is important to control the temperature of the food and not eat hot food.
According to Chai Huiping, liking pickled, smoked, barbecued foods or frequent consumption of moldy foods will also increase the risk of esophageal cancer. Pickled, barbecued, smoked food, fried food, etc. contain a lot of nitrite, nitrite will produce nitrosamines after entering the human body, and moldy foods are prone to produce aflatoxin, both of which are strong carcinogens. In areas with a high incidence of esophageal cancer, such as the area near the Taihang Mountains, many residents used to like hot and scalding food, and also ate more pickled and smoked foods, such as sauerkraut and salted meat, which increased the risk of esophageal cancer.
"In addition, smoking and excessive alcohol consumption are also one of the risk factors for esophageal cancer." Chai Huiping reminded that in order to reduce the risk of esophageal cancer, it is necessary to change poor eating habits and unhealthy lifestyles. For example, do not eat particularly dry, hard and hot food, do not eat overnight dishes, do not eat moldy food, eat less or do not eat pickled, smoked, and barbecued foods, reasonably match meals to balance nutrition, eat more foods rich in vitamins, trace elements and dietary fiber, and eat more fresh vegetables and fruits. At the same time, quit smoking, quit drinking alcohol or drink less, chew slowly when eating, etc.
To stay away from stomach cancer, it is advisable to actively eradicate Helicobacter pylori
Gastric cancer refers to an epithelial-derived malignancy that originates in the stomach. According to the latest data from China in 2020, the incidence and mortality rate of gastric cancer ranked third among all malignant tumors. There are about 1.2 million new cases of gastric cancer in the world every year, and China accounts for about 40% of them.
"Globally, East Asia is one of the regions with a high incidence of gastric cancer. There are many risk factors for the development of gastric cancer, and age is an important one. The incidence of gastric cancer is less than 1/100,000 before the age of 25, but the incidence will increase year by year after the age of 45. According to Li Zhemin, deputy chief physician of the first ward of the Gastrointestinal Cancer Center of Peking University Cancer Hospital, the "Gastric Cancer Screening, Early Diagnosis and Early Treatment Program (2024 Edition)" starts from five aspects: environment, genetics, infection, lifestyle and past medical history, comprehensively lists the main risk factors for gastric cancer, and clearly defines the high-risk groups of gastric cancer.
The Gastric Cancer Screening, Early Diagnosis and Treatment Protocol (2024 Edition) clearly states that Helicobacter pylori (Hp) infection is one of the main risk factors for gastric cancer. If you are infected with Helicobacter pylori, is it not far from stomach cancer?
"Not really. Studies have found that infection with H. pylori does increase the risk of stomach cancer, and the incidence of stomach cancer is also high in areas with a high rate of positive detection of H. pylori. However, being infected with H. pylori does not mean that you will definitely get stomach cancer in the future. Li Zhemin introduced that like other tumors, the occurrence of gastric cancer is a multi-factorial, multi-step complex process, and genetic factors, environmental factors, bad lifestyle habits and past medical history are closely related to the occurrence of gastric cancer. Helicobacter pylori itself can cause chronic inflammation, peptic ulcers, etc., so even if most infected people have no symptoms, it is recommended to actively eradicate Helicobacter pylori to reduce the risk of stomach cancer, even if conditions permit.
"Most people's stomach cancer is not hereditary, and just because a relative has it doesn't mean that they will have cancer. However, if there is an immediate family member who has stomach cancer, the risk of other members is indeed increased. Li Zhemin introduced that smoking, heavy drinking, unclean diet, like to eat pickled food, high-salt diet and other dietary habits will also increase the risk of stomach cancer. In addition, those who have suffered from chronic atrophic gastritis, gastric ulcers, gastric polyps, gastric residual gastric diseases and other gastric precancerous diseases after surgery are also high-risk groups for gastric cancer, and should go to the hospital for regular examinations to achieve early prevention, early detection and early treatment.
Early symptoms are not obvious, and regular screening is key
According to experts, whether it is esophageal cancer or gastric cancer, both programs emphasize early diagnosis and early treatment. However, most of the patients with esophageal cancer and gastric cancer have no obvious clinical symptoms in the early stage, and when patients return to the hospital after symptoms, they often have progressed to the middle and advanced stages, missing the best treatment window and increasing the medical burden.
"Early esophageal cancer usually has no specific symptoms, and the typical symptoms of mid-to-late stage esophageal cancer are progressive dysphagia, which is difficult to swallow first dry food, then semi-liquid food, and finally difficult to swallow water and saliva." In recent years, the 5-year survival rate of patients with advanced esophageal cancer in mainland China has improved, but it is still at a low level, and if it can be detected and treated early, the 5-year survival rate of patients can be significantly improved.
"For stomach cancer, the effect of treatment varies greatly depending on the time of detection. More than 90% of early-stage gastric cancer can be cured, but if it is advanced or advanced gastric cancer, the overall 5-year survival rate is less than 50%. Li Zhemin emphasized that for most people, only after screening can they know whether their stomach has lesions.
Both protocols recommend endoscopy for esophageal cancer and gastric cancer screening, and it is recommended that people at high risk of esophageal cancer and gastric cancer undergo endoscopy every 5 years in principle, and those with related lesions are recommended to shorten the screening interval.
"One of the highlights of these two programs is that they are very targeted, emphasizing screening for high-risk groups of esophageal cancer and stomach cancer." Li Zhemin introduced that taking gastric cancer as an example, the incidence of gastric cancer in the general population is low, and endoscopy for gastric cancer screening requires a lot of human and material resources, and the acceptance of patients is low. Therefore, screening only for high-risk groups is an effective approach.
"For people over the age of 40 who have a family history of malignant tumors, it is recommended to have a routine physical examination with endoscopy every year." Chai Huiping introduced that as far as esophageal cancer and gastric cancer are concerned, endoscopy is what people often call gastroscopy. Regular gastroscopy in high-risk groups is beneficial for early detection of esophageal and gastric abnormalities. Once an early lesion is found, it can be taken out for biopsy by gastroscopy to determine the nature of the lesion, and if conditions permit, the lesion can be directly removed under gastroscopy for early treatment.
On social media, some netizens said they were shy away from gastroscopy because of the fear of pain. "In fact, painless gastroscopy has become more popular now. For the screener, it's just a sleep, and before you know it, the test is over. Li Zhemin reminded that prevention, screening, and early diagnosis are the most economical and effective means to treat tumors, and if you want to stay away from esophageal cancer and stomach cancer, you should not only pay attention to early screening, but also establish the concept of healthy life and develop healthy eating habits and lifestyles.
People's Daily overseas edition reporter Wang Meihua
Source: People's Daily Overseas Edition
