Stratification of gastric cancer risk based on family history with cost-effectiveness of opportunistic endoscopic screening: a hospital-based cross-sectional study (SIGES)

Objectives The strategy for opportunistic endoscopic screening driven by family history of gastric cancer needs to be optimized in a tailored manner through further risk stratification. Methods A hospital-based cross-sectional study included health check-up controls and gastric cancer patients at West China Hospital, Sichuan University. Demographic characteristics, comorbidities, family history of malignancies, and serology were analyzed for associations with gastric cancer risk. Associations between family history of gastric cancer and incident gastric cancer risk were assessed, and a rapid cost-effectiveness analysis was performed. Results In total, 58,218 observations were analyzed, including 619 gastric cancer patients. Family history of gastric cancer was an independent risk factor for gastric cancer (adjusted odds ratio [aOR] = 5.59, 95% CI 3.81–8.20) and was associated with an increased risk of upper digestive tract benign comorbidities (aOR = 1.51, 95% CI 1.09–2.71). For persons with a family history of gastric cancer who were older than 40 years (odds ratio [OR] = 2.36, 95% CI 1.29–4.32), endoscopic screening could be mildly recommended in general practice. Endoscopic screening should be moderately recommended for those with a family history of gastric cancer if they were older than 60 years (OR = 8.90, 95% CI 3.84–20.61) and strongly recommended if they also had upper digestive tract benign comorbidities (OR = 16.78, 95% CI 7.03–40.06), seropositivity for carcinoembryonic antigen (CEA) and/or carbohydrate antigen 19-9 (CA19-9) (OR = 20.77, 95% CI 9.15–47.14), or anemia (OR = 80.11, 95% CI 33.07–194.05). A rapid cost-effectiveness analysis indicated that moderate-to-strong recommendations were preferred, but based on willingness-to-pay considerations, mild-to-strong recommendations had a considerable detection rate for gastric cancer. Sensitivity analysis yielded consistent findings for decision-making. Conclusions Family history of gastric cancer is an independent risk factor for gastric cancer. Optimized risk stratification based on family history can improve the cost-effectiveness of detecting gastric cancer. The mechanism by which a family history of gastric cancer increases gastric cancer risk and a more tailored family history-driven endoscopic screening strategy require further investigation.