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Peer-reviewedCC BY 4.0Esophagus

Incidental detection of cancers during population-based endoscopic gastric cancer screening in Japan

  • Kensuke Uraguchi1
  • Kenta Hamada2
  • Naomi Matsumoto3
  • Toshiharu Mitsuhashi4
  • Mizuo Ando1
  • Kenji Fujimoto5
  • Shunsaku Hayase3
  • Takashi Yorifuji3
5 affiliations
  1. 1Department of Otolaryngology–Head and Neck Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558 Japan
  2. 2Department of Practical Gastrointestinal Endoscopy, Okayama University, Okayama, Japan
  3. 3Department of Epidemiology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
  4. 4Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
  5. 5Occupational Health Data Science Center, University of Occupational and Environmental Health, Kitakyushu, Japan
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Abstract

Background: Upper gastrointestinal endoscopy traverses the full upper aerodigestive tract, unlike radiography, potentially enabling incidental detection of non-gastric malignancies. However, its population-level incidental detection rate for non-gastric upper aerodigestive tract cancers has not been systematically quantified. The aim of this study was to compare endoscopic screening with radiography and quantify detection of non-gastric upper aerodigestive tract cancers in a population-based setting.

Methods: This population-based cohort study was conducted by linking the Okayama City municipal gastric cancer screening registry with the Kokuho Database (KDB) for fiscal years 2016–2021. Among 36,326 participants contributing 64,822 screening examinations (40,832 radiography; 23,990 endoscopy), diagnoses of oral cavity, pharyngeal, laryngeal, and esophageal cancer occurring within 2 months of screening were ascertained from the KDB. Generalized estimating equations with modified Poisson regression were used to estimate adjusted risk ratios (aRRs) comparing endoscopy with radiography.

Results: Endoscopic screening was significantly associated with higher composite incidental detection rates for non-gastric upper aerodigestive tract cancers (95.9 vs. 34.3 per 100,000 examinations; aRR 2.94, 95% confidence interval [CI] 1.50–5.76; p = 0.002). Specifically, esophageal cancer detection was markedly higher with endoscopy (83.4 vs. 17.1 per 100,000; aRR 5.16, 95% CI 2.16–12.32; p < 0.001). No statistically significant differences were observed for oral cavity, pharyngeal, or laryngeal cancers.

Conclusions: Endoscopic gastric cancer screening is associated with substantially higher incidental detection of non-gastric upper aerodigestive tract cancers, particularly esophageal cancer. These findings suggest an additional detection value for endoscopy that extends beyond its primary gastric cancer target in organized screening programs.

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Cite

BibTeXRIS
BibTeX
@article{uraguchi2026incidental,
  title = {{Incidental detection of cancers during population-based endoscopic gastric cancer screening in Japan}},
  author = {Kensuke Uraguchi and Kenta Hamada and Naomi Matsumoto and Toshiharu Mitsuhashi and Mizuo Ando and Kenji Fujimoto and Shunsaku Hayase and Takashi Yorifuji},
  journal = {Esophagus},
  year = {2026},
  month = aug,
  doi = {10.1007/s10388-026-01238-8},
  url = {https://doi.org/10.1007/s10388-026-01238-8},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Incidental detection of cancers during population-based endoscopic gastric cancer screening in Japan
AU  - Kensuke Uraguchi
AU  - Kenta Hamada
AU  - Naomi Matsumoto
AU  - Toshiharu Mitsuhashi
AU  - Mizuo Ando
AU  - Kenji Fujimoto
AU  - Shunsaku Hayase
AU  - Takashi Yorifuji
PY  - 2026
DA  - 2026/08/10
JO  - Esophagus
DO  - 10.1007/s10388-026-01238-8
UR  - https://doi.org/10.1007/s10388-026-01238-8
AB  - Background: Upper gastrointestinal endoscopy traverses the full upper aerodigestive tract, unlike radiography, potentially enabling incidental detection of non-gastric malignancies. However, its population-level incidental detection rate for non-gastric upper aerodigestive tract cancers has not been systematically quantified. The aim of this study was to compare endoscopic screening with radiography and quantify detection of non-gastric upper aerodigestive tract cancers in a population-based setting.  Methods: This population-based cohort study was conducted by linking the Okayama City municipal gastric cancer screening registry with the Kokuho Database (KDB) for fiscal years 2016–2021. Among 36,326 participants contributing 64,822 screening examinations (40,832 radiography; 23,990 endoscopy), diagnoses of oral cavity, pharyngeal, laryngeal, and esophageal cancer occurring within 2 months of screening were ascertained from the KDB. Generalized estimating equations with modified Poisson regression were used to estimate adjusted risk ratios (aRRs) comparing endoscopy with radiography.  Results: Endoscopic screening was significantly associated with higher composite incidental detection rates for non-gastric upper aerodigestive tract cancers (95.9 vs. 34.3 per 100,000 examinations; aRR 2.94, 95% confidence interval [CI] 1.50–5.76; p = 0.002). Specifically, esophageal cancer detection was markedly higher with endoscopy (83.4 vs. 17.1 per 100,000; aRR 5.16, 95% CI 2.16–12.32; p < 0.001). No statistically significant differences were observed for oral cavity, pharyngeal, or laryngeal cancers.  Conclusions: Endoscopic gastric cancer screening is associated with substantially higher incidental detection of non-gastric upper aerodigestive tract cancers, particularly esophageal cancer. These findings suggest an additional detection value for endoscopy that extends beyond its primary gastric cancer target in organized screening programs.
SN  - 1612-9059
SN  - 1612-9067
ER  -