Screening strategies for the early detection of non-cardia gastric cancer in low- to moderate-prevalence regions: Asia-Pacific gastroesophageal cancer congress consensus 2026
Abstract
Abstract Background Gastric cancer (GC) remains a major global health burden, and early detection is essential for improving patient outcomes. Although GC screening has been widely implemented in East Asian countries with a high disease burden, the optimal screening strategy for low- to moderate-prevalence regions remains unclear. To address this gap, the Asia Pacific Gastroesophageal Cancer Congress (APGCC) convened an international consensus meeting to develop evidence-based recommendations for improving the detection of non-cardia gastric cancer (NCGC). Methods The APGCC working group developed 11 clinical questions (CQs) addressing GC screening, with a particular focus on NCGC. For each CQ, assigned authors conducted literature reviews using PubMed and prepared evidence summaries and draft recommendations. Consensus was achieved through a two-round modified Delphi process involving 37 international voting members. Results The consensus recommendations addressed population-based screening, screening modalities, identification of high-risk individuals, quality indicators for esophagogastroduodenoscopy (EGD), image-enhanced endoscopy, and artificial intelligence-assisted endoscopy. Population-based endoscopic screening is not recommended in low- to moderate-prevalence regions because of insufficient evidence. However, if screening is performed, EGD is preferred over upper gastrointestinal series for the detection of early NCGC in asymptomatic individuals. The recommendations also emphasize the importance of high-quality endoscopic examinations, risk-stratified screening using serum biomarkers, and the appropriate integration of advanced endoscopic technologies. Conclusions These APGCC consensus recommendations provide practical guidance for improving the early detection of NCGC in low- to moderate-prevalence regions. This consensus also highlights important evidence gaps and establishes a framework for future research and the development of region-specific GC screening strategies.
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Authors: Ayaka Takasu, Fumiaki Ishibashi, Rapat Pittayanon, Hon Chi Yip, James Weiquan Li, Munkhsaruul Bayaraa, Hyunsoo Chung, Do Hoon Kim, Kamin Harinwan, Quang Dinh Le, Adolfo Parra‐Blanco, P Kassab, Vincenzo Giorgio Mirante, José Murillo-Rodriguez, Regina Rie Imada, Renata Nobre Moura, Sabina Beg, Pedro Delgado‐Guillena, Marta Rodríguez-Carrasco, Seung‐Hun Chon, Chul S. Hyun, Grigorios Christodoulidis, Vo Duy Long, Zili Xiao, Sergey Kashin, Roman Kuvaev, Yhi Wong, Robert Bechara, Mitsuru Esaki, Waku Hatta, Motohiko Kato, Seiichiro Abe, Sho Suzuki, Kohei Takizawa, Joo Ha Hwang, Wai Keung Leung, Duc Trong Quach, Matsuda Satoru, Han-Kwang Yang, Takuji Gotoda
Institutions: University of Hong Kong, Fudan University, University of Medicine and Pharmacy at Ho Chi Minh City, Nottingham University Hospitals NHS Trust, University of Cologne, University Hospital Cologne, King Chulalongkorn Memorial Hospital, Phramongkutklao Hospital, Kyushu University, Chinese University of Hong Kong, Yale University, University of Ulsan, Asan Medical Center, National Cancer Center, Stanford University, Chulalongkorn University, Tohoku University, Stanford Medicine, Nihon University, Seoul National University, Keio University, Huadong Hospital, Irmandade da Santa Casa de Misericórdia de São Paulo, International University of Health and Welfare, Sengkang General Hospital, Instituto do Câncer do Estado de São Paulo, University Medical Center HCMC, Kingston Health Sciences Centre, Japanese Foundation For Cancer Research, East and North Hertfordshire NHS Trust, Azienda Ospedaliera Universitaria Integrata Verona, University Hospital of Larissa, Kanagawa Cancer Center, IPO Porto, Santa Casa Hospital, Bệnh viện Nhân dân Gia Định, SHOWA Medical University Northern Yokohama Hospital, Keio University Hospital, NIHR Nottingham Digestive Diseases Biomedical Research Unit, Yaroslavl State Medical Academy, National Cancer Center Hospital, Phramongkutklao College of Medicine, Costa Rican Department of Social Security, Yaroslavl State University, Tokyo Dental College Ichikawa General Hospital