Screening for and surveillance of premalignant conditions of the stomach.

Strategies for population-based screening are thus far only implemented in high incidence countries such as South Korea or Japan with data showing a positive impact on gastric cancer mortality. Screening in most Western countries is deemed not cost-effective as these are mainly classified as low or intermediate risk regions. This is in part due to high costs for endoscopy as the diagnostic gold-standard. Blood testing for serum pepsinogens is implemented as a pre-screening tool in some Asian countries but can better highlight mucosal atrophy than the cancer itself. Endoscopic surveillance of patients with advanced preneoplastic conditions allows detection of early neoplastic lesions that can be treated endoscopically, resulting in better outcome, and is hence now also recommended by several European countries. However, there is no uniform approach, so screening and surveillance strategies need to take regional characteristics into account including gastric cancer incidence and cost for endoscopy among others.