World-first NTUH cancer screening test featured in medical journal

Taipei, Oct. 16 (CNA) The success of National Taiwan University Hospital's (NTUH) two-in-one screening model in getting people to be tested for colorectal and gastric cancer markers has been highlighted in the Journal of the American Medical Association (JAMA).

The findings of the decade-long "large-scale pragmatic randomized clinical trial" on the two-in-one screening model in Changhua County were published in JAMA, a peer-reviewed international medical journal, on Oct. 1, according to the hospital.

Lee Yi-chia (李宜家), deputy director of NTUH's Department of Medical Research, said the stool test combines testing for blood in the stool, a colorectal cancer marker, and for Helicobacter pylori (H. pylori) bacteria, a potential indicator of gastric cancer.

The trial found that by combining the two, more people were willing to engage in cancer screening, reducing the risk of death from colorectal cancer and the probability of getting gastric cancer, Lee added.

In particular, Lee said, for those who underwent the two-in-one screening compared to those who only received a single fecal immunochemical test (FIT) for colorectal cancer, gastric cancer incidence was reduced by 32 percent.

The World Health Organization has recognized the H. pylori bacteria as a Group 1 carcinogen, but many countries are "still unsure about how to screen it effectively" from a public health perspective, Lee said.

Although preventing an H. pylori infection, which often shows no symptoms, can significantly lower the risk of gastric cancer, many countries have had trouble getting people to get screened for it, Lee noted.

Stool, blood and breath tests for H. pylori are all available, but some countries have promoted endoscopies as the main test method, Lee said, making it even less likely people get tested.

An endoscopy is an invasive procedure that involves running a tube with a camera down a patient's throat, and the test's discomfort or the need to have it done under full-body anesthesia can discourage people from having it done.

First piloted in 2012 as a collaboration between NTUH and the Changhua County Public Health Bureau, the combination FIT and H. pylori fecal antigen test increased participation rates by 14 percent in the study compared to inviting individuals to undergo only the FIT, an NTUH statement released Wednesday said.

The two-in-one test also drew in people in Changhua County who had previously not participated in colorectal cancer screening programs, the statement added.

That reflects the essence of the test program, which Lee described as "an organized screening program on the population level for asymptomatic people."

Lee said the study's findings were highly regarded, with the article in the JAMA receiving nearly 20,000 views within two weeks of its publication, and JAMA Associate Editor John Inadomi discussing the results in his podcast.

In addition to Changhua County, the two-in-one screening model has been implemented this year in nine cities and counties, said Lin Li-ju (林莉茹), director of the Health Promotion Administration's Cancer Prevention and Control Division.

Those cities and counties are Keelung, New Taipei, Miaoli County, Taichung, Nantou County, Chiayi City, Tainan, Pingtung County, and Penghu County, Lin said, and more cities and counties are expected to join the program next year.

The test is available at health bureau offices in those locations.

Around 16,000 and 4,000 people, respectively, are diagnosed with colorectal cancer and gastric cancer each year, making them the second and eighth most common cancers in Taiwan, with around 8,000 people dying from the two cancers combined annually, according to Lin.