GUT 1997;41:513-517 ( October )

Gastric cancer below the age of 55: implications for screening patients with uncomplicated dyspepsia

J Christie, N A Shepherd, B W Codling, R M Valori

Gloucester Gastroenterology Group, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK

Correspondence to: Dr R M Valori.

Accepted for publication 4 June 1997

AimsTo test the hypothesis that gastric cancer presenting with uncomplicated dyspepsia is rare below the age of 55. 
Patients and methodsThe area studied was the postcode defined catchment area of a district general hospital (Gloucestershire Royal) serving a population of 280 500. An open access endoscopy service has been available in this district for more than 17 years. All cases of gastric cancer during a seven year period (1986-92) were drawn from the local pathology database. The database of the neighbouring hospital and the South West Cancer Registry were searched for missed cases from the postcoded area. Hospital and general practitioner records were retrospectively reviewed with respect to duration of symptoms, and previous consultation and investigation for dyspepsia; and alarming symptoms and signs suggestive of underlying malignancy (unexplained recent weight loss, dysphagia, haematemesis or melaena, anaemia, previous gastric surgery, palpable mass, and perforation).
ResultsTwenty five of 319 cases of gastric cancer detected during the seven year period were aged less than 55. Twenty four of these 25 patients presented with one or more suspicious symptoms or signs. Only one patient (4%) aged less than 55 presented with uncomplicated dyspepsia. In two patients there was a delay in diagnosis of more than six months after first presenting to the general practitioner. Both these patients had significant symptoms at presentation.
ConclusionGastric cancer is rare below the age of 55 (7.8% of all cases) and, even in the presence of established open access endoscopy, presents with suspicious symptoms or signs in 96% of cases. The age limit for screening uncomplicated dyspepsia can be raised safely to 55. 
(GUT 1997;41:513-517)

Keywords: gastric cancer;  open access endoscopy;  disease prevention;  disease control;  general practice;  epidemiology;  diagnosis

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© 1997 by Gut
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