Editor,—We read with interest the paper by Christieet al (Gut 1997;41:513–17) discussing screening of patients for gastric cancer below the age of 55 in the context of an open access endoscopy service. Based on their data the authors suggest that gastric cancer is rare below the age of 55 and presents with suspicious symptoms and signs in the overwhelming majority of cases. Thus they advocate a lower age limit of 55 for screening “uncomplicated” dyspepsia.

There are however a number of fundamental flaws in the design and interpretation of this study. The data are retrospective and incomplete and based on the study of only 25 patients (the under 55 group) out of 319 with gastric cancer. There is no comparison of this group with the remaining 296 patients over 55 with regard to pattern of presentation or symptoms.

Perhaps more importantly there is no mention of the number of patients who actually presented for endoscopy or were picked up on the open access service. Surely the only way to set protocols for this service would be to analyse the data from it. In contrast this study seems merely to …