Awareness of risk factors and warning symptoms and attitude towards gastric cancer screening among the general public in China: a cross-sectional study

Gastric Cancer Screening: Intention to Adhere and Patients' Perspective

BACKGROUND AND AIMS

Gastric cancer (GC) is the third cause of cancer mortality worldwide. A screening strategy that combines an upper gastrointestinal endoscopy (UGIE) with a screening colonoscopy may be cost-effective in intermediate-risk regions. This study aimed to evaluate the intention to adhere to combined endoscopic screening and assess knowledge of GC symptoms, risk factors, and barriers to screening.

METHODS

Cross-sectional study enrolling individuals eligible for CRC screening in northern Portugal, where a populational fecal occult blood test (FOBT) program is implemented. The validated PERCEPT-PREVENT tool was applied across three groups: (a) not yet invited to CRC screening, (b) FOBT-positive referred to colonoscopy, and (c) primary colonoscopy screening.

RESULTS

A high acceptance rate was observed for combined endoscopic screening (94%; n = 264) [not yet invited to CRC screening 98% (n = 90) vs. FOBT-positive referred to colonoscopy 90% (n = 103) vs. primary colonoscopy 97% (n = 71); p = 0.017], with the vast majority reporting intention to adhere in the setting of full reimbursement (97%; n = 255). Most respondents were unaware of any possible GC symptom (76%; n = 213), risk factor (73%; n = 205), and UGIE-related complication (85%; n = 237). Regular follow-up with the primary care physician (Odds Ratio (OR) 27.59, 95% confidence interval (CI) 2.99-254.57), lower perceived negative health consequences of UGIE (OR 1.40, 95% CI 1.13-1.74), and lower perceived financial burden (OR 2.46, 95% CI 1.04-5.85) were the only factors independently associated with a higher intention to undergo combined screening.

CONCLUSIONS

Willingness to undergo combined endoscopic screening was notably high and positively impacted by lower perceived barriers. Additional efforts should be undertaken to improve levels of digestive health literacy.

Downregulation of lncRNA EPB41L4A-AS1 promotes gastric cancer cell proliferation, migration and invasion

BACKGROUND

The incidence of gastric cancer ranks the first among digestive tract tumors in China. However, there are no specific symptoms in the early stage of the tumor and the diagnosis process is complex, so more effective detection methods are very needed. In this study, a novel long noncoding RNA (lncRNA) was introduced as a diagnostic biomarker for gastric cancer, which brought new thinking to the exploration of its pathological mechanism and clinical prediction.

METHODS

The level of lncRNA EPB41L4A-AS1 (EPB41L4A-AS1) in gastric cancer serum and cells was verified via real-time quantitative polymerase chain reaction (RT-qPCR). Receiver operating characteristic (ROC) curve was performed based on the EPB41L4A-AS1 level, and the diagnostic possibility of EPB41L4A-AS was analyzed. The chi-square test evaluated the correlation between EPB41L4A-AS expression and clinical information. The cells were cultured and transfected in vitro, and the mediations of abnormal EPB41L4A-AS level on the viability and motility of gastric cancer cells were verified through cell counting kit-8 (CCK-8) and Transwell assay. Furthermore, luciferase activity assay was performed to confirm the sponge molecule microRNA-17-5p (miR-17-5p) of EPB41L4A-AS1.

RESULTS

EPB41L4A-AS1 was decreased in gastric cancer, and low EPB41L4A-AS1 level indicated resultful diagnostic value. Overexpression of EPB41L4A-AS1 inhibited the activity of gastric cancer cells, while knockdown of EPB41L4A-AS1 promoted tumor deterioration. EPB41L4A-AS1 directly targeted and regulated the expression ofmiR-17-5p.

CONCLUSION

This study elaborated that EPB41L4A-AS1 is lowly expressed in gastric cancer. Silencing EPB41L4A-AS1 was beneficial to cell proliferation, migration, and invasion. EPB41L4A-AS1 provides a new possibility for the diagnosis of gastric cancer patients by targeting miR-17-5p.

Interventions to Improve Endoscopic Screening Adherence of Cancer in High-Risk Populations: A Scoping Review

Background

Colorectal, and gastric cancers have the second, and fourth mortality rates worldwide, respectively. Endoscopic screening is a crucial diagnostic tool for colorectal, and gastric cancers. Effective interventions can improve adherence to endoscopic screening in high-risk populations, which is important for cancer prevention and mortality reduction. This study aimed to identify interventions that could improve adherence to endoscopic screening for cancer in high-risk populations.

Methods

Combination keywords including colorectal cancer, gastric cancer, screening adherence, and interventions were used to search for articles in PubMed, Web of Science, Cochrane Library, and MEDLINE Complete. The review methodology was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-SCR).

Results

A total of 12 articles were included in this review: 9 randomized controlled trials(RCT) and 3 quasi-experimental studies(QEDs). Among the extracted studies, 11 were about colorectal cancer, and 1 was about gastric cancer. Most studies used lecture-based or Information Technology-based health education interventions. Narrative interventions have proven to be novel and effective approaches for promoting adherence to endoscopic screening. Health education interventions included cancer epidemiology, cancer risk factors, warning symptoms, and screening methods.

Conclusion

All interventions involved were effective in increasing individual knowledge of cancer-related endoscopic screening, willingness to undergo screening, and screening behaviors. These findings provide a reference for designing endoscopy-related cancer screening interventions.

Development of a gastric cancer risk calculator for questionnaire-based surveillance of Iranian dyspeptic patients

BACKGROUND

Gastric cancer (GC) is considered a silent killer, taking more than three quarters of a million lives annually. Therefore, prior to further costly and invasive diagnostic approaches, an initial GC risk screening is desperately in demand.

METHODS

In order to develop a simple risk scoring system, the demographic and lifestyle indices from 858 GC and 1132 non-ulcer dyspeptic (NUD) patients were analysed. We applied a multivariate logistic regression approach to identify the association between our target predictors and GC versus NUD. The model performance in classification was assessed by receiver operating characteristic (ROC) analysis. Our questionnaire covering 64 predictors, included known risk factors, such as demographic features, dietary habits, self-reported medical status, narcotics use, and SES indicators.

RESULTS

Our model segregated GC from NUD patients with the sensitivity, specificity, and accuracy rates of 85.89, 63.9, and 73.03%, respectively, which was confirmed in the development dataset (AUC equal to 86.37%, P < 0.0001). Predictors which contributed most to our GC risk calculator, based on risk scores (RS) and shared percentages (SP), included: 1) older age group [> 70 (RS:+ 241, SP:7.23), 60-70 (RS:+ 221, SP:6.60), 50-60 (RS:+ 134, SP:4.02), 2) history of gastrointestinal cancers (RS:+ 173, SP:5.19), 3) male gender (RS:+ 119, SP:3.55), 4) non-Fars ethnicity (RS:+ 89, SP:2.66), 5) illiteracy of both parents (RS:+ 78, SP:2.38), 6) rural residence (RS:+ 77, SP:2.3), and modifiable dietary behaviors (RS:+ 32 to + 53, SP:0.96 to 1.58).

CONCLUSION

Our developed risk calculator provides a primary screening step, prior to the subsequent costly and invasive measures. Furthermore, public awareness regarding modifiable risk predictors may encourage and promote lifestyle adjustments and healthy behaviours.

Cognition of the warning symptoms and risk factors for cancer among Chinese college students: a cross-sectional study based on a summer social practice activity

BACKGROUND

To investigate the cognition of cancer warning symptoms and cancer risk factors among Chinese college students, analyze the influencing factors, and explain the correlations between cancer cognition and cancer symptom discrimination, cancer fear and psychological distress.

METHODS

Chinese college students were recruited in this cross-sectional study funded by a summer social practice activity in Yunnan Province, China. Cognition rates of cancer warning symptoms and cancer risk factors were evaluated using Cancer Warning symptoms Cognition Questionnaire (CWSCQ) and Cancer Risk Factors Cognition Questionnaire (CRFCQ), respectively. Factors associated with cognition of cancer warning symptoms, and factors associated with cognition of cancer risk factors were evaluated using multiple linear regression analysis. Interactions between cancer cognition, cancer symptom discrimination, psychological distress, and cancer fear were evaluated by structural equation modeling.

RESULTS

There were 846 effective samples, with an effective rate of 80.9%. The cognition rates of cancer warning symptoms were from 47.9% to 84.4%, which were affected by cancer symptom discrimination, education, attitudes towards cancer screening, living expenses, drinking history, and ways to obtain cancer knowledge (p < 0.05). The cognition rates of cancer risk factors were from 46.3% to 91.3% in participants, which were affected by education, cancer symptom discrimination, psychological distress, attitudes towards cancer screening, life satisfaction, cancer history in relatives and friends, ways to obtain cancer knowledge, smoking history, and nursing history for cancer patients (p < 0.05). Cancer cognition and cancer symptom discrimination showed intermediary effects on psychological distress and cancer fear (p < 0.001).

CONCLUSIONS

The overall cancer cognition situation among Chinese college students is not optimistic, which highlights the necessity of improving the cancer health literacy among Chinese college students. With the increasing morbidity and mortality rates of cancer, it is necessary to raise awareness of early detection, and early treatment of cancer among the general public. Health education interventions are helpful to improve cancer health literacy.

The role of corporate social responsibility and government incentives in installing industrial wastewater treatment plants: SEM-ANN deep learning approach

Contaminated industrial wastewater is one of the severe causes of health diseases. The wastewater treatment trend in developing countries is less, and governments are not strictly pursuing the wastewater management protocols adopted by firms. To study the intention to install wastewater treatment plants at the firm level and provide policy suggestions to the developing countries' governments, we have collected a cross-sectional dataset from manufacturing firms. We have presented an integrated model based on the theory of planned behaviour and tested our proposed model by implying SEM-ANN deep learning techniques. Results revealed that Environmental knowledge, installation cost, firm reputation, and corporate social responsibility positively influence firm management's intention to install wastewater treatment plants, but awareness of the risk associated with contaminated wastewater has a negative influence. On the other hand, Government incentives do not influence the process. In addition, our study has found that firm size moderates the relationship between explained and exploratory variables. Our study provided valuable insight into the available literature and provided some policy suggestions to developing countries' governments to cope with water scarcity and health issues caused by contaminated industrial wastewater.

Predictors of cancer screening behavior of the working population in China based on the information-motivation-behavioral skills model

Background

The cancer screening rate in the working population is very low in China. Information-motivation-behavioral skills (IMB) model has been applied to elucidate screening behavior for various chronic diseases but has not been investigated in analyzing cancer screening behavior. This study aimed to examine factors influencing cancer screening behavior and their linkages based on the IMB model.

Methods

A cross-sectional study was conducted in Shanghai, China from August to October 2021. Data were obtained through an anonymous questionnaire. Predictive relationships between variables in the IMB model and cancer screening behavior were evaluated. Structural equation modeling (SEM) was constructed to demonstrate the utility of the IMB model.

Results

Among the 556 participants included in the analysis, 34.4% of participants had ever done a cancer screening. The construct validation analysis supported that the measure items included were acceptable. SEM found that knowledge of cancer warning signs and symptoms (β = 0.563, p < 0.001) and cancer screening behavioral skills (β = 0.264, p = 0.003) were related to participation in cancer screening, whereas cancer screening motivation was not directly influenced the participation in cancer screening (β = - 0.075, p = 0.372).

Conclusion

The cancer screening rate was found to be lower than expected in the working population. The IMB model could be used to make decisions in implementing behavioral interventions to participate in cancer screening among the Chinese working population. Enhancing the knowledge of cancer warning signs and symptoms and strengthening behavioral skills should be focused on to improve participation in cancer screening.

Determinants of gastric cancer screening attendance in Southeastern China: a cross-sectional study

OBJECTIVES

This study aimed to identify the determinants of gastric cancer screening attendance among individuals aged 40 years in a region with high gastric cancer in China.

DESIGN

An anonymous, cross-sectional survey was conducted between October 2021 and March 2022.

SETTING

A self-administered online survey was conducted in Fujian Province in Southeastern China.

PARTICIPANTS

People aged 40 years living in five selected cities in Fujian Province with no history of cancer.

MAIN OUTCOME MEASURES

Gastric cancer screening attendance was measured with the question 'Have you ever been screened for gastric cancer in the past'.

RESULTS

In total, 2547 complete responses were obtained. The mean age of respondents was 47.72±7.20 years, and 59.8% were men. A total of 42.6% of participants reported that they had undergone gastric cancer screening. The result of multivariable logistic regression analysis showed that participants with a first-degree relative affected with gastric cancer (OR=2.02, 95% CI: 1.58 to 2.59) and high perceived susceptibility of gastric cancer (OR=2.03, 95% CI: 1.58 to 2.59) were the strongest facilitators for screening attendance. Other factors positively associated with screening attendance were age 51-60 years (OR=1.69, 95% CI: 1.31 to 2.18), living in urban regions (OR=1.27, 95% CI: 1.05 to 1.55), friends/neighbours/colleagues with gastric cancer (OR=1.30, 95% CI: 1.07 to 1.58), history of chronic gastric disease (OR=1.90, 95% CI: 1.57 to 2.30), perceived high cost (OR=1.28, 95% CI: 1.01 to 1.61) and physician recommendation (OR=1.71, 95% CI: 1.36 to 2.16). On the other hand, factors negatively associated with screening attendance included perceived barriers, namely screening is only necessary when symptoms present (OR=0.71, 95% CI: 0.58 to 0.87) and perceived appointment for gastroscopy screening is difficult and time-consuming (OR=0.75, 95% CI: 0.60 to 0.94). No significant association was found between knowledge level and participation in screening.

CONCLUSION

This study highlights important individual-level factors and barriers to gastric cancer screening. Strategies targeting under-screened populations and eliminating patient-perceived barriers to gastric cancer screening are essential.

Knowledge, attitude, and practice of healthcare workers on early gastrointestinal cancer in China

Objective

Gastrointestinal cancer is the leading cause of cancer-related death in China, and its early screening is largely recommended by healthcare workers. This study investigated the knowledge, attitudes, and practice (KAP) of healthcare workers on early gastrointestinal cancer (EGC).

Methods

This cross-sectional study was conducted on healthcare workers who volunteered to participate from 30 hospitals in China between September and December 2022. A self-administered questionnaire including 37 questions was developed.

Results

A total of 545 completed questionnaires were finally obtained. Healthcare workers had moderate knowledge level [9.22 ± 1.80 (65.88±12.89%), total score: 14], positive attitude [21.84 ± 2.67 (91.01 ± 11.14%), total score: 24], and excellent practice level [19.07 ± 4.43 (79.47 ± 18.44%), total score: 24] on EGC. Pearson's correlation analysis suggested that knowledge score was positively correlated with attitude (r = 0.264, P < 0.001) and practice score (r = 0.140, P = 0.001), and higher attitude score was significantly correlated with higher practice score (r = 0.380, P < 0.001), which were supported and reinforced by structural equation modeling. In addition, subgroup analysis showed that knowledge scores might be influenced by sex, age, education, type of hospital, type of occupation, professional title, and years of working (all P < 0.05); attitude scores might be influenced by years of working (P < 0.05); and practice scores were statistically distinct among groups of different sex, department, and years of working (all P < 0.05).

Conclusion

Healthcare workers have moderate knowledge level, positive attitude, and excellent practice levels on EGC. Good knowledge and positive attitude might be correlated with excellent practice. KAP level might be influenced by sociodemographic characteristics.

Knowledge and Awareness About Gastric Cancer Among the General Population in Al-Baha City, Saudi Arabia

Background Gastric cancer is a significant health concern worldwide, and its incidence varies across different populations. This study aimed to assess the level of knowledge and awareness of gastric cancer among the general population in Al-Baha City, Saudi Arabia.  Methodology This is a cross-sectional study that was conducted among the residents of Al-Baha city older than 18 years. The study was conducted based on a questionnaire that has been developed by a previous study. Data were initially recorded in an Excel sheet before being exported to the SPSS program, version 25 for data analysis. Results The survey included 426 respondents from Al-Baha city, Saudi Arabia, with 56.8% being females and the majority being in the age groups (21-30 years). Alcohol consumption (mean=4.5, SD= 0.77), smoking cigarettes or Shisha (mean= 4.38, SD=0.852), family history of gastric cancer (mean= 4, SD=1.008), a past medical history of gastric cancer (mean= 3.99, SD=0.911), stomach ulcer (mean=3.76, SD=0.898), and consumption of smoked food (mean= 3.69, SD=0.956) are the most widely recognized risk factors. The most highly recognized symptoms are gastrointestinal bleeding (mean= 4.03, SD=0.875), abdominal lump (mean= 3.94, SD=0.926), weight loss (mean= 3.93, SD=0.963), recurrent nausea and vomiting (mean=3.76, SD=0.956), and abdominal pain (mean= 3.57, SD=0.995). The study also identified several subgroups of the population that may benefit from targeted educational programs, including individuals in the age group of 41-50 years and those in non-medical occupations. Conclusion The study found that participants had a moderate level of knowledge about the risk factors and symptoms of gastric cancer, with significant variability among different subgroups of the population. Further research is needed to investigate the prevalence and risk factors of gastric cancer in Saudi Arabia and other similar populations, to develop effective prevention and management strategies for this disease.

Development of a Low-Cost Gastroscope Prototype (GP) for Potential Cost-Effective Gastric Cancer Screening in Prevalent Regions

Background Screening for gastric cancer is known to be associated with reduced mortality in populations with high prevalence. However, many countries with high prevalence do not screen, with high costs being a significant reason for this.

Aims To describe, develop, and assess the potential for a low-cost gastroscope for early cancer screening and patient risk stratification.

Methods Our interdisciplinary team used both off-the-shelf and fabricated components to create multiple gastroscope prototypes (GP) in iterative fashion based off clinician feedback. Clinician endoscopists were surveyed using Likert scales regarding device potential, video quality, and handling when testing on a GI training device. Video quality comparison to clinically standard high-definition white light endoscopy (HD-WLE) was done using the absolute categorical ratings (ACR) method.

Results A candidate cost-effective GP with clinical potential was developed. Although initial versions were scored as inferior via ACR on all views tested when compared to HD-WLE (p < 0.001), participants agreed the concept may be beneficial (M = 4.52/5, SD = 0.72). In testing improved versions, participants agreed the device had the ability to identify discrete (M = 4.62/5, SD = 0.51) and subtle lesions (M = 4/5, SD = 0.7) but most felt video quality, although improved, was still less than HD-WLE. Sufficiency of maneuverability of device to visualize gastric views was rated as equivocal (M = 2.69/5, SD = 1.25). Conclusion The presented low-cost gastroscopic devices have potential for clinical application. With further device development and refinement including the possible addition of technologies in telemedicine and artificial intelligence, we hope the GP can help expand gastric cancer screening for populations in need.

Screening Behaviors and Related Factors among the First-Degree Relatives of Chinese Patients with Gastric Cancer

Objective

This study was aimed at investigating the screening behaviors of the first-degree relatives (FDRs) of Chinese patients with gastric cancer as well as the factors influencing screening behaviors.

Methods

In a cross-sectional design, 197 FDRs of patients with gastric cancer were enrolled at the Peking University Cancer Hospital. Four questionnaires were used: a demographic questionnaire, a knowledge questionnaire of risk factors and warning symptoms for gastric cancer, the Gastric Cancer Health Belief Scale, and a questionnaire screening for behavioral motivators and barriers. Logistic regression analysis was performed to determine the factors influencing screening behaviors.

Results

Among the 197 FDRs of patients with gastric cancer, 30.96% (61/197) of patients had undergone gastric cancer screening. Among those who participated in gastric cancer screening, the most common screening methods were gastroscopy and the Helicobacter pylori testing, both of which were applied in 63.93% (39/61) of participants, followed by serum tumor marker testing (55.74%, 34/61) and barium meal examination of the upper digestive tract (29.51%, 18/61). The gastric cancer risk factor knowledge score was 9.02 ​± ​3.95, and the gastric cancer warning symptom knowledge score was 4.39 ​± ​1.85. The participants' knowledge score was moderate, at 13.41 ​± ​5.16. The total health beliefs score was low, at 88.91 ​± ​12.66. Factors independently associated with the screening behaviors of FDRs included educational background, knowledge of gastric cancer risk factors, and health motivation (P ​< ​0.05).

Conclusions

The participation rate in gastric cancer screening of FDRs of patients with gastric cancer was relatively low and was affected by multiple factors. Our results highlighted the urgent need for educational campaigns and precision interventions to raise gastric cancer awareness.

Risk factors in the development of gastric adenocarcinoma in the general population: A cross-sectional study of the Wuwei Cohort

Several risk factors have been identified for the development of gastric adenocarcinoma (GAC), where the control group was usually a healthy population. However, it is unclear at what stage known risk factor exert their influence toward the progression to cancer. Based on the Wuwei Cohort, we enrolled 1,739 patients with chronic non-atrophic gastritis (no-CAG), 3,409 patients with chronic atrophic gastritis (CAG), 1,757 patients with intestinal metaplasia (IM), 2,239 patients with low-grade dysplasia (LGD), and 182 patients with high-grade dysplasia (HGD) or GAC to assess the risk factors between each two consecutive stages from no-CAG to GAC/HGD using adjusted logistic regression. We found that different groups of risk factors were associated with different stages. Age, occupation of farmer, low annual family income, Helicobacter pylori (H. pylori) infection, drinking, eating hot food, histories of gastritis and peptic ulcer were associated with the development of CAG. Age, illiteracy, H. pylori infection, smoking, eating hot food, eating quickly, and histories of gastritis and gallbladder diseases were associated with the progression to IM from CAG. Male, occupation of farmer and history of peptic ulcer were associated with the development of LGD from IM. Age, male and polyp history appeared to be risk factors associated with the development of GAC/HGD from LGD. In conclusion, it seems that most risk factors function more as a set of switches that initiated the GAC carcinogenesis. H. Pylori eradication and control of other risk factors should be conducted before IM to decrease the incidence of GAC.

The safety and efficacy of carbon nanoparticle suspension injection versus indocyanine green tracer-guided lymph node dissection during radical gastrectomy (FUTURE-01): A single-center randomized controlled trial protocol

Background

The use of lymph node (LN) tracers can help obtain a complete dissection of the lymph nodes and increase the detection rate of LNs and metastatic LNs. Carbon nanoparticle suspension injection (CNSI) and indocyanine green (ICG) have been widely used in radical gastrectomy in recent years. Nevertheless, the comparison of their clinical effects has not been studied.

Method/design

The FUTURE-01 trial will be the first randomized, open-label, single-center trial to compare CNSI and ICG. The study started in 2021 and enrolled 96 patients according to a prior sample size calculation. The primary outcome is the number of LNs retrieved. The secondary outcomes are LN staining rate, LN metastasis rate, stained LN metastasis rate, perioperative recovery and survival.

Conclusion

By comparing the safety and efficacy of CNSI and ICG tracer-guided LN dissection in patients with gastric cancer, we can determine the most appropriate LN tracer at present. With the help of LN tracers, the operation is simplified, and the prognosis of these patients is improved. Our study is a prospective exploration of the safety, efficacy, and prognosis of CNSI and ICG.

Clinical trial registration

https://clinicaltrials.gov/ct2/show/NCT05229874?cond=NCT05229874&draw=2&rank=1, identifier NCT05229874.

Knowledge and information sources towards Helicobacter pylori in Jordan

In 2017, the Jordanian Ministry of Health reported that gastric cancer was one of Jordan's most diagnosed cancers. Gastric cancer is often linked to Helicobacter pylori, one of the foremost risk factors. Despite the high prevalence of H. pylori in Jordan, no information is available regarding the general population's awareness of the harmful effects of this pathogen. The study aims to assess the knowledge and the impact of the source of knowledge on H. pylori among the general population in Jordan. A cross-sectional study involving 933 participants was conducted between May and July of 2021. After meeting the inclusion criteria and consenting to participate in this study, participants completed the questionnaire. An interview-based questionnaire covered the following sections: sociodemographic data and knowledge related to H. pylori infection. 63% of the participants had a high level of education, 70.5% got their information about H. pylori infection from non-medical sources, and 68.7% had a low level of knowledge. Working in the medical field, attaining information from medical resources, and having a history of self-reported or family member of H. pylori infection showed a significant association with a high level of knowledge. The Mann-Whitney U test showed that the mean ranks of all knowledge items in the medical source group significantly exceed those of the non-medical source group (p-values < 0.05). In Jordan, the awareness of H. pylori was unsatisfying, like in other countries. Nevertheless, misconceptions in knowledge about H. pylori were identified and further awareness must be spread and advocated. Close observation of the non-medical sources of information is essential for delivering sufficient amount of knowledge to the general population.

Willingness to Undergo Gastroscopy for Early Gastric Cancer Screening and Its Associated Factors During the COVID-19 Pandemic - A Nationwide Cross-Sectional Study in China

PURPOSE

This study aimed to investigate the willingness of Chinese adults aged 40 years and older to undergo gastroscopy for gastric cancer (GC) screening during the COVID-19 pandemic in 2020. The secondary purpose was to identify factors influencing willingness to undergo gastroscopy.

METHODS

A cross-sectional questionnaire survey was conducted in selected cities and counties from nine provinces in China using a multi-stage sampling approach. A multivariate logistic regression model was used to determine the independent predictors of willingness to undergo gastroscopy.

RESULTS

This study included 1900 participants, and 1462 (76.95%) responded that they would undergo gastroscopy for GC screening. Participants of younger age, from the eastern region, living in an urban area, with higher educational levels, with Helicobacter pylori (H. pylori) infection, or with precancerous stomach lesions, were more willing to undergo gastroscopy. The top four reasons to reject gastroscopy were fear of pain or discomfort, worry about a possible devastating test result, no symptoms in self-feeling, and concern about the high expense. Of all those who would reject gastroscopy for GC screening, 36.76% (161/438) would be willing to accept painless gastroscopy, while 24.89% (109/438) would be willing to undergo gastroscopy screening if higher medical reimbursement rates were available. Participants considered that gastroscopy was a relatively fearful and unknown procedure, accompanied by high risks and benefits compared to all other life events.

CONCLUSION

In general, 76.95% of participants over 40 years old were willing to undergo gastroscopy for GC screening in China during the COVID-19 pandemic. Participants' willingness to undergo GC screening increased due to medical resource constraints and increased interest in their health. Individuals with H. pylori infection are more likely to undergo gastroscopy, whereas old age individuals, those with lower educational levels, and those living in rural areas are more likely to reject gastroscopy.

High-risk population's knowledge of risk factors and warning symptoms and their intention toward gastric cancer screening in Southeastern China

Background

As the incidence of gastric cancer (GC) increases sharply in adults aged over 40 years, screening of this high-risk population is important. This study aimed to explore knowledge level of GC related risk factors and symptoms, and to identify influencing factors associated with intention toward GC screening among people aged 40 years old and above in China.

Methods

A cross-sectional, web-based survey was conducted among people aged 40 years old and above between October 2021 and March 2022 in Southeastern China. The participants' knowledge was assessed by a series of questions about risk factors (24-item scale) and warning symptoms (14-item scale).

Results

A total of 2547 complete responses were received. The mean age was 47.72 (±7.20) years and near 60% were male. Respondents had a moderate level of knowledge about risk factors and warning symptoms of GC. The total mean knowledge score was 23.9 (±9.8) out of a possible score of 38. Majority (80%) of respondents reported intention to be screened for GC in the next 5 years. The most influential predictors of screening intention were income level (OR = 2.13, 95% CI: 1.36-3.32), perceived benefits (OR = 1.99, 95% CI: 1.33-2.73), perceived severity (OR = 1.68, 95% CI: 1.20-2.34), ever took GC screening (OR = 1.63, 95% CI: 1.28-2.08), perceived poor overall health (OR = 1.59, 95% CI: 1.19-2.11), and perceived barriers (OR = 1.56, 95% CI: 1.17-2.09). Other significant factors were ever diagnosed with chronic gastric diseases, total knowledge score, and cues-to-action. The major reasons for not willing to take screening were "endoscopy is uncomfortable" (29.6%), "worry about screening results" (23.6%), and "have no symptoms" (21.3%).

Conclusion

High-risk population aged 40 years and above expressed high intention to receive GC screening. Intervention to improve health promotion and reduce the barriers to uptake of GC screening among high-risk populations in China is warranted.

Colorectal Cancer and Its Screening Among Public in the Western Region of Saudi Arabia

Background: Colorectal cancer (CRC) is defined as a cancer that starts in the colon or the rectum. CRC is the most commonly diagnosed cancer among Saudi males and ranks third in female individuals. Awareness among the population about CRC symptoms, risk factors, and screening tests is essential for preventing further morbidity and mortality. This study aimed to assess CRC knowledge in the western region of Saudi Arabia, as well as awareness of CRC risk factors, symptoms, and screening based on various demographic data.

Methods: We conducted a cross-sectional study with a representative random sample of 358 Saudi residents in the western region. A self-administered questionnaire was distributed through social media sites starting from October 2021 till December 2021. Participants' awareness of CRC risk factors, symptoms, and screening was assessed using the questionnaire. For data analysis, we used SPSS Statistics, version 24 (IBM Corp., Armonk, NY).

Results: Of the 385 participants, 76.4% were females, and most participants had a university degree level of education. Study respondents reported fear of colonoscopy as the top reason why they avoided CRC screening. Most participants (63.4%) showed insufficient knowledge. Certain factors showed a significant association with the participants' knowledge about CRC, such as age (p<.001), higher education (p=.002), and having a career in health care (p=.002).

Conclusion: As the study resulted in overall insufficient knowledge about CRC among respondents, certain factors showed a significant association with the knowledge level. Raising awareness and health promotion programs should target older age groups and those with below university degree level of education to ultimately prevent morbidity and mortality related to colorectal cancer.

What is the general Chinese public's awareness of and attitudes towards Helicobacter pylori screening and associated health behaviours? A cross-sectional study

OBJECTIVE

To evaluate the general population's awareness of and attitudes toward Helicobacter pylori (HP) screening and health behaviours.

DESIGN

Cross-sectional study.

SETTING

Hengyang, Hunan Province, China.

PARTICIPANTS

Using stratified cluster random sampling, a pretested structured questionnaire was used to interview members of the general population aged ≥18 years.

PRIMARY AND SECONDARY OUTCOME MEASURES

Knowledge of and attitudes toward HP screening and associated health behaviours, sociodemographic factors associated with HP knowledge, and screening behaviours.

RESULTS

This study featured 1042 participants. The average knowledge score was 11 (Q_L=4, Q_U=20, range 0-29). Approximately 68.9% of the participants said they had heard of HP, but 67.5% had never had an HP test. The most common reasons for not undergoing screening were 'no symptoms' (55.7%) and 'lack of knowledge regarding the benefits of the test' (21.1%). Independent factors related to knowledge included age, education level, occupation, HP infection, frequency of drinking unboiled water (p<0.05). Factors independently associated with screening behaviour included occupation, average monthly income, presence/absence of indigestion, stomach discomfort or pain, and/or stomach disease and knowledge score (p<0.05). Overall, 941 (90.3%) participants never used anti-HP toothpaste, and 442 (40.5%) never used serving spoons or chopsticks. The risk factors for HP infection included eating out and eating in groups (p<0.05).

CONCLUSION

In China, the general population has poor knowledge of HP, but most people have a positive attitude towards HP screening. Being asymptomatic and lacking knowledge about testing were the main reasons for reluctance to be screened. These results highlight the urgent need for educational activities to raise awareness, enhance screening rates for HP, and encourage people to adopt a healthy lifestyle.

Healthy Lifestyle Factors, Cancer Family History, and Gastric Cancer Risk: A Population-Based Case-Control Study in China

Background: We aimed to explore the relationship between lifestyle factors, cancer family history, and gastric cancer risk.

Methods: We examined the association between lifestyle factors, cancer family history, and gastric cancer risk based on a population-based case-control study in Taixing, China, with 870 cases and 1928 controls. A lifestyle score was constructed considering body shape, smoking, alcohol drinking, tooth brushing habit, and food storage method. Unconditional logistic regression models were used to calculate odd ratios (ORs) and 95% confidence intervals (CIs).

Results: Compared with participants with a lifestyle score of 0, subjects with a lifestyle score of 1 (OR 0.59, 95%CI 0.43–0.83), 2 (OR 0.42, 95%CI 0.30–0.59), 3 (OR 0.29, 95%CI 0.20–0.41), 4 (OR 0.20, 95%CI 0.13–0.32), or 5 (OR 0.10, 95%CI 0.04–0.22) had a lower risk of gastric cancer (P for trend < 0.001). Overall, 34% of gastric cancer cases (95%CI 27–41%) can be attributed to non-compliance with ≥3 healthy lifestyle. Family history of early-onset cancer is closely related to the occurrence of gastric cancer, with an OR ranging from 1.77 to 3.27. Regardless of family history, a good lifestyle is associated with a reduced risk of gastric cancer, with an OR value between 0.38 and 0.70.

Conclusions: The early-onset cancer family history is closely related to the occurrence of gastric cancer and a good lifestyle is associated with a reduced risk of gastric cancer regardless of family history. Our results provide a basis for identifying and providing behavior guidance of high-risk groups of gastric cancer.

PARP1 Inhibitor Combined With Oxaliplatin Efficiently Suppresses Oxaliplatin Resistance in Gastric Cancer-Derived Organoids via Homologous Recombination and the Base Excision Repair Pathway

Oxaliplatin (OXA) resistance in the treatment of different types of cancer is an important and complex problem. The culture of tumor organoids derived from gastric cancer can help us to provide a deeper understanding of the underlying mechanisms that lead to OXA resistance. In this study, our purpose was to understand the mechanisms that lead to OXA resistance, and to provide survival benefits to patients with OXA through targeted combination therapies. Using sequence analysis of OXA-resistant and non-OXA-resistant organoids, we found that PARP1 is an important gene that mediates OXA resistance. Through the patients’ follow-up data, it was observed that the expression level of PARP1 was significantly correlated with OXA resistance. This was confirmed by genetic manipulation of PARP1 expression in OXA-resistant organoids used in subcutaneous tumor formation. Results further showed that PARP1 mediated OXA resistance by inhibiting the base excision repair pathway. OXA also inhibited homologous recombination by CDK1 activity and importantly made cancers with normal BRCA1 function sensitive to PARP inhibition. As a result, combination of OXA and Olaparib (PARP-1/2/3 inhibitor), inhibited in vivo and in vitro OXA resistant organoid growth and viability.

Barriers and Facilitators Associated with Delays in the Diagnosis and Treatment of Gastric Cancer: a Systematic Review

BACKGROUND

The present study was conducted to identify barriers and facilitators of early diagnosis and treatment of gastric cancer.

METHODS

Comprehensive search was conducted on 2021 in various databases, including Medline, Web of science, and Scopus. Keywords such as gastric cancer, screening programs, endoscopy, barriers, facilitators, and factor were used for the search, as single or in combination. Also a manual search was done in valid scientific journals to find related full-text articles. The search results were entered into the Endonote-X8 software, which automatically removes duplicate articles. Then, the title and the abstract and finally, the  text of the articles were studied. Articles that addressed barriers and facilitators of early diagnosis and treatment of gastric cancer were included.

RESULTS

In according to the results of 22 included articles, delay time in the diagnosis and treatment of gastric cancer were high, and factors such as age, sex, race and ethnicity, economic and social status, access to diagnostic services, implementation of screening programs, type and accuracy of screening methods, use of insurance services, error in care services, and presence of gastrointestinal symptoms were considered to be contributing factors in this regard.

CONCLUSIONS

It seems that to reduce delay in the diagnosis and treatment of gastric cancer, factors such as implementing screening programs using acceptable methods with high sensitivity and accuracy with a high level of participation, increasing insurance coverage and reducing the share of people in payments, increasing people's access to diagnostic services, educating people about the symptoms and risks of gastric cancer, undertaking proper follow-up in patients and suspects cases identified in screening, as well as increasing patients' access to medical services through financial and insurance support are significantly important.

Preferences of first-degree relatives of gastric cancer patients for gastric cancer screening: a discrete choice experiment

BACKGROUND

It is very necessary to implement gastric cancer screening in China to reduce the mortality of gastric cancer, but there are no national screening guidelines and programs. Understanding of individual preferences is conducive to formulating more acceptable screening strategies, and discrete choice experiments can quantify individual preferences. In addition, the first-degree relatives of gastric cancer patients are at high risk for gastric cancer. Compared with those without a family history of gastric cancer, the risk of gastric cancer in first-degree relatives of gastric cancer patients is increased by 60%. Therefore, a discrete choice experiment was carried out to quantitatively analyse the preferences of first-degree relatives of gastric cancer patients for gastric cancer screening to serve as a reference for the development of gastric cancer screening strategies.

METHODS

A questionnaire was designed based on a discrete choice experiment, and 342 first-degree relatives of gastric cancer patients were investigated. In STATA 15.0 software, the data were statistically analysed using a mixed logit model.

RESULTS

The five attributes included in our study had a significant influence on the preferences of first-degree relatives of gastric cancer patients for gastric cancer screening (P < 0.05). Participants most preferred the sensitivity of the screening program to be 95% (coefficient = 1.424, P < 0.01) with a willingness to pay 2501.902 Yuan (95% CI, 738.074-4265.729). In addition, the participants' sex and screening experiences affected their preferences. An increase in sensitivity 35 to 95% had the greatest impact on the participants' willingness to choose a gastric cancer screening program.

CONCLUSION

The formulation of gastric cancer screening strategies should be rooted in people's preferences. The influence of sex differences and screening experiences on the preferences of people undergoing screening should be considered, and screening strategies should be formulated according to local conditions to help them play a greater role.

Helicobacter pylori Infection: Comparison of Knowledge between Health Science and Non-Health Science University Students

Background: Helicobacter pylori (H. pylori), an important human pathogen, is classified as a human carcinogen. It is known to cause dyspepsia, peptic ulcers, and gastric cancer. Awareness regarding H. pylori infections in Saudi Arabia awaits investigation to reduce or even eliminate the infection that would ease the substantial burden of managing H. pylori among both malignant and non-malignant diseases. Aims: The study aims were to (1) assess the knowledge of H. pylori infection, testing, and management among undergraduate students in Saudi Arabia and (2) compare the H. pylori knowledge among health science and non-health science students. Methods: This study involved a cross-sectional online survey among 334 undergraduate students in health science and non-health science colleges at King Saud University, Saudi Arabia, using a valid and reliable author-developed survey. The survey had two sections: the socio-demographic factors and knowledge items regarding H. pylori. Data were collected during the 2019–2020 academic year. Data analysis included descriptive statistics, Chi-square, and Mann–Whitney U test. The knowledge scores were categorized as poor, fair, and good. Results: Less than 10% of the students in both groups had a good knowledge level about H. pylori. The comparison of the overall mean between both groups was non-significant. Moreover, the level of knowledge of the respondents was significantly associated with their university level (p < 0.001), family monthly income (p < 0.007), having heard about H. pylori infection (p < 000.1), and a previous history of H. pylori infection (p < 000.1). Conclusion: The overall knowledge level of Saudi undergraduate students about H. pylori infection was low. Thus, health awareness interventions through educational programs are recommended for improving their knowledge about H. pylori infection and its prevention.

Awareness, attitude and barriers of colorectal cancer screening among high-risk populations in China: a cross-sectional study

OBJECTIVE

To assess the awareness, attitude and barriers of colorectal cancer screening among high-risk populations in China.

DESIGN

A cross-sectional study was employed.

SETTING

This study was conducted in nine hospitals in Hunan province, China.

PARTICIPANTS

Individuals with a high-risk for colorectal cancer were interviewed using a pretested structured questionnaire.

PRIMARY AND SECONDARY OUTCOME MEASURES

Knowledge, attitude towards colorectal cancer screening, sociodemographic factors associated with screening knowledge and behaviour and barriers of colorectal cancer screening.

RESULTS

This study included 684 participants. The mean knowledge score was 11.86/24 (SD 4.84). But over 70% of them held a positive attitude towards screening. Only 13.3% had undergone colorectal cancer screening. Independent factors related to knowledge were education level of college or above, working as a white collar, higher income, having health insurance, having seen a doctor in the past year and with a high perceived risk (p<0.05). Factors independently associated with screening behaviour included personal history of colorectal disease, having seen a doctor in the past year, previous discussion of colorectal cancer screening, high perceived risk and better knowledge (p<0.05). Main reasons for not undergoing screening were no symptoms or discomfort (71.1%), never having thought of the disease or screening (67.4%) and no doctor advised me (29.8%).

CONCLUSION

In China, the majority of high-risk people had deficient knowledge and had never undergone colorectal cancer screening. But most of them held a positive attitude towards the benefits of colorectal cancer screening. This has promising implications to design targeted educational campaigns and establish screening programmes to improve colorectal cancer awareness and screening participation. Healthcare professionals should advise high-risk individuals to participate in screening and inform them about cancer risk.

The Barriers and Facilitators of Gastric Cancer Screening: a Systematic Review

AIM

Gastric cancer is the third leading cause of cancer death and the fifth most common cancer worldwide. Screening is one of the most important ways to increase survival. The aim of this systematic review was to determinate barriers and facilitators for accessing gastric cancer screening.

MATERIALS AND METHODS

In this systematic review, for identifying barriers and facilitators of gastric cancer screening, a comprehensive search was conducted in electronic databases such as PubMed, Web of Science, and Scopus in 2021. Combination keywords such as gastric cancer, screening, endoscopy, barriers, and facilitators were used for searching. Full text original studies in English language that are dealing with barriers and facilitators for accessing gastric cancer screening were included in this review.

RESULTS

A total 13 articles included in this review. Ten barriers and ten facilitators were evaluated. The most common reported barriers were lack of signs, fear of screening procedure, fear of screening outcome, cost of screening, and embarrassment. The most frequent facilitator was socio demographic factors such as age, education, and employment.

CONCLUSION

For promoting success in gastric cancer, screening programs, knowing barriers, and facilitators is  necessary. No signs and symptoms of disease have been shown as the major barriers toward gastric cancer screening in most studies.

Prevalence and associated risk factors of gastritis among patients visiting Saint Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia

Background

The health of individuals is not only the absence of disease checked medically, but also encompasses social and psychological aspects. Any departure from the state of physiological, psychological, or social well-being was affected by different factors. However, all contributory factors were not equally responsible for affecting disease. This study was undertaken as a search for the relative effects of sociocultural and individual behavioral factors contributing to acute and chronic gastritis patients visiting Saint Paul Hospital Millennium Medical College (SPHMMC).

Methods

A cross-sectional study was carried out on 364 patients visited SPHMMC in the study. Primary data were collected through an interview schedule tool with an exit approach by validating questions pertaining to sociocultural and individual behavioral factors. The status of gastritis was measured as whether patients had Helicobacter Pylori infection, signs and symptoms indicated gastritis that occurred, and persisted for less than a month, greater than a month, or none of the signs and symptoms. Descriptive statistics, bivariate analysis, and multivariable ordinal logistic regression model were used to identify the predictors of gastritis severity. P-value ≤ 0.05 was declared as an indicator of statistically significant.

Results

The prevalence of gastritis in the study area was 78.8%. Specifically, 48.9% and 29.9% had acute and chronic gastritis, respectively. The study found that low income and taking medicinal drugs was slightly significantly contributed to higher gastritis status; however, being younger age was slightly significantly contributed to lower gastritis status. Furthermore, the results indicated that eating spiced foods (Adjusted Odds Ratio (AOR) = 1.508; 95% CI: 1.046, 2.174), lack of physical exercise regularly (AOR = 1.780; 95% CI: 1.001, 3.168), stress (AOR = 2.168; 95% CI: 1.379, 3.4066), and substance use (AOR = 1.478; 95% CI: 1.093, 1.999) were significantly contributed to higher gastritis status.

Conclusions

The findings suggested that women should take enough rest and sleep well, men refrain from involvement in any risky behaviors, young people and those who earn low income per month should equip with knowledge and understanding on how to practice good health behaviors, eating foods on time, avoiding eating spiced food frequently, doing physical exercise regularly, and taking medicinal drugs according to physician advice are recommended.

Cancer Warning Symptoms Awareness and Associated Factors Among Individuals Living in Assella Town, Ethiopia

Introduction

Community awareness about cancer warning symptoms and risk factors in the general population is essential and can be considered as a basis for cancer control programs. Since Patients are rarely aware of the early warning symptoms and cancer risk factors, the burden of disease is increasing everywhere in the world. Evidences has been shown that cancer is highly prevalent in Ethiopia in which the diagnosis is made at later stages of the disease.

Objective

To assess Cancer Warning Symptoms awareness and associated factors among individuals living in Assella Town, Ethiopia.

Methods

A community-based cross-sectional study was employed in Assella town from May 1^st to June 1^st, 2020 among 410 adult residents 18 years old and above. A systematic random sampling technique was employed to select the households from which the study subjects randomly identified. Data were collected through face-to-face interview by using pre-tested structured questionnaire and entered into Epi data version 3.1 then exported to SPSS version 25.0 for analysis. Logistic regression analyses were used to identify factors associated with outcome variables. Odds ratio and 95% CI at P-values <0.05 was used to determine the presence of association.

Results

The findings of this study revealed that the overall level of awareness of cancer warning symptoms is 214 (52.2% (AOR = 95% CI 47.1, 56.8)). Educational level (AOR = 3.44, 95%CI, 1.50–7.88 (p = 0.003)), awareness of cancer risk factors (AOR = 2.56, 95% CI, 1.67, 3.93, (p < 0.001)) and economic status (AOR = 3.13 (95% CI 1.84, 5.33, p < 0.001)) were identified as factors significantly associated with awareness of cancer warning symptoms among adult populations.

Conclusion

Almost one-out-of-two adults residing in Assella town has awareness about cancer warning symptoms. Educational level, awareness of cancer risk factors, and economic status among Assella town residents were identified as factors associated with good level of awareness about cancer warning symptoms.

Cancer burden in China: trends, risk factors and prevention

As the most populous country in the world, China has made strides in health promotion in the past few decades. With the aging population, the burden of cancer in China continues to grow. Changes in risk factors for cancer, especially diet, obesity, diabetes, and air pollution, continue to fuel the shift of cancer transition in China. The burden of upper gastrointestinal cancer in China is decreasing, but still heavy. The rising burden of colorectal, prostate, and breast cancers is also significant. Lung cancer became the top cause of cancer-related deaths, together with smoking as the most important contributor to cancer deaths. The Chinese government has taken several approaches to control cancer and cancer-related risk factors. Many achievements have been made, but some challenges remain. Health China 2030 is ambitious and depicts a bright vision of the future for cancer control in China. The decrease in the cancer burden in China will require cross-sector collaboration and coordinated efforts on primary and secondary preventions by governments, public health organizations, and individuals. In this review, we describe the trends of cancer burden and discuss cancer-related risk factors in China, identifying strategies to reduce the burden of cancer in China.

Nursing Students' Awareness about the Warning Signs of Cancer

Objective:

Nursing students who take care of the patient in clinical area practices as a part of their internships in primary health care and clinical areas, should be aware of the warning signs of cancer so that they may inform the community about them.

Methods:

This study was conducted to determine the awareness of nursing students about the warning signs of cancer. The research was planned as a descriptive and cross-sectional study. The research was completed with 460 nursing students between February 2019 and May 2019.

Results:

The average age of the students participating in the study was 20.05 ± 2.04 years. Female nursing students were more familiar with the warning signs of cancer, than male nursing students. Second, third- and fourth-grade nursing students knew the warning sign of better than the first graders. More nursing students who had taken the internal diseases nursing course knew the warning sign of better compared to the students who did not take the course. Nursing students with a family member with a history of cancer knew the warning better than those who did not have a family history of cancer. Thickening or lump in the breast or elsewhere” was the most known warning sign of cancer (92.6%), whereas the least known sign was “indigestion or difficulty in swallowing” (47.0%).

Conclusions:

Female nursing students those who had taken the internal diseases nursing course and those who had a family member with a history of cancer were more aware of the warning signs of cancer.

Role of HOXB7 in promoting gastric cancer progression and oxaliplatin (L-OHP) resistance

BACKGROUND AND AIM

Our study aimed to investigate the ways by which HOXB7 affects gastric cancer progression and oxaliplatin (L-OHP) resistance.

METHODS

First, the expression of HOXB7 in paired cancer and paracancerous tissues of L-OHP-sensitive and L-OHP-resistant gastric cancer patients was qualitatively and quantitatively analyzed by immunohistochemistry. Then, the expression of HOXB7 in these tissues was further quantitatively analyzed at protein and transcriptional levels. The expression of HOXB7 in the SGC-7901 L-OHP-resistant gastric cancer cell line was further verified by immunofluorescence, western blot, and RT-qPCR. In addition, by transfecting the SGC-7901 cell line, control (sh-con) and HOXB-7-silenced (sh-HOXB7) gastric cancer cell lines were created. Subsequently, the migratory and invasive abilities of these cells were determined by the transwell assay. The proliferation rate of both control and HOXB-7-silenced cells induced by varying concentrations of L-OHP was detected by the CCK-8 assay, while the degree of apoptosis in the same cells induced by 60 µM L-OHP was detected by flow cytometry.

RESULTS AND CONCLUSION

Results suggested that HOXB7 was overexpressed in both the tissues of L-OHP-resistant gastric cancer patients and the SGC-7901 gastric cancer cell line. Moreover, HOXB7 promoted the migratory and invasive abilities of gastric cancer cells. By silencing HOXB7 protein expression, the proliferation rate of L-OHP-resistant gastric cancer cells decreased considerably, while their degree of apoptosis increased significantly. These results showed that HOXB7 promoted gastric cancer progression and L-OHP resistance.

Knowledge level of cancer symptoms and risk factors in the Gaza Strip: a cross-sectional study

BACKGROUND

In low-income settings, cancer is often diagnosed in advanced stages due to late presentation. Good public awareness of cancer signs and symptoms has a positive impact on the time patients take before they present to healthcare professionals. Therefore, this study examined public knowledge of cancer signs and symptoms as well as risk factors in Gaza.

METHODS

This was a cross-sectional study. Participants were recruited from adult visitors (≥18 years) to governmental hospitals covering all five governorates of Gaza, and adolescent students (15 to 17 years) from 10 high schools in corresponding locations. An Arabic version of the Cancer Awareness Measure (CAM) was completed in a face-to-face interview. It described demographic data and knowledge of: cancer prevalence, age-related risk, signs and symptoms as well as risk factors both in recall and recognition questions.

RESULTS

Of 3033 participants invited, 2886 completed the CAM (response rate = 95.2%). Adult mean age ± standard deviation was 33.7 ± 11.7 years and that of adolescents was 16.3 ± 0.8 years. Half of the participants (n = 1457, 50.5%) were adolescent (781 females; 53.6%) and 1429 (49.5%) were adult (702 females; 49.1%). About two thirds (n = 1885) thought about cancer as unrelated to age. Only 196 participants (6.8%) identified colorectal cancer as the most common cancer among men. Awareness of cancer signs/symptoms was poor to fair, where 'lump' was most commonly recognized (n = 2227, 77.2%) and 'change of bowel habit' the least (n = 670, 23.2%). Only 217 participants (7.5%) had a good level of recognizing risk factors with 'smoking' being the most identified and 'eating less than five portions of fruits and vegetables a day' the least. There was a higher likelihood for adults to identify most cancer signs/symptoms and risk factors than adolescents, except for recalling 'unexplained pain', 'persistent cough/hoarseness', 'non-healing ulcer', 'smoking', and 'eating less than five portions of fruits and vegetables a day'.

CONCLUSION

Public awareness of cancer signs/symptoms and risk factors needs to improve to facilitate early presentation and diagnosis in Gaza. Combining the delivery of public campaigns with tailored education to population groups, including the youth, may increase their knowledge and maintain its impact.

Gastric Cancer in Young Adults: A Different Clinical Entity from Carcinogenesis to Prognosis

Approximately 5.0% of gastric cancer (GC) patients are diagnosed before the age of 40 and are not candidates for screening programs in most countries and regions. The incidence of gastric cancer in young adults (GCYA) has declined over time in most countries except in the United States. Genetic alterations, environmental factors, and lifestyle may predispose some young adults to GC. According to molecular classifications, the cancer of most GCYA patients belongs to the genomically stable or microsatellite stable/epithelial-mesenchymal transition subtype, with the common genetic aberrations being mutations in CDH1. What characterizes GCYA are a higher prevalence in females, more aggressive tumor behaviors, diagnosis at advanced stages, fewer comorbidities and being better treatment candidates, and a similar or better survival outcome when compared with older patients. Considering the greater loss of life-years in younger patients, lowering the incidence of GC and diagnosing at a relatively early stage are the two most effective ways to decrease GC mortality. To achieve these goals, the low awareness of GCYA among general people, policy-makers, clinicians, and researchers should be changed.