Feasibility of a Symptomatic Screening Program for Early Detection of Gastric Cancer in Roatán, Honduras.

Abstract

Gastric cancer (GC) is a leading cause of cancer-related death in Central America, with late-stage diagnosis common because of nonspecific early symptoms. Symptomatic screening guidelines validated in high-income settings have been used to identify patients requiring urgent referral for upper GI endoscopy. This tool was piloted to assess feasibility for early detection of GC at a primary care clinic in Roatán, Honduras. If positive, a referral to endoscopy was placed, and patients contacted monthly for up to 4 months to collect information on demographics, GC risk factors, barriers to receiving endoscopy, and if they received an endoscopy. Provider questionnaires assessed endoscopy capacity and perceived patient barriers. Five hundred patients were screened over 12 months. Nine screened positive, with seven clinically relevant to GC. Of these, four (57%) were female, average age was 49 years (IQR, 18), average number of years lived in Roatán was 29 (IQR, 34), and hypertension (57%) and hyperlipidemia (29%) were the most reported comorbidities. Two (29%) had a family history of cancer, four (57%) had a previous H. pylori infection, six (71%) took medication for acid reflux, and four (57%) had dietary risk factors for GC. All patients cited cost as a barrier to care, while two (29%) each reported difficulty traveling to a facility, lack of knowledge on which facilities did endoscopy, and uncertainty of whether they needed the procedure as other barriers. Although symptomatic screening guidelines are feasible for screening GC in Honduras, limitations in endoscopy access and capacity pose barriers to early diagnosis. These findings highlight the need to increase diagnostic capacity and address financial barriers to endoscopy.