Background
The disease burden of upper gastrointestinal (UGI) cancers, specifically esophageal (EC) and gastric cancers (GC), are notably high in China. To address this pressing public health concern, the government launched a program for Early Cancer Diagnosis and Treatment in Rural Areas (ECDT-RA) in 2005 as a key strategic intervention.
Objectives
To assess the longitudinal impact of the ECDT-RA program on UGI cancer incidence, mortality and survival rates across implementation regions of China.
Methods
A total of 64 cancer registries that had maintained high-quality, continuous cancer surveillance data since 2008 were included in this study. The ECDT-RA program was implemented in regions served by 19 cancer registries, which were designated as screened areas. The remaining 45 registries were classified as non-screened areas. The EC and GC cases and population data from these 64 registries during 2008 to 2020 were extracted. Age-standardized incidence (ASIR) and mortality rates (ASMR) by year were calculated using Segi’s standardized population. Regression analysis was used to examine trends in ASIRs and ASMRs across regions and the average annual percentage change (AAPC) was reported. EC and GC cases diagnosed were followed up until 31st December 2024. The 5-year age-standardized relative survival rate by pathological subtype, anatomical subsite and region were analyzed.
Results
Compared to non-screened regions, screened regions demonstrated a faster decline in ASIRs for both EC (AAPC: -6.3% vs -5.1%, P<0.001) and GC (AAPC: -4.3% vs -3.7%, P<0.001). Similarly, the ASMRs reduction in screened regions also outpaced that in non-screened regions for EC (AAPC: -5.8% vs -4.8%, P<0.001) and GC (AAPC: -4.6% vs -4.0%, P<0.001). A total of 133 648 EC records and 168 871 GC records were included in the survival analysis. The 5-year relative survival for EC was significantly higher in screened regions compared to non-screened regions (38.2% vs 28.7%, P<0.05), with this pattern observed consistently for both esophageal squamous cell carcinoma (40.4% vs 31.3%, P<0.05) and adenocarcinoma (41.3% vs 31.8%, P<0.05). The 5-year relative survival for GC was significantly higher in screened regions compared to non-screened regions (40.5% vs 35.1%, P<0.05), and this difference held true for both cardia GC (41.6% vs 39.0%, P<0.05) and non-cardia GC (39.8% vs 34.4%, P<0.05). The Cox proportional hazards models demonstrated that, after adjusting for age and sex, the mortality risk for EC (HR=0.84, 95%CI: 0.83 to 0.85) and GC (HR=0.91, 95%CI: 0.90 to 0.92) in screened regions remained significantly lower than that in non-screened regions.
Conclusions
Regions participating in the ECDT-RA program exhibited significantly steeper declines in both UGI cancer incidence and mortality rates, accompanied by substantially improved survival rates, thereby demonstrating the program's notable effectiveness.

Figure 1. The age-standardized incidence (ASIR) and mortality rates (ASMR) in screened and non-screened regions in China, 2008-2020.