Endoscopic investigation for gastric cancer in a high-risk group.

Early gastric cancer (EGC) was diagnosed in only a small percentage (less than 1%) of gastric cancer cases seen at Tygerberg Hospital over a 10-year period (1976-1985). This study, aimed at increasing the yield of EGC, was conducted in some high-incidence areas for gastric cancer. Coloured men, who are at high risk for gastric cancer, were identified by their medical practitioners and investigated. A total of 272 coloured males with nonspecific foregut symptoms underwent upper gastro-intestinal endoscopy and multiple biopsy specimens were obtained from all localised mucosal lesions. Twelve gastric cancers were histologically verified, of which 11 were diagnosed in males over 40 years of age. Two EGCs were diagnosed in older males, resulting in a markedly higher proportion of EGC in this subgroup (18.2%) than the proportion of EGC in inpatients at our institution (0.9%). Twenty-two per cent of males over 40 years of age had gastric ulcers compared with 9.2% of younger males. Chronic atrophic gastritis was present in 56.2% of older males but in only 24.6% of younger males. Those over 40 years of age emerged as a subgroup with a high prevalence of gastric cancer and EGC, and concomitant conditions.