Gastric cancer below the age of 55: implications for screeningpatients with uncomplicated dyspepsia

Aims—To test the hypothesis that gastric cancerpresenting with uncomplicated dyspepsia is rare below the age of 55.
Patients and methods—The area studied was thepostcode defined catchment area of a district general hospital(Gloucestershire Royal) serving a population of 280 500. An openaccess endoscopy service has been available in this district for morethan 17 years. All cases of gastric cancer during a seven year period(1986-92) were drawn from the local pathology database. The databaseof the neighbouring hospital and the South West Cancer Registry were searched for missed cases from the postcoded area. Hospital and generalpractitioner records were retrospectively reviewed with respect toduration of symptoms, and previous consultation and investigation fordyspepsia; and alarming symptoms and signs suggestive of underlyingmalignancy (unexplained recent weight loss, dysphagia, haematemesis ormelaena, anaemia, previous gastric surgery, palpable mass, and perforation).
Results—Twenty five of 319 cases of gastric cancerdetected during the seven year period were aged less than 55. Twentyfour of these 25 patients presented with one or more suspicioussymptoms or signs. Only one patient (4%) aged less than 55 presentedwith uncomplicated dyspepsia. In two patients there was a delay in diagnosis of more than six months after first presenting to the generalpractitioner. Both these patients had significant symptoms at presentation.
Conclusion—Gastric cancer is rare below the age of55 (7.8% of all cases) and, even in the presence of established openaccess endoscopy, presents with suspicious symptoms or signs in 96% of cases. The age limit for screening uncomplicated dyspepsia can beraised safely to 55.

Keywords:gastric cancer; open access endoscopy; diseaseprevention; disease control; general practice; epidemiology; diagnosis