J. Tso1, S. Galeas2, B. Martinez2, K. Vallecillo2, M. Faleh Abidalhassan3, N. Webster2, H. Leiva2, M. Al-Qaraghli3, C. Gaskill3 1University Of California – Davis, School Of Medicine, Sacramento, CA, USA 2Clínica Esperanza, Sandy Bay, ROATÁN, Honduras 3University Of California – Davis, Department Of Surgery, Division Of Surgical Oncology, Sacramento, CA, USA
Introduction: Gastric cancer (GC) is the leading cause of cancer-related death in Central Latin America, with late-stage diagnosis being common due to nonspecific early-stage symptoms. The National Institute for Health and Care Excellence (NICE) has developed symptomatic screening guidelines validated in high income settings to identify patients requiring urgent referral for upper gastrointestinal endoscopy. We piloted this tool to assess feasibility in early detection of gastric cancer in Roatán, Honduras.
Methods: A screening tool was adopted based on NICE guidelines for the context of Roatán. Patients screened positive if they had dysphagia or were over the age of 55 with weight loss and upper abdominal pain, acid reflux, or dyspepsia. This study took place at a non-profit medical clinic which serves as the region’s main primary care clinic. Nonpregnant adult patients were consecutively screened during their usual care. If positive, a referral to endoscopy was placed and they were approached for study enrollment. Enrolled patients were contacted monthly to collect information on patient demographics, risk factors for GC, barriers to receiving endoscopy, and timing and findings of endoscopy. Endoscopy capacity and perceived patient barriers was assessed through a provider questionnaire.
Results: 500 patients were screened over 12 months. 9 screened positive, with 7 screenings being clinically relevant to gastric cancer. Of these, 4 (57%) were female, average age was 49 years old (IQR: 18), average number of years lived in Roatán was 29 (IQR: 34), and hypertension (57%) and hyperlipidemia (29%) were the most commonly reported comorbidities. Two (29%) patients had a family history of cancer, 4 (57%) had a previous H. pylori infection, 6 (71%) took medication for acid reflux, and 4 (57%) had dietary risk factors for gastric cancer. All (100%) patients cited cost as a barrier to care in receiving and endoscopy, while 2 (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. 1 of 7 patients received an endoscopy with a medical brigade 6 months after their positive screening, resulting in a diagnosis of chronic gastritis and hiatal hernia.
For a population of 109,000 people, there is currently one permanent endoscopy provider report doing 2-3 endoscopies per week with one working endoscope at a private medical center for 8100 lempiras ($327) per procedure. There is currently no local pathology capacity for diagnosing GC; samples are sent to an outside facility for 1500 lempiras ($60) each.
Conclusion: While NICE criteria are a feasible method for screening GC in Honduras, limitations in endoscopy access and capacity pose barriers to early diagnosis. Our findings highlight the need to increase diagnostic capacity and address financial barriers to endoscopy and pathology services.