Current Status and Significance of Korea’s National Gastric Cancer Screening Program

Gastric cancer remains a major public health concern in Korea, which has one of the highest incidence rates worldwide.Korea's National Gastric Cancer Screening Program was established to facilitate early detection and reduce gastric cancer-related mortality.This review summarizes the current status, clinical significance, achievements, limitations, and future directions of the program, with emphasis on the recently revised screening guideline.The national program currently provides biennial screening for adults aged 40 years or older, whereas the revised guideline recommends upper gastrointestinal endoscopy every 2 years for asymptomatic adults aged 40-74 years.Endoscopy is the preferred screening modality because it allows direct visualization of subtle mucosal lesions, immediate biopsy, and higher diagnostic accuracy than upper gastrointestinal series.Population-based Korean studies have shown that endoscopic screening is associated with earlier-stage diagnosis and reduced gastric cancer-specific mortality.The program's achievements have been supported by high participation rates, widespread access to endoscopy, increased detection of early gastric cancer, standardized treatment pathways, and systematic quality management.However, important challenges remain, including missed lesions, interval cancers, variability in endoscopic quality, uncertainty regarding the optimal screening interval, and limited evidence of benefit among adults aged 75 years or older.Future strategies should focus on improving endoscopic quality and safety, strengthening post-screening follow-up, individualizing screening decisions for older adults, and developing risk-based approaches incorporating Helicobacter pylori infection, gastric atrophy, intestinal metaplasia, family history, and other risk factors.Continued refinement of the national screening program is essential to further reduce gastric cancer mortality in Korea.