Suspected GI cancer needs diagnostic endoscopy, not a screening test

The Asociación Mexicana de Gastroenterología convened 20 specialists in gastroenterology, oncology, endoscopy, epidemiology and public health to write a position statement for primary care, published on 26 October. Through structured voting they agreed 13 statements and three algorithms covering alarm features, risk factors, diagnostic studies and referral tiers (urgent, priority and elective) for oesophageal, gastric and colorectal cancer.

Its central message is a distinction family physicians often blur: a patient with alarm features needs a diagnostic procedure, upper endoscopy or high-quality colonoscopy, not a population screening test. Delays in recognising and referring symptomatic patients were the problem the statement set out to address.

It is written for Mexico's health system, and it is expert consensus rather than new trial evidence. The principle transfers directly to Indian primary care, where gastric and oesophageal cancer often present late and a faecal test is sometimes used in place of a colonoscopy for a symptomatic patient.

• Refer patients with GI alarm features for diagnostic endoscopy or colonoscopy, not a screening test.
• Use referral urgency tiers based on alarm features and risk factors rather than a single queue.
• Do not let a negative faecal test reassure you in a patient with rectal bleeding or iron deficiency anaemia.
• Record the alarm features in the referral so the endoscopy unit can prioritise.

Why it matters

Screening tests are built for people without symptoms, and using them for people with symptoms delays diagnosis.

Don't overread it

This is expert consensus written for the Mexican setting, not new outcome data.

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