许多类型的癌症在发病率和死亡率方面存在种族和民族差异，这是有据可查的。因此，对于基于种族和民族的临床筛查指南来解决癌症健康差异的政策和临床兴趣是可以理解的。尽管理论上有好处，但此类提案通常不会解决相关的道德考虑。本文以胃癌和食管腺癌为例，研究了在考虑基于种族和民族进行筛查时的相关伦理争论，这些癌症已显示出种族和民族的差异。基于种族和族裔的临床预防保健服务有可能改善筛查的利弊之间的平衡。因此，针对高风险种族或族裔群体的计划可以为普通人群的筛查提供实用的替代方案，其中筛查率可能太低而无法证明足够的有效性。然而，根据基于社会的分类（例如种族或民族）设计筛查是有争议的，并且有可能产生与社会身份或其他结构介导的环境因素相关的交叉耻辱。其他伦理考虑因素包括错误分类、对健康差异的意外负面影响、忽视潜在的风险因素以及被分配更高风险的心理成本。考虑到伦理方面的考虑，当且仅当没有替代指标时，种族和族裔在癌症筛查中的实际应用在多元文化国家才最相关。即使在这些情况下，政策制定者和临床医生也应在目标人群的历史和文化背景下仔细考虑伦理问题。对替代指标的进一步研究，例如健康的社会决定因素和基于文化的特征，可以为风险分层提供更充分的因素。

Racial and ethnic disparities in incidence and mortality are well documented for many types of cancer. As a result, there is understandable policy and clinical interest in race- and ethnicity-based clinical screening guidelines to address cancer health disparities. Despite the theoretical benefits, such proposals do not typically address associated ethical considerations. Using the examples of gastric cancer and esophageal adenocarcinoma, which have demonstrated disparities according to race and ethnicity, this article examines relevant ethical arguments in considering screening based on race and ethnicity. Race- and ethnicity-based clinical preventive care services have the potential to improve the balance of harms and benefits of screening. As a result, programs focused on high-risk racial or ethnic groups could offer a practical alternative to screening the general population, in which the screening yield may be too low to demonstrate sufficient effectiveness. However, designing screening according to socially based categorizations such as race or ethnicity is controversial and has the potential for intersectional stigma related to social identity or other structurally mediated environmental factors. Other ethical considerations include miscategorization, unintended negative effects on health disparities, disregard for underlying risk factors, and the psychological costs of being assigned higher risk. Given the ethical considerations, the practical application of race and ethnicity in cancer screening is most relevant in multicultural countries if and only if alternative proxies are not available. Even in those instances, policymakers and clinicians should carefully address the ethical considerations within the historical and cultural context of the intended population. Further research on alternative proxies, such as social determinants of health and culturally based characteristics, could provide more adequate factors for risk stratification.