SCREENING OF A HIGH RISK GROUP OF THE STOMACH CANCER USING SERUM PEPSINOGEN TEST

Abstract

Aim : Based on the findings that many gastric cancers develop in the stomach mucosa affected by severe and extensive chronic gastritis, and several studies have indicated that the serum pepsinogen levels, serve as a marker of chronic atrophic gastritis, so that, we aimed to establish the gastric cancer screening system using pepsinogens. Methods: In 1991, 4, 647, in 1992, 4, 758, and in 1993, 2, 242, in total 11, 647 (1, 742 persons in female; incidence 15%) company employees were given an annual periodic-health check-up that consists of an interview with regard to their general health conditions, a physical examination, an ECG, a chest X-ray and a blood sampling. The blood samples for routine laboratory test were taken after fasting and aliquot of the separated sera were individually stored at -20°C until serum pepsinogen levels were measured by Pepsinogen I and II Riabead Kits (Dainabot Co. Ltd, Japan). Results : As the result of their initial screening, out of 2, 456 subjects (21%) with a serum pepsinogen I levels of less than 70 μg/l and a pepsinogen I/II ratio less than 3.0, 1971 (17%) were selected for further investigation by endoscopy. This led to the detection of 17 subjects (incidence ; 0.15%) with gastric cancer, 13 were in the early stage (76%), and 8 subjects with adenoma (incidence ; 0.07%). Thus the cancer selection rate of this new screening method was found to be comparable, and in some ways superior to the traditonal barium X-ray screening. Moreover, this new screening method also has many advantages : (1) The method is easy and subjects experience no discomfort ; (2) No X-ray hazards are incurred and no side effects are experienced due to barium ingestion ; (3) The screening cost is less expensive (about a half the cost of barium X-ray screening) ; and (4) The procedure is quick and many serum samples can be measured at a same time. Conclusion : We have deviced a mass screening method that evaluate the serum pepsinogen levels to initially identify subjects with a high risk of a gastric cancer, and newly established the gastric cancer screening system, named "stomach dry dock".