Abstract
We studied the mass screening methods for gastric cancer by examining the results of upper gastrointestinal X-ray screening performed in 98,030 individuals and endoscopic screening performed in 10,340 individuals at our hospital. We investigated the presence or absence of risk factors in the patients identified as having esophageal cancer and the presence or absence of chronic gastritis in the background gastric mucosa in those with gastric cancer. Gastric and esophageal cancers were identified in 75 and 2 individuals undergoing X-ray screening (detection rates 0.077%, 0.002%), and in 21 and 3 individuals undergoing endoscopic screening (0.203%, 0.029%), respectively, with endoscopic screening showing a significantly higher detection rate in those 50 years of age or older (p < 0.001). The percentages of early-stage gastric cancer were 80.0% with X-ray screening and 81.0% with endoscopic screening, exhibiting no significant difference. Atrophic boundaries were observed on the side of the atrophic gastric mucosa presumed to be Helicobacter pylori-positive in all patients with gastric cancer. All patients with esophageal cancer had risk factors for esophageal cancer. Although endoscopic examination should be performed in all people as screening in terms of cancer detection rates, it is very difficult to implement such a policy, and the risk of esophageal cancer cannot be evaluated using the ABC method. Therefore, conventional X-ray screening should be performed first, followed by endoscopic screening primarily for patients with progression of gland atrophy induced by Helicobacter pylori infection and those at high risk of developing esophageal cancer.
