2020 Volume 58 Issue 3 Pages 255-270
The "Kakogawa hybrid gastric cancer screening system," established in the Kakogawa area of Hyogo prefecture in 2015, is characterized by the integration of three cancer screening methods and the stratification of cancer risk according to the Helicobacter pylori (H. pylori) infection status. Examinees choose one of the following methods: modified X-ray examination (2015 onwards), ABC classification method*1 (2015 onwards), or endoscopic examination (2017 onwards). Unlike the conventional X-ray screening method (until 2014), the new system provides an estimated H. pylori diagnosis regardless of which method the examinee chooses. If the examinee is diagnosed as currently or formerly infected with H. pylori, irrespective of the presence or absence of any suspicious lesions, further endoscopic examination is encouraged. The second endoscopic examination provides a final diagnosis regarding not only the suspicious lesion but also the H. pylori status. Moreover, the second endoscopic examination determines the optimal examination interval according to the degree of gastric atrophy. The detection rates of gastric cancer after applying the new system were 0.31%, 0.31%, and 0.33% in 2015, 2016, and 2017, respectively, which were higher than those of the conventional method (0.15%-0.20%). Thus, the new system is more effective as a gastric cancer screening method and demonstrates the importance of a risk stratification-oriented strategy.
(*1: gastric cancer screening by combined assay for serum anti-H. pylori IgG antibody and serum pepsinogen)
