Endoscopic screening for gastric cancer in Wakayama City

Abstract

Background: In gastric cancer screening, the upper gastrointestinal series has long been performed as the only method with evidence of a reduction effect on gastric cancer mortality. With the remarkable progress of endoscopic technology in the gastrointestinal field, endoscopy is now the first choice for gastrointestinal tract examination instead of X-ray examination. There has been a discrepancy between clinical practice and medical examination.

Subjects and methods: In Wakayama City, endoscopic examination has been available for population-based screening since 2012. Subsequently, in the revised 2015 guidelines, endoscopy was newly recommended for both population-based and opportunistic screening. In Wakayama City, endoscopic examination using a double-check system was introduced in 2015, one year ahead of the national policy.

Results: A significant increase in the cancer detection rate was observed with the introduction of endoscopy (2.9 cancers per 1,000 screening exams) and the double-check system (5.5 cancers per 1,000 screening exams) compared with the period of X-rays alone (0.6 cancers per 1,000 screening exams). In addition to gastric cancer, the detection rate of esophageal cancer has also increased. Most of the detected cancers were pointed out at the time of primary endoscopy and it was considered that introducing workshops or evaluation sheets could have the effect of improving the accuracy of endoscopic examinations. On the other hand, the participation rate showed a tendency to increase at the beginning of the endoscopic introduction but remained flat thereafter.

Conclusions: The gastric cancer detection rate significantly increased with the introduction of endoscopy with the double-check system; however, the screening participation rate is still low. It is necessary to strengthen the examination accuracy control and encourage medical screening.