X-ray screening for gastric cancer combined with serum risk stratification - Significance of the introduction of endoscopy to detect early stage gastric cancer -

Abstract

Yamagata City government and the Yamagata City Medical Association initiated a gastric cancer/gastritis X-ray screening with stratified gastric cancer risk assessment (ABC classification) in fiscal year 2017. The total number of subjects was 13,663, which included all residents of Yamagata city older than 40 years old. They underwent conventional X-ray screening, and optional ABC classification was performed for subjects who did not receive the ABC classification assessment and those who did not undergo Helicobacter pylori treatment. Subjects in ABC classification groups B, C, or D were recommended to undergo gastric endoscopy. Five patients were diagnosed with early stage gastric cancer, which was not detected by X-ray screening. We confirmed that gastric X-ray screening combined with ABC classification was useful. When upper gastrointestinal endoscopy was initiated as the secondary diagnostic examination, we organized a secondary diagnostic examination committee to manage the quality of diagnostic accuracy. Establishment of the endoscopic examination system with a practical protocol, which included a double-check analysis of endoscopic image interpretation and feedback of the results to the examiners, enabled us to build a foundation for gastric endoscopic screening to detect early stage gastric cancer.