Investigation of the target age and screening method for opportunistic screening

Abstract

Objective (background): On the basis of the results of opportunistic gastric cancer screening at our hospital, we investigated the target age and screening method for future opportunistic screening.

Subjects and methods: We reviewed the data of 20 years of opportunistic gastric cancer screening (56,603 X-rays and 15,263 endoscopies) at Kochi Red Cross hospital in five-year blocks: period I, 1999 to 2003; period II, 2004 to 2008; period III, 2009 to 2013; and period IV, 2014 to 2018.

Results: The gastric cancer detection rate by endoscopic screening for the entire dataset was 0.32%, which was significantly higher than that obtained by X-ray screening, at 0.06% (p < 0.001). The discovery rate of esophageal cancer over the entire dataset was significantly higher for endoscopic screening than X-ray screening, at 0.059% and 0.009%, respectively (p < 0.001). The gastric cancer detection rate of subjects in their 40s who would be excluded from opportunistic screening in the future was 0.09% in period I and 0.01% in period IV (not significant). 20.9% of subjects in the same age group in 2016 had atrophic gastritis. A total of 14 of 49 gastric cancers (28.6%) detected in periods III and IV had developed after Helicobacter pylori (H. pylori) eradication, and 13 of 14 cases were discovered by endoscopic screening.

Conclusions: In opportunistic gastric cancer screening, the assessment of subjects in their 40s should be continued, and efforts should be made to reduce the risk of gastric cancer by eradicating H. pylori-associated active gastritis as well as for early detection of gastric cancer in the same age group. Endoscopic screening is recommended to effectively detect gastric cancer developed after eradication and esophageal cancer.