A study of stomach cancer mass screening using the pepsinogen test method in combination with the barium X-ray method

Abstract

In order to cope with the trend of decrease in the participation rate of Hakui City residents in stomach cancer mass screenings and the fact that the participants tend to be the same with no new residents joining the screenings, we investigated the efficiency of stomach cancer mass screening in Hakui City using the serum pepsinogen (PG) test method in combination with the barium X-ray method. The serum PG-I and -II levels were measured by chemiluminescent immunoassay as the first step. PG-positive subjects were recommended to undergo further screening by endoscopy, and PG-negative subjects were recommended to undergo examination by the barium X-ray method as the second step. In 2004, 1868 persons were enrolled in the study; the number of enrolled persons increased by 40% compared to the previous year. The total number of cases in which stomach cancer was discovered was 6, and the rate of discovery was 0.32%, a significant increase. Four of these were diagnosed as early cancer by endoscopy. The total PG-positive rate was 47%: 13% for 1+, 25.9% for 2+ and 8.2% for 3+. The subjects who needed further thorough examinations accounted for 39.9%, and 78.4% of the positive subjects were further examined by endoscopy. The total cost for the 2004 screening was almost half of that for the previous year. In conclusion, the two-step strategy comprising the PG test and barium X-ray can be used as a mass screening method for stomach cancer, because this method not only allows a larger population to participate, but also enables efficient examination, cost effectiveness, and improvement of the participants safety. Further studies are needed to establish a method for following up those who have been found PG-positive and who are therefore at high risk for stomach cancer.