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.

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We measured blood proteins in feces to examine their usefulness in fecal occult blood testing. The antigenicity of hemoglobin (Hb) in feces was most unstable in the protein that we measured. The quantity of transferrin (Tf) as an indicator of blood volume was 5 times that of Hb in feces from colon cancer patients, and Tf was more stable than Hb as a bleeding marker. The detection of alpha 1 acidglycoprotein (AG) showed not only a quantity of blood equivalency 20 times higher than that of Hb in feces from colon cancer patients, but also a high rate of detection in stomach cancer patients. It was thought that AG is a useful bleeding marker capable of demonstrating bleeding from the whole gastrointestinal tract. Alpha-1 antitrypsin was found to be highly dense in feces, but was not a specific bleeding marker. Because the antigenicity of Hb is easily lost during Hb measurement as a screening test for colon cancer, false positives as well as false negatives can easily occur. However, such problems may be addressed by utilizing different bleeding markers.

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We have investigated efficient procedures for conducting TCS screening. We have already published the first and second reports on this subject. For this third report, however, this issue was reexamined by extending the study period to increase the number of TCS receivers and TCS detected invasive cancers and by introducing the new concept of the rate of invasive cancer detection by virtual second TCS. The efficient procedure for conducting TCS screening was found to be as follows: TCS is actively performed in patients aged 30 or older who have never received TCS and present with symptoms suspicious for colorectal cancer; a second TCS is performed 2 years later in patients in whom mucosal cancer or adenoma was detected by the initial one; a second TCS is performed 4 years later in patients in whom no neoplastic lesion was detected by the initial one; and a third one is not performed for an extended period of time. However, this procedure does not apply to patients in whom invasive cancer was detected, patients in whom observation by TCS was insufficient, or patients who developed new symptoms suspicious for colorectal cancer after examination by TCS.

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From 1992 to 2003, the detection rate of intrahepatic portohepatic venous (PV) shunt in a mass survey using abdominal ultrasonography was 26 cases among 179, 242 persons (0.014%); 0.017% in men, 0.010% in women. Beginning in 1998 we adopted ultrasonic diagnostic instruments with a Doppler function. The detection rate of intrahepatic PV shunt increased to 0.02% in this latter period, representing an additional 0.007%. The male: female ratio was 3.3:1, and the mean age was 53.3 years. No subject had abnormal blood tests. Sites of PV shunts were the right hepatic lobe in 17 patients, and the left in 9. When we compared 20 cases detected after 1998 (group B) with 6 detected before 1998 (group A), the mean diameter of the PV shunt in group B was 17.0mm, significantly smaller than in group A (142mm). Nine shunts had been missed in mass surveys; 4 of these cases were misdiagnosed with liver cysts, and 5 lacked apparent findings. Ultrasonic instruments with a color Doppler capacity contributed to improved detection. Careful study of ultrasonographic features of any cystic lesion or dilated portal vein in the liver is needed, including confirmation of a Doppler signal within the abnormality.

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The time has come for the first update of the qualification for certified Radiological Technologists established in 2001 by the Japanese Society of Gastroenterological Mass Survey. As certain issues in the system have been pointed out, including the lack of practical examination for the qualification, efforts to address them have already started. Considering this issue based on my experience, I remember the lack of useful instruction for certified technicians on how to take “radiographs that enable the accurate detection of abnormalities on the screen and thus contribute to proper diagnosis. ” An education system should be established in which certified technologists can acquire radiographinterpretation and diagnosing abilities adequate for gastric radiologists.

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