We studied the utility of the serum pepsinogen test (PG test) and the optimum interval between tests in stomach cancer screening at the Kansai Occupational Health Association. From April 2002 to March 2006, 74,382 subjects (47,708 men, 26,674 women) were screened for stomach cancer. We detected 55 cases of gastric cancer during this period. The PG-test-positive rate was higher in older subjects than in younger ones, as in cancer cases. There was a case of early gastric cancer registering as PG-test-positive and UGIS-negative, so the PG test was useful as a complementary test to UGIS in the mass screening. We also examined the changes in the positive rate of the PG test over 5 years. As a result, we found that 5 of 55 gastric cancer cases changed from PG-test-positive to PG-test-negative. Similarly, 8 of 100 randomly sampled cases who had no gastric cancer changed from PG-test-positive to PG-test-negative; however, in most cases, the result of the PG test did not change over several years. Thus, we found that a 3-year interval between PG tests might be sufficient.

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We have previously reported 3 studies on the efficient implementation of total colonoscopy (TCS) screening. In this study, we divided the target population into 3 groups - young people (less than 40 years old), middle-aged people (40-64 years old), and elderly people (65 years old and older) - and investigated the efficient implementation of the second and third TCS screening.
According to the results, it was concluded that the efficient implementation of the second and third TCS screening is as follows: (i) A second or third TCS screening is not recommended for young people. (ii) Middle-aged people in whom intramucosal carcinomas or adenomas have been detected at the first TCS should have the next TCS 3 years later, and middle-aged people in whom no tumor lesions were detected at the first TCS should have the second TCS 5 years later and a third TCS should not be conducted. (iii) Elderly people in whom intramucosal carcinomas or adenomas have been detected at the first TCS should have the next TCS 1 year later, and elderly people in whom no tumor lesions were detected at the first TCS should have the second TCS 3 years later; if any intramucosal carcinomas or adenomas are detected at the second TCS, the third TCS should be conducted 2 years later, and if not, 4 years later.

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At our institution, Matsushita Health Care Center, patients diagnosed with mildly and moderately atypical and protruding-type small colorectal adenomas by total colonoscopy (TCS) from 1997 to 1999 were followed by annual fecal occult blood testing (FOBT) combined with TCS for 5 years. Ninety-one advanced lesions such as adenoma larger than 5mm or carcinoma were detected in these patients by follow-up TCS. The pathological findings and size of 63 out of 91 lesions were determined. These 63 lesions were classified into a positive or negative group based on FOBT results during follow-up. The positive group consisted of 30 lesions detected by TCS with a positive FOBT result, and the negative group consisted of 33 lesions detected by TCS in spite of a negative FOBT result. Clinical characteristics such as pathological findings, size and detection rate by previous TCS were compared between the two groups. The average tumor size of the positive group was significantly larger than that of the negative group, while the pathological findings were not significantly different between the two groups. The detection rate by previous TCS of the positive group was significantly lower than that of the negative group. Nevertheless, all lesions in the positive group were detected early enough for endoscopical therapy to be performed. We suggest that such lesions missed by previous TCS or those growing rapidly can be detected early enough by annual FOBT during follow-up for small colorectal adenomas.

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We performed ultrasonography on 155,238 participants in a mass-screening program implemented between 1995 and 2004. We diagnosed GB-ADM in 720 subjects (0.46%) during these 10 years. GB-ADM was detected in 574 of 101,209 men (0.43%) and in 146 of 71,499 women (0.20%), indicating a greater prevalence in men. We determined the prevalence of GB-ADM and clinical features such as gender, age, macroscopic findings and complications in 125 persons over intervals up to 10 years (mean observation period, 5.8 years). Ultrasonography showed 58 cases (46%) to be localized, while 37 (30%) were segmental and 30 (24%) were diffuse. Thus, localized cases were the most frequent. No patients had gallbladder carcinoma. Gallstones were present at the initial screening in 6 of 125 patients followed up for GB-ADM (4.8%): 1 (0.8%) among the localized cases, 4 (3.2%) among the segmental cases and 1 (0.8%) among the diffuse cases. Gallbladder polyps were detected during screening in 19 of 125 patients with GB-ADM (15.2%): 4 (3.2%) among the localized cases, 6 (4.8%) among the segmental cases and 9 (3.2%) among the diffuse cases. In 5 of the 125 patients who underwent follow-up (4.0%), serial ultrasonographic observations showed a further increase in the gallbladder wall thickness, but no new gallstones, new polyps or carcinomas. More extensive long-term observations will be necessary to clarify whether or not any relationship exists between GB-ADM and gallstones, as well as between GB-ADM and gallbladder carcinoma.

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Virtual colonoscopy (VC) has been used for colon screening at our hospital since June 2003, and during the approximately four years since then, this procedure has been carried out on 4,644 people. Disorders other than lesions of the colon have coincidentally been identified from the VC axial images, and among these, the identification of pancreatic lesions has been conspicuous. Disorders other than lesions of the colon have been observed in 44 patients (0.94%), the largest number of which has been pancreatic lesions (29 cases, 0.62%). The detected pancreatic lesions were pancreatic cysts (17 cases, 0.37%), intraductal papillary mucinous neoplasms (IPMN) (seven cases, 0.13%), pancreatic pseudo-cysts (two cases, 0.04%), pancreatic carcinoma (one case, 0.02%), solid-pseudopapillary neoplasm (SPN) (one case, 0.02%) and mucinous cystic neoplasm (MCN) (one case, 0.02%). We reported four cases of pancreatic lesion (SPT, pancreatic carcinoma, IPMN, and simple pancreatic cyst). The utility of pancreatic lesion diagnosis through multi-detector computed tomography (MDCT) in dynamic studies has been previously reported, but there have been no reports of the use of plain axial images. We would consider it ideal if plain axial images could contribute to the detection of pancreatic lesions, in addition to screening for lesions of the colon during VC.

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