The problems of mass screening for pancreatobiliary cancer are a low detection rate and the excessive number of patients with progressive cancers when diagnosed. From my experience of performing ultrasonography as a close examination in mass screening, I report the current status of early diagnosis of pancreatobiliary cancer. From September 1989 to January 2009, I performed ultrasonography in 4,045 people in a mass screening institution, whose total number of mass screenings averaged 22,950 people per year. We treated 39 patients (1.0%) with malignant tumors; 10 patients (0.24%) had pancreatic cancer, 6 gallbladder cancer (0.15%), 2 bile duct carcinoma (0.05%), and 7 hepatocelluar carcinoma (0.17%). The resection rate of gallbladder cancer was 83%, and that of bile duct carcinoma and pancreatic cancer was only 50%. Intraductal papillary mucinous neoplasms are recognized as a high risk of pancreatic cancer and may be diagnosed in the early stage by close follow-up examinations performed for such patients. The close cooperation with a mass screening institution and expert hospitals is as important as improving the rate of workup examinations.

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The causal relationship of gallstone diseases to biliary cancer has long been controversial. In this regard, it is necessary to develop a primary screening system associated with the following diagnostic strategy for early biliary cancer, and thus, the guideline for gallstone treatment recently developed by the Japanese Society of Gastroenterology will be beneficial for screening cancer risk factors and complications in the follow-up system. In this review, an approach to biliary cancer management based upon the guideline for biliary stone treatment is discussed as a part of biliary disease screening in light of the following aspects: 1) the prevalence of biliary diseases, 2) the benefit of guidelines, and 3) the benefit of PET.

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The subjects of this study were 7,101 workers who underwent stomach cancer screening using the pepsinogen (PG) test from April 2003 to March 2010. Between these 7 years, 3,061 underwent the screening once, and 4,040 twice or more (maximum of 8 times). The positive rate of the first-time PG test was 15.7% (1,118/7,101). Of the first-time positive test cases, 24.6% (213/867) changed to negative afterwards. On the other hand, of the first time negative test cases, 3.6% (181/5,039) changed to positive afterwards. Of the 828 cases that underwent the PG test more than three times, the results of 78 cases (9.4%) changed more than two times. Furthermore, the results of 4 cases changed four times. As a result of a total of 13,005 PG tests, 4 (0.031%) gastric cancers were diagnosed, which were not detected by X-ray screening. This study suggests that the problems of workplace screening using the PG test are the varying opinions which often changed year by year and the low cancer detection rate.

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We prospectively diagnosed Helicobacter pylori infections by performing gastric radiography during medical checkups in Japanese Red Cross Hospital, and compared the serum titers of H pylori antibody. The range, width, and form of the gastric mucosal folds and the size of granules on the mucosal surface of the gastric antrum and body were assessed, and then, a diagnosis of H pylori was made on the basis of these findings.
We investigated 143 cases with no history of H pylori eradication. On the basis of radiographic findings, 77 cases (53.8%) were diagnosed as having H pylori infection, and 47 cases (32.9%) were positive for serum H pylori antibody. The sensitivity was 100%; specificity, 68.8%; and accuracy, 79.0%.
When radiological diagnosis was re-performed by excluding the range of gastric mucosal folds from the diagnostic criteria, 43 cases (30.1%) were diagnosed with H pylori infection. Thus, although the sensitivity decreased to 85.1%, the number of false positive cases also reduced; the specificity and accuracy were increased to 96.9% and 93.0%, respectively.

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An observational study was conducted in 4,242 subjects who underwent first-time colonoscopy for positive immunochemical fecal occult blood test (IFOBT) from 2005 to 2008. Clinical information on study subjects including age, gender, smoking and drinking habits, and body mass index (BMI) was collected. The analyses were performed adjusted for age and gender to determine which lifestyle factor (smoking, drinking, or obesity) is a risk for developing colorectal advanced neoplasia or cancer. For men or relatively young-aged (< 60 years) subjects, smoking and drinking habits increased the risk of having colorectal neoplasia, while for women, obesity increased the risk of CRC. Smoking and drinking habits and obesity affect the prevalence of colorectal neoplasia differently according to patient age and gender.

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