In Japan, 29,000 people died of pancreatic cancer in 2011. The number has been increasing recently. Whereas, the 5-year survival rate of pancreatic cancer has remained at less than 10% for the past 50 years.
To improve the long-term survival, early detection is necessary. But, the pancreas is a small organ situated in a retroperitoneal cavity. Therefore, detailed examination is necessary to detect pancreatic cancer in an early stage without invasion to the surrounding tissue. The current screening with detailed examination for healthy people to detect early pancreatic cancer is not efficient. We propose a systematic approach composed of 3 steps for the detection of early stage pancreatic cancer. The 1^st step is to detect high risk people, such as those with pancreatic cyst and/or main pancreatic duct dilatation. The 2^nd step is to follow up the high-risk people strictly and identify any faint sign suggestive of the development of pancreatic cancer. The 3^rd step is to perform an adequate examination and reach a definitive diagnosis of pancreatic cancer in an early stage. At the Osaka Medical Center for cancer and CVD, we started the above system in 1998. By March 2011 (mean follow-up period: 71.89 months), pancreatic cancer had developed in 27 of 1,023 high-risk people. Of these pancreatic cancer cases, 67% were diagnosed at the early stage of Stage 0, 1A or 1B. Surgical resection was performed in 74%. And the 5-year survival rate of the 27 cases after diagnosis was 54.6%.

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We investigated the outcomes of endoscopic screening for stomach cancer in individual medical examinations in Maebashi City between FY2006 and FY2010. The number of examinees increased every year and a marked increase was noted particularly among those aged 60 years and older. The mean stomach cancer detection rate was 0.53%, whereas the detection rate by fiscal year showed a decreasing trend from FY2007 onward, mainly due to a decrease in the number of new examinees. The number of facilities with transnasal endoscopes increased from 13 to 48, and the number of examinees undergoing transnasal endoscopic screening also increased from 1,667 to 9,651. We classified medical examiners into specialists and non-specialists based on their experiences with an endoscope, and compared the two groups in terms of the stomach cancer detection rate, early cancer detection rate, biopsy rate, positive predictive value, and false negative rate. However, no significant differences were found between them. There were large inter-facility differences in the biopsy rate and positive predictive value, irrespective of whether the screening was performed by a specialist or a non-specialist. Future challenges include the acquisition of new examinees that have not undergone stomach cancer screening, and the reduction of inter-facility differences in the diagnostic performance of endoscopy.

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In 2010, the Kobe Steel Corporation Group introduced a new gastric cancer screening test combining the ABC health check and endoscopic test to the periodical health check of its employees and started eradication of Helicobacter pylori as a treatment based on gastroendoscopic findings. We have been checking serum pepsinogen (PG) for 2 consecutive years. Of 16,837 cases screened, 1.1% of PG negative subjects became PG positive while 6.8% of PG positive subjects became PG negative. The remaining 92.1% of subjects showed unchanged PG status. Eradication of Helicobacter pylori was performed for 32.0% of the subjects whose PG value became positive and for 80.7% of the subjects whose PG value became negative. Excluding the effect of eradication of Helicobacter pylori, subjects whose PG value became positive were 0.7% and subjects whose PG value turned negative were 1.3%. With cases of a discrepancy between the risk classification and gastroendoscopic findings and with cases of PG pseudopositive or PG pseudonegative, it is crucial to incorporate gastroendoscopic findings for screening. PG values are helpful for judging eradication but it is difficult to evaluate the degree of gastric atrophy solely by the PG value for successful eradication cases of Helicobacter pylori, since PG values become negative at the early stage of successful pylori eradication cases.

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Seven hundred and fifty-five candidates, who underwent not only a barium X-ray examination but also a combination test of using a urine anti-Helicobacter pylori IgG antibody (H.p test) and serum pepsinogen levels (PG method), were analyzed. X-ray films were checked without the result of the combination test. When X-ray films of subjects were judged as infection-free, they were classified as Group A1. When X-ray films were judged as chronic atrophic gastritis (CAG), they were classified as Group C. Additionally, according to the degree of the spread of atrophy, it was described as C2-4. The PG method is widely known as a serum marker of atrophic gastritis, which is a precancerous change in the stomach. There are several cut-off points, and PGI<=70.0 and PGI/II ratio<=3.0 are recommended as positive by Miki. The candidates were divided into positive adaptations of Miki's criterion.
Six hundred and fifty-one candidates (86.2%) did not have history of the eradication. Depending on the age of the candidates, a negative proportion of the H.p test was 75% in those under 40, 61% in those aged 40-49, 44% in those aged 50-59, and 31% in those aged over 60 years old. Two hundred and seventy-five cases were classified as the A1 group depending on the X-ray film, and 95% (261/275) were negative for both the H.p test and PG method (H.p-/PG-). Three hundred and fifty-four cases were classified as the C group, and 91% (322/354) were positive for the H.p test or PG method.
Most cases of infection-free subjects were both negative for the H.p test and PG method (Miki's criterion). The criterion of a normal stomach, which was classified on X-ray films, has to be adopted for these infection-free subjects. They do not need to be recommended for an annual examination.
If there aren't enough doctors who can classify X-ray films as either infection-free subjects or chronic atrophic gastritis, a combination test using both the H.p test and PG method will be administered as part of the first step in gastric cancer screening, because a combination test is simple without requiring both images and judgment from X-ray films.

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(Objective) The most frequently observed abnormality in abdominal ultrasonography is fatty liver. However, it is difficult to conduct thorough examination in all patients with fatty liver. In recent years, fat accumulation in the pancreas has attracted attention as a risk factor of arteriosclerotic disease. In this study, we focused on the degree of fat accumulation in the pancreas for the purpose of extracting fatty livers with a greater risk of arteriosclerosis.
(Subjective and Methods) One hundred and twenty one patients with fatty liver were investigated. As an index to show the degree of fat accumulation in the pancreas, brightness was evaluated by histogram values and the difference in brightness between the pancreas and spleen was indicated as the “pancreas-spleen difference.”
(Results) In patients with fatty liver, receiver operating characteristic analysis (ROC) was performed for the pancreas-spleen difference with the presence or absence of concurrent metabolic syndrome as the outcome, and the pancreas-spleen difference cutoff value was set at 45. It resulted in moderate accuracy with sensitivity of 0.652, specificity of 0.702, and area under the curve (AUC) of 0.705. The patients in the group with a high pancreas-spleen difference had concurrent metabolic syndrome at a higher frequency and had higher values of visceral fat area, higher body weight, higher BMI and higher abdominal circumference, suggesting that it is a group of patients with fatty liver with a greater risk of arteriosclerosis.
(Conclusion) It was indicated that adding the pancreas-spleen difference to the ultrasonic screening test could extract types of fatty livers that have high affinity for metabolic syndrome.

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