The aspiration rates of high-density barium meal were higher than low-density barium using the conventional method. To assess evidence-based cancer screening, the potential hazards of cancer screening should be evaluated. However, few studies have investigated the adverse effects of the upper gastrointestinal series using a high-density barium meal. This study compared the adverse effects rates reported by the Japanese Society of Gastrointestinal Cancer Screening (JSGCS) with estimates from the Pharmaceuticals and Medical Devices Agency (PMDA). We conducted sensitivity analysis of the number of cancer screening participants that was a denominator of the adverse effects rates.
In the scenario where JSGCS investigated half of the number of cancer screening participants, mortality rates per 100,000 were 0.036 from estimates based on the PMDA, and 0.032 from the JSGCS, showing no significant differences (P=0.91). Furthermore, PMDA-estimated aspiration rates per 100,000 population were significantly lower (P<0.05) and gastrointestinal perforation rates per 100,000 population were significantly higher (P<0.05) than those reported by the JSGCS. Although huge differences were found between the JSGCS reports and the PMDA estimates in both aspiration and gastrointestinal perforation rates, mortality rates were similar.
Although serious adverse effects, including death, have been monitored, minor adverse effects, including aspiration, have differed in each report. Adverse effects should be defined and continuously monitored.

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With the aim of improving the accuracy of abdominal ultrasound screening for diagnosing cancer and lifestyle diseases, we conducted a comparative examination of the categorized criteria for abdominal ultrasound cancer screening provided by the Japanese Society of Gastrointestinal Cancer Screening and screening results determined based on the classification of abdominal ultrasound findings and follow-up actions provided by the Japan Society of Ningen Dock. If further examination was required of the conditions classified as Category 3 and above according to the cancer screening criteria, the recall rate for the cancer screening criteria was slightly higher than that for the dock criteria, but the difference did not reach statistical significance. According to organ, the recall rate for the liver or kidneys was significantly lower and that for the gallbladder/bile duct was significantly higher in the cancer screening criteria than in the dock criteria. All detected cancers could have been detected by either set of criteria. The guideline for cancer screening describes the points to be observed in great detail and, therefore, has a high likelihood of providing consistent screening accuracy. Cancer can still be detected under the conditions classified as Category 3. Therefore, a complete physical examination should be performed at least for the first visit and diagnostic findings should be documented. Although fatty liver and gallstones are classified under Category 2, they still require lifestyle guidance. Therefore, the present observations may suggest that follow-up actions covering lifestyle diseases, based on the guideline for cancer screening, be developed and added to the screening results.

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According to the annual report of Gastrointestinal Cancer Screening in Japan (2011), approximately 70% of individuals with positive screening results underwent diagnostic examination in the population-based colorectal cancer screening, whereas in the workplace-based colorectal cancer screening only approximately 30% of individuals underwent diagnostic examination. To improve compliance with diagnostic examination, we implemented the following strategies: 1) shortened the interval from screening test to diagnostic examination; 2) confirmed whether individuals with positive screening results have undergone diagnostic examinations; 3) encouraged compliance of individuals who did not undergo diagnostic examinations. Between April 1992 and March 2012, a total of 142,437 immunological fecal occult blood tests were performed and 5,180 (3.6%) tests yielded positive results. Of the individuals with positive results, 95.4% underwent diagnostic examinations. Thus, it is suggested that these strategies are effective in improving the compliance with diagnostic examination in the workplace-based colorectal cancer screening. However, to maximize the impact of the intervention, it will be necessary to adopt an organized screening program.

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X-ray examination for gastric cancer screening revealed a smooth-surface elevated lesion, about 25mm in size, at the greater curvature side of the gastric fornix in a 54-year-old man. Endoscopy showed a gastric SMT of the same size at the same area. The lesion presented as homogeneous low attenuated enhancement on abdominal CT with contrast medium injected. Three years later, X-ray examination for gastric cancer screening revealed the lesion had increased in size to about 40mm. By endoscopy, several areas of small erosions were found at the surface of the lesion. Biopsy was performed and showed irregular tumor cells with KIT, CD34 strong positive and α-SMA positive by immunohistological staining and finally a GIST was diagnosed. EUS showed a comparatively homogeneously low echoic mass located in the 4th layer. On abdominal CT with contrast medium injected, an area of high attenuated enhancement was found in the lesion. Surgical resection was performed. And the pathological diagnosis was a high-grade GIST.

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A 66-year-old man underwent a health checkup (a complete medical checkup) and was found to have gallbladder enlargement and biliary sludge by abdominal ultrasonography. He was diagnosed as category 3 according to the Categorized Criteria for Abdominal Ultrasound Cancer Screening of The Japanese Society of Gastroenterological Cancer Screening (JSGCS).
Considering this was the initial assessment, further detailed examination was recommended. He visited another hospital with a complaint of fever on the following day of the health check up where bile duct cancer was suspected. He was referred to our hospital and underwent surgery because of the diagnosis of lower bile duct cancer as revealed by the detailed examination.
Although this patient was observed with no jaundice and only ALT and γ-GT rise in the liver function test at the health checkup, he was recommended for further detailed examination according to the findings of Category 3 in the Categorized Criteria for Abdominal Ultrasound Cancer Screening.
Although it is unfeasible to conduct detailed examination for all cases in category 3 and 3', all cases in the initial assessment (category 3) should be closely examined.

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