Population-based screening for gastric cancer in Miyagi prefecture has been mainly conducted by Miyagi Cancer Society, and approximately 180,000 inhabitants a year have undergone a barium X-ray examination provided by our institute. Our institute has adopted the total management system of the mass screening program called “the Miyagi method,” in which our institute conducts the planning of the first examinations and detailed examinations, collection of the final diagnosis and reporting to municipalities. We have enthusiastically performed a call/recall to individuals who have not undergone a detailed examination yet. Thus, the percentages of examinees undergoing detailed examinations have been maintained at a high level of around 95% for a long time in our institution. The quality of radiography has also been improved by the introduction of highly-concentrated low viscous barium and the digital device. In consequence, while our cancer discovery rate has remained at around 0.2%, the recall rate has gradually decreased to 6.7% and the positive predictive value has improved to 3.1%. In addition, the proportion of early-stage cancer has recently increased to 78.9%. Our institute began to use new criteria of X-ray image interpretation in consideration for Helicobacter pylori (H.pylori) infection from the mass screening of 2014. In the criteria, a healthy stomach without H.pylori infection, showing neither gastritis nor atrophy, can be distinguished from chronic gastritis and diagnosed as showing “no abnormality. “Methods of mass screening for gastric cancer by X-ray fluorography will change over time, but providing a high quality screening program based on appropriate accuracy control is essential to maximize the benefit of examinees.

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Shizuoka city introduced endoscopic screening in April 2012 in addition to conventional X-ray gastric cancer screening. As the city government is positive in introducing endoscopic screening, it has been smoothly implemented in cooperation with the medical association and public hospitals. In the 3 years since its start, the percentage of examinees has increased from 7.1% (13,840/194,930) to 10.5% (20,444/195,200). Also in the data during the fiscal years of 2012 and 2013, while the detection rate of gastric cancer by X-ray screening was 0.06% (17/29,008), that of endoscopic screening was significantly higher at 0.18% (19/10,272). The Gastric Cancer Screening Accuracy Control Committee is currently trying to change the minds of screening member doctors to accelerate eradication therapy by performing “Screening of H.pylori infected gastritis” simultaneously in regular gastric cancer screening. Whereas an increase in the number of examinees selecting endoscopic screening is expected, our task will be accuracy control including technical improvements of endoscopists and securing such endoscopists. In addition, ABC classification should be adopted for efficient screening operation.

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Helicobacter pylori (H. pylori) infection is the primary cause of atrophic gastritis, which is a major risk factor for the development of gastric cancer. This study aimed to reveal the relationship between atrophic gastritis and lifestyle factors. Data for analysis were obtained from a baseline survey of the Japan Multi-Institutional Collaborative Cohort (J-MICC) Study in the Kyoto area. Eligible subjects were individuals who were 35 to 69 years old and who participated in a self-administered questionnaire survey including lifestyle factors and in a health check-up between 2011 and 2012. The inclusion criteria of this study were as follows: those who had no history of upper gastrointestinal surgery, upper gastrointestinal disease treatment, and renal failure. Of the 1,894 individuals who participated in the J-MICC Study in Kyoto during the study period, 1,280 (67.6%) were included in this analysis (419 men and 861 women). Atrophic gastritis was diagnosed by the pepsinogen (PG) test method: serum PG I level (≤70ng/ml) and PG I / PG II ratio (≤3.0). The presence of immunoglobulin G antibodies to H. pylori indicated H. pylori infection. After adjusting for age, H. pylori infection, smoking status, and alcohol consumption, the odds ratio of atrophic gastritis associated with beef and/or pork intake 3 times a week or more frequently was 2.22 in men [95% confidence interval (CI) 1.07 - 4.58]. In women, the odds ratio of atrophic gastritis associated with passive smoking within a year was 2.03 (95% CI 1.02 - 4.03). In conclusion, the results of this study in a Japanese population show a positive association between atrophic gastritis and beef and/or pork intake more than 3 times a week (in men) and passive smoking within a year (in women).

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We examined changes in the number of gastric cancer cases and the age at tumor development during the 19 years from 1994 to 2012. During this 19-year period, the number of gastric cancer cases decreased by half, and the age at early-stage gastric cancer development increased by 10 years. Among all patients with gastric cancer, there were only a few less than 50 years of age (3.6%), and the largest age group was comprised of patients in their 70s. Overall, 84% of patients with gastric cancer were at least 60 years old. For efficient gastric cancer screening, raising the age for the start of screening and strategies for people 60 years of age or older appear to be urgent tasks.

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Detection of posterior lesions on gastric angle to body by using conventional transoral is sometimes difficult. In contrast, imaging of the posterior wall on gastric angle to body by retroverted view using transnasal endoscopy is easier than by using conventional transoral endoscopy. Retroverted view using transnasal endoscopy is useful for the detection of posterior lesions on gastric angle to body.

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