The number of patients with pancreatic ductal cancer (PDC) is increasing, and there are now over 30,000 patients in Japan. The prognosis of pancreatic cancer is still poor, and the number of deaths due to hepatic cancer, has become the 4th cause of all cancers in Japan. Diagnosis of this disease with mass formation is easy by imaging modalities, ultrasound, endoscopic ultrasound, CT and MRI. But many mass formed PDCs are far advanced cancers with a poor prognosis. Patients with small PDC of less than 10 mm or in situ have longer survival. Risk factors for PDC are reported by Japan Pancreas Society. Our data of PDC's risk factors are diabetes mellitus (DM), and intra-ductal papillary mucinous neoplasm (IPMN). DM is seen in approximately 60% of cases of PDC, but the number of cases of diabetes exceeds 7 million and further narrowing is necessary. A large-scale examination is required taking into account age, biomarkers and imaging diagnosis.

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Those who test negative for both anti-Helicobacter pylori(Hp) antibody and serum pepsinogen(PG) are allowed to be excluded from population-based screening due to what is thought to be their extremely low risk for gastric cancer. We tested this hypothesis by examining gastric cancer patients diagnosed at our center.
Patients who were negative for both anti-Hp antibody and serum PG (—“the negative group”—) accounted for 10% of gastric cancer patients. This percentage was thought too high.
“The negative group” proved to be significantly older, and showed a significantly milder degree of endoscopic atrophy. However, 85% of this group showed C-II or a more severe degree of endoscopic atrophy according to the Kimura-Takemoto classification system. Therefore, patients in “the negative group” who showed endoscopic atrophy were presumed to be false negative cases for anti-Hp antibody. We suggest that the problem of how to detect such patients is an urgent issue.

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Abdominal ultrasound screening has been widely adopted. However, quality control is difficult because the ability of the sonographer influences the accuracy. We introduced the “Abdominal Ultrasound Results Classification and Follow-up Guideline” by the Japan Society of Ningen Dock and assessed the accuracy between the sonographers before and after the introduction for the required workup judgment. Subjects were 24,598 cases. Before introduction (9,741 cases), the required workup rates were 1.10% to 3.13% and differences in sonographers judgements were seen. But after introduction (14,857 cases), the required workup rates increased to 4.41% to 5.95% and the differences between sonographers were reduced. Each sonographer was entrusted the required workup judgment based on the individual sonographer’s skill without the guideline. Therefore, a difference occurred and had an influence on the required workup rate lowering level where there were hesitations about a judgment. After introduction, these subjective and vague judgments of the sonographers decreased, and the mean required workup rates increased generally without differences between sonographers. This result suggests that the introduction of the “Abdominal Ultrasound Results Classification and Follow-up Guideline” contributed significantly to improvement in the inspection precision and judgement equalization. In 2014, the Manual for Abdominal Ultrasound in Cancer Screening and Health Checkups by the The Japanese Society of Gastrointestinal Cancer Screening was announced, and we are introducing it now in this health care center. With this new manual introduction, we expect a further improvement in the inspection precision.

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