This paper reports on the history of the Kyushu branch of the Japanese society of gastrointestinal cancer screening and the Fukuoka Area Gastric Mass Screening Interpretation Study Group. We discuss the achievements of the screening in this area. Additionally, we review the development of gastric cancer screening using endoscopy in Fukuoka city starting in 2000. Dr. Shinji Kitagawa introduced screening endoscopy for gastric cancer, then Dr. Yuichi Nakamura took over the task, which was ahead of the contemporary national cancer screening programs. In some parts of Fukuoka Prefecture, endoscopic screening started in 2016. Currently, 31 municipalities conduct endoscopic screening, which is about half of the cities in the prefecture. Those cities have a total of 1,030,132 eligible people for cancer screening, which accounts for 80% of the prefecture's target population for gastric cancer screening.

Furthermore, we report on the current status of and issues regarding endoscopic screening for gastric cancer in Fukuoka Prefecture.

Objective: We assessed the effectiveness of the assistance of radiological technologists in interpreting screening X-rays for gastric cancer using the categorized criteria for X-ray image reading (category classification).

Subjects and methods: One radiologist and six radiological technologists with different durations of experience independently classified 232 patients who underwent screening X-ray for gastric cancer from April 2011 to March 2017 and who underwent detailed gastroscopy to determine the final diagnosis, and we compared their categorizations.

Results: The match rate of the classifications between all technologists and the radiologist was good at 75.8% (kappa coefficient: 0.601). The match rate of qualified gastric cancer examination specialists, 83.9% (kappa coefficient: 0.71), was better than that of unqualified persons, 68.0% (kappa coefficient: 0.454). Unqualified persons tended to underestimate findings compared with qualified specialists.

Conclusions: Although the results suggested that a technologist could assist in interpretation using the categorized criteria, it is desirable that the technologist who assists is a specialist in gastric cancer screening. To correct the disparity in the reading ability among technologists, it is necessary for technologists to participate actively in study sessions, undertake reading training in a practical format, and accumulate case studies to improve their reading accuracy and standardize their reading ability.

Background: In Fujieda City, the modified ABC classification system has been used for gastric cancer risk assessment since April 2013. Endoscopic gastric cancer screening has been introduced in April 2018, based on the results of the modified ABC classification system. We examined the present status and the problems of the gastric cancer examination system in Fujieda City.

Methods: Target populations screened under the modified ABC classification system included subjects aged 39-75 years every five years (they had to undergo screening only once in their life). After framing the serum pepsinogen test positive (PG (+) ) at PG I ≤ 70 ng/mL and PG I/II ≤ 3.0, the modified ABC classification system was divided into (1) A group: Helicobacter pylori (H. pylori) antibody < 3 U/mL and PG (-) and PG I/II > 4 and PG II < 15 ng/mL; (2) A' group: "3 U/mL ≤ H. pylori antibody < 10 U/mL and PG (-) and 3 < PG I/II ≤ 4" or "3 U/mL ≤ H. pylori and < 10 U/mL and PG (-) and PG II ≥ 15 ng/mL"; (3) B1 group: H. pylori antibody ≥ 10 U/mL and PG (-) and PG II < 30 ng/mL; (4) B2 group: H. pylori antibody ≥ 10 U/mL and PG (-) and PG II ≥ 30 ng/mL; (5) C group: H. pylori antibody ≥ 10 U/mL and PG (+) ; and (6) D group: H. pylori antibody < 10 U/mL and PG (+). We excluded people who take PPI and related drugs. People in groups A/A', or excluded-patients, were notified about the endoscopy screening based on subsidy from the city, and people in groups B-D were notified about the screening based on health insurance. Periodical endoscopic screening was performed on the examinees in groups B-D.

Results: We found that the detection rate of stomach cancer was 0.27%, and that in group A, it was 0.0081%; group A', 0.18%; group B1, 0.43%; group B2, 0.26%; group C, 1.22%; and group D, 1.23%. The detection rate of cancer in the periodical endoscopic screening is 0.53% (41/7, 700; A 0, A' 2, B1 4, B2 5, C 26, D 4). All gastric cancers in group A' were found after the fourth year of conducting the modified ABC classification system for gastric cancer risk assessment.

Conclusions: Gastric cancer is rarely detected in group A based on the modified ABC classification, and exclusion from gastric endoscopic screening can be considered for this group. In addition, it is acceptable to extend the examination interval for the A' group.

Background: Early detection of cancer is important, and there is a need for a simple and accurate cancer-detection method. The Nematode-NOSE (N-NOSE) test, developed by Hirotsu et al., is a simple cancer test that applies the highly sensitive olfaction of the nematode (Caenorhabditis elegans) to urine samples. The specificity and sensitivity of N-NOSE have previously been reported to be 95.0% and 95.8%, respectively.

Subjects: In this study, observational studies were conducted to evaluate the ability of N-NOSE using urine samples of 74 patients with gastrointestinal cancers and 30 patients without cancers.

Results: The index of N-NOSE differed significantly (p<0.0001) between those with and without cancers, and ROC analysis showed an AUC of 0.774. The sensitivity of N-NOSE for cancers was high (81.1%), and its specificity in excluding cancer was 70.0%. Moreover, the sensitivities were 80.0% for esophageal cancer, 68.8% for stomach cancer, 80.0% for colorectal cancer, 90.9% for hepatocellular carcinoma, 100% for biliary tract cancer, and 80.0% for pancreatic cancer. A stage-based analysis in this study showed high sensitivity of N-NOSE in detecting early-stage cancers (76.9% for stage I and 90.9% for stage II), showing superiority to tumor markers. No significant relationship was found between the N-NOSE index and patients' age, sex, complications, liver function, renal function, and general urine test results.

Conclusions: These results suggest that N-NOSE can be a noninvasive, highly sensitive, and simple cancer risk test.

The Osaka City Endoscopic Gastric Cancer Screening Conference was established in March 2016 to discuss issues on population-based endoscopic screening for gastric cancer. There is a consensus that cleaning and disinfection with a high-level disinfectant are essential, that patients undergoing antithrombotic treatments should be excluded from screening, and that sedatives should be prohibited in principle. There was agreement that endoscopic documentation should include approximately 40 images and that the review of images should be performed in the same facility. Regardless of the experience with screening or diagnostic endoscopy, doctors who performed more than 1,000 upper endoscopic examinations and were currently performing more than 100 endoscopic examinations annually were accepted as examiners or reviewers. Currently, we are focusing on training endoscopic examiners and double-check doctors. Screening endoscopists are encouraged to take images that are comprehensive and of a high quality, and the workshops being held at present focus on the presentation of false-negative cases. Future trainings will focus on the endoscopic diagnosis of Helicobacter pylori infection and the evaluation of atrophic gastritis, including education regarding the Kyoto classification of gastritis.