Purpose: It is now possible to organize gastroendoscopic screenings after the Ministry of Health, Labour and Welfare's revised its cancer screening guidelines in February 2016. This study verifies the gastroendoscopic screening system built for the entire Fukui Prefecture, including 16 cities and towns, to provide equal, safe and high-quality gastric cancer screenings.

Method: This study verified and analyzed the data of all 21,238 patients who underwent gastroendoscopic screening in FY2016 to FY2018, which included 8,933 men and 12,305 women aged 40-99 years.

Results: Overall, 2,196 (10.3%) patients required a complete examination. Of these, 90.5% patients underwent the complete examination. The number of gastric cancer cases detected was 119 (97 cases of early-stage gastric cancer and 22 cases of advanced gastric cancer). The detection rate was 0.56% and the positive predictive value was 5.42. The rate of patients requiring a complete examination, the rate of patients who underwent the complete examination, the gastric cancer detection rate and the proportion of patients with early-stage cancer were equal to or greater than those detected by local governments that have introduced gastroendoscopic screenings out of the Fukui Prefecture. However, the positive predictive value tended to be lower.

Conclusion: The introduction of organized gastroendoscopic screenings across the prefecture was relatively smooth in the Fukui Prefecture. The development of the centralization of double checks and precision management are being maintained. Nevertheless, further precision management, safety and quality improvements are required.

Background: Screening for gastric cancer using an endoscope following gastrography has been approved as a population-based screening method in Japan; however, most municipalities have not yet introduced it. We recently developed a medical carrier service that is equipped with a transnasal endoscope and is available for use even in depopulated areas (n = 5575).

Subjects and methods: We herein investigated whether this service made it easier for people to undergo gastric examination using a questionnaire filled by patients who used this service (n = 325).

Results: After this service, the screening rate markedly increased (5% in 2016 vs. >11% in 2017-2019). Moreover, cancer detection rate (0.12% by gastrography vs. 0.26% by endoscopy) as well as positive predictive value (0.9 by gastrography vs. 6.7 by endoscopy) also increased. The analysis of the filled questionnaires revealed that the reasons why patients chose the endoscope in the vehicle are due to its convenience (52.3%) and receptivity (40.0%). However, a small proportion of patients preferred gastrography (4.3%).

Conclusion: It is necessary to establish an appropriate screening system that will be widely accepted; this will help eliminate gastric cancer-related death.

Objective (background): On the basis of the results of opportunistic gastric cancer screening at our hospital, we investigated the target age and screening method for future opportunistic screening.

Subjects and methods: We reviewed the data of 20 years of opportunistic gastric cancer screening (56,603 X-rays and 15,263 endoscopies) at Kochi Red Cross hospital in five-year blocks: period I, 1999 to 2003; period II, 2004 to 2008; period III, 2009 to 2013; and period IV, 2014 to 2018.

Results: The gastric cancer detection rate by endoscopic screening for the entire dataset was 0.32%, which was significantly higher than that obtained by X-ray screening, at 0.06% (p < 0.001). The discovery rate of esophageal cancer over the entire dataset was significantly higher for endoscopic screening than X-ray screening, at 0.059% and 0.009%, respectively (p < 0.001). The gastric cancer detection rate of subjects in their 40s who would be excluded from opportunistic screening in the future was 0.09% in period I and 0.01% in period IV (not significant). 20.9% of subjects in the same age group in 2016 had atrophic gastritis. A total of 14 of 49 gastric cancers (28.6%) detected in periods III and IV had developed after Helicobacter pylori (H. pylori) eradication, and 13 of 14 cases were discovered by endoscopic screening.

Conclusions: In opportunistic gastric cancer screening, the assessment of subjects in their 40s should be continued, and efforts should be made to reduce the risk of gastric cancer by eradicating H. pylori-associated active gastritis as well as for early detection of gastric cancer in the same age group. Endoscopic screening is recommended to effectively detect gastric cancer developed after eradication and esophageal cancer.

Objective: This study aimed to clarify the clinical characteristics that are associated with advanced colorectal neoplasia (AN) in fecal immunochemical test (FIT) positive subjects.

Method: This study included 905 candidates who underwent colonoscopy (CS) as part of colorectal cancer screening out of 3779 patients who were positive for FIT from January 2014 to December 2016 at our hospital. A multivariate analysis was performed to retrospectively investigate the clinical characteristics associated with AN.

Results: Of the 905 patients, 148 (16.4%) had AN. Overall, 93 patients had a history of undergoing CS, and their AN positive predictive value (PPV) was significantly lower than that in 812 patients without CS history (1.1% vs. 18.1%). In the multivariate analysis of 812 patients with no CS history, age ≥60 years (OR 2.64, 95%CI: 1.78-3.95, P < 0.001), hypertension (OR 1.62, 95%CI: 1.06-2.47, P = 0.026), current smoking (OR 1.77, 95%CI: 1.05-2.94, P = 0.034), daily drinking habit (OR 1.63, 95%CI: 1.09-2.41, P = 0.017), and FIT value ≥259 ng/ml (OR 1.92, 95%CI: 1.31-2.83, P < 0.001) were significant risk factors associated with AN. The PPV increased as the number of risk factors increased; 4.3% (no risk factors), 9.3% (one risk factor), 28.8% (two or more risk factors), 33.1% (three or more risk factors), 42.9% (four or more risk factors).

Conclusion: To improve the effectiveness of colorectal cancer screening, it is necessary to promote the recommendation of CS to FIT-positive subjects with AN risk factors without CS history.