The 50^th Tokai-Hokuriku regional meeting was held in September 2021. Because 50 years had passed since the first regional meeting, the progress of the gastrointestinal cancer screening program in the Tokai-Hokuriku area was reviewed. The regional meeting was called “Tokai-Hokuriku Meeting of Gastric Mass Survey” from the first to the 11^th meeting. After the 12^th meeting, it was renamed“Regional Meeting” and was held along with the“Tokai-Hokuriku Meeting of Gastric Mass Survey” on the same day. The format of the meeting was maintained till the 46^th meeting. The name of “Tokai-Hokuriku Meeting of Gastric Mass Survey” was changed to “Tokai-Hokuriku Meeting of Gastrointestinal Mass Survey” and eventually to “Tokai-Hokuriku Meeting of Gastrointestinal Cancer Screening” in accordance with the change of the name of the society. At the 46^th meeting, the“Tokai-Hokuriku Meeting of Gastrointestinal Cancer Screening” was dissolved and combined into the regional meeting. After that, only the regional meetings were held. Three methods of mass screening in the 1970s, the change in the number of society members, the difference in the number of people undergoing upper gastrointestinal series, the name of chapter managers, the name of presidents of Annual Meeting and General Meeting, the names of the winners of the Kaizo Ariga Award for Cancer Screening and JSGCS Paper of the Year Awards, reports from the first to the third Annual Meeting, the progress of cancer screening in Aichi Prefecture, Fukui Prefecture, and Ishikawa Prefecture, and the early years of ultrasound-based screening were described mainly by quoting from the literature.

Even though the implementation of endoscopy as a tool for population-based gastric cancer screening has been approved, it is difficult to introduce it in municipalities with limited medical resources. However, there is a serious shortage of physicians who are skilled in interpreting gastric X-rays, and it is becoming difficult to maintain a cross-checking system for radiographic screening. To enhance the accuracy of X-ray interpretation, The Japanese Society of Gastrointestinal Cancer Screening (JSGCS) formulated the “Categorized Criteria for X-ray Image Reading of the Population-Based Gastric Cancer Screening.” There are six categories (Category 1, 2, 3a, 3b, 4, and 5) based on the presence or absence of Helicobacter pylori-infected gastritis, the certainty of the existence of a lesion, and the degree of confidence in malignancy. Category 3a or higher is required for a close examination, while category 1 or 2 is determined based on the presence or absence of gastritis or atrophy in cases without the need for close examination. The categorization system is a simple index to indicate the presence of a lesion and the degree of confidence in malignancy. It is expected that by sharing this index with X-ray radiographers for gastric cancer screening, their skills and knowledge can be utilized in gastric X-ray interpretation. The JSGCS has established a system of certified radiographers assisting for X-ray image interpretation. To supplement the shortage of physicians who can interpret gastric X ray images and maintain the accuracy of gastric X-ray screening, it is desirable to reconstruct the X-ray interpretation system and introduce the assistance service of certified X-ray technicians for X-ray image interpretation.

A 70-year-old man presented to our department with an intra-abdominal mass that was 50 mm in size and was detected by abdominal ultrasonography during a health checkup. He had no symptoms and had undergone annual physical examinations, including fecal immunochemical testing since the age of 65 years, but no abnormalities were detected. Positron emission tomography-computed tomography revealed fluorodeoxyglucose accumulation only in the small intestinal tumor, and no other lesions were thought to be present. However, screening endoscopy revealed an ulcerative lesion with a submucosal elevation in the descending colon, which was biopsied and diagnosed as poorly differentiated adenocarcinoma. Both lesions were resected, and the small intestinal tumor was diagnosed as a gastrointestinal stromal tumor that measured <5 cm with a Ki-67 percentage score of <5%, which was low-risk according to the Fletcher classification. On the other hand, preoperatively, the descending colon cancer stage was considered to be cT3N0M0; however, the postoperative pathological stage was determined to be pT4aN1M0. Postoperative adjuvant chemotherapy was administered, but six months after the surgery, the patient developed multiple liver and intra-abdominal lymph node metastases and died of liver failure due to obstructive cholangitis. Thus, this was a rare case in which the patient had a negative fecal immunochemical test for six consecutive years but had advanced colon cancer and died.