Although endoscopic screening is being introduced for population-based gastric cancer screening in Japan, it is difficult to introduce in municipalities with limited medical resources. Therefore, gastric X-ray screening is expected to remain prominent in the future. The “Gastric Cancer Screening Technician Reading Assistance System” has been established to address the decrease in the number of gastric X-ray readers. This system is expected to promote team medicine and efficient screening. AI assistance may improve quality and efficiency in endoscopic screening. In gastric X-ray screening, Helicobacter pylori gastritis is classified as a Category 2, high-risk group for gastric cancer; in gastric endoscopic screening, there is no classification corresponding to Category 2, which is an issue for further study. In recent years, changes have occurred in disorders of the upper gastrointestinal tract, including an increase in the number of esophageal cancer cases. Therefore, it is important to detect esophageal cancer in gastric cancer screening, and especially in endoscopic screening, the esophagus should be carefully observed with image-enhanced observation. Whether the pharynx and duodenum should be included as target organs for screening is an issue for further study. Follow-up surveys are important to evaluate screening, but are not being conducted reliably. The digitization of medical information, which is promoted by the government, may make it possible to share information between cancer screening and medical claims, thereby re-establishing a system of accuracy control.

Cancer screening in the stomach, breast, cervix, colon, liver, and lung is offered by the Ministry of Health and Welfare in South Korea. The National Health Screening Program aims to decrease cancer-related mortality by detecting early-stage cancers. In addition to cancer screening provided by the government, opportunistic cancer screening is provided to all Korean employees by their employers. The Korea Central Cancer Registry collects data from mass screening and opportunistic screening, so the exact participation rate is calculated. Guidelines recommend endoscopy for Koreans aged between 40 and 74 years because gastric cancer-related mortality significantly decreases. However, the mortality did not decrease in older subjects nor in the subjects who were screened with UGIS. In 2020, 90.2% of gastric cancer screening was performed with endoscopy in South Korea. An internet reservation system for cancer screening prevents endoscopists from overwork. The gastric cancer screening rate was 44.7% in 2010, increased to 62.9% in 2019, and then decreased in 55.7% in 2020 due to the pandemic of severe acute respiratory syndrome coronavirus 2. The rate of gastric cancer or adenoma in endoscopic screening was 0.48%. The age-standardized incidence of gastric cancer per 100,000 persons decreased by 0.2% per year until 2011, and then decreased by 4.6% per year thereafter. The age-standardized mortality rate of gastric cancer per 100,000 persons decreased from 57.6 in 1985 to 7.1 in 2019, passing Japan’s rate in 2012. The five-year survival rate increased from 43.9% in 1993-1995 to 77.5% in 2015-2019. These changes are reflected by the increase in the rate of early-stage gastric cancer from 28.6% in 2009 to 63.6% in 2019. The prevalence of Helicobacter pylori (H. pylori) infection has been decreasing and the eradication rate has been increasing in Korea, suggesting that the gastric cancer screening program needs adjustment according to the status of H. pylori infection. Therefore, biannual endoscopic screening should not be required for all Koreans in the future. Gastric cancer screening should be initiated after discriminating between H. pylori-naïve, -infected, and -eradicated subjects by trained endoscopists in diagnosing H. pylori infection status using endoscopy and serum assay findings. H. pylori should be eradicated properly in infected patients as the primary prevention of gastric cancer, before starting secondary prevention by biannual endoscopic screening.

OBJECTIVES: Colonoscopy is a standard examination technique for patients with positive fecal occult blood test results. However, patients occasionally refuse colonoscopy because of the pain experienced during a previous colonoscopy procedure. Additionally, in some cases, total colonoscopy is difficult to perform. Therefore, this study aimed to investigate the significance of computed tomography colonography (CTC) in patients with positive fecal occult blood test results who refused colonoscopy or underwent incomplete colonoscopy.

SUBJECTS and METHODS: From May 2012 to April 2022, 261 patients with a positive fecal occult blood test result who refused colonoscopy or did not undergo total colonoscopy underwent CTC. The CTC reporting and data system was used to analyze the patient data.

RESULTS: CTC results revealed polypoid lesions measuring 6-9 and >10 mm and a suspected malignant lesion in 17, five, and one patient, respectively. Further examination revealed three cases of colon cancer, one case of marginal zone B-cell MALT lymphoma, two cases of advanced adenoma, one case of pancreatic cancer, and one case of mesenteric gastrointestinal stromal tumor.

CONCLUSION: CTC is important for the early detection of colon cancer in patients with a positive fecal occult blood test result who refuse colonoscopy or cannot undergo total colonoscopy.

【background】 We have built a new data transmission system that includes images by ICT (information and communication technology). We examined whether this new system can reduce disadvantages of the examinees.

【subjects and methods】 We included 155,312 endoscopic examinees from fiscal 2008 to fiscal 2019 (before the introduction of the new system) and 23,802 endoscopic examinees in 2020 and 2021 fiscal years (after the introduction of the new system; 14,056 examinees used the new system). We identified several disadvantages of the examinees using the conventional examinations: 1)loss of examinees’ data, 2)incorrect entries in the examination sheets, reading errors of OCR sheets, and manual input errors, 3)mistakes in notifying the examinees of the examination results, and 4)difficulty in backing up a large number of images. We examined whether the new system reduced these disadvantages. We also evaluated the office burden of the medical association staff.

【results】Loss of examinees’ data, mis-entries of examination sheets, posting errors, and notification errors of examination results were almost completely controlled. We were also able to back up 10 years’ worth of image data. The burden of office work was reduced by 47% and 70% in the first and second years, respectively.

【conclusions】Utilizing ICT, we were able to built a risk management system that reduces disadvantages to gastric cancer endoscopy examinees. Human error can be prevented by the new system, enabling smooth and efficient examinations.