Objective: We performed cancer screening in patients with gallbladder disease (GBD) using a high-frequency probe.

Methods: Participants were 58 patients with GBD aged 32-79 years (median, 48) showing ultrasonographic abnormalities. The men-to-women ratio was 35:23. Two ultrasonographic probes were used for all patients; a convex probe (Toshiba PVT-375BT [3.5 MHz]) and linear electronic scan probe (PLT-704SBT [7 MHz]). The ultrasonographic console was the Toshiba Aplio 500. Statistical analysis used t-tests or χ² tests, appropriately.

We categorized ultrasonographic findings in 3.5-MHz and 7-MHz images as 0, uninterpretable; 1, normal; 2, benign; 3, difficult to distinguish; and 4, malignancy suspected. A fifth category addressed clinical judgment (A, no abnormality; B, mild abnormality; C, repeat ultrasonographic examination required; D, medical care required; and E, treatment underway).

Ultrasonic image findings and assessment categories were based on the revised abdominal ultrasound screening assessment manual (2021). For each patient, ultrasonic images obtained using 7-MHz images were evaluated as 0, poorer; 1, equivalent; 2, better; and 3, much better than that of 3.5-MHz images. The judge is a board certified fellow of the Japan Society of Ultrasonics in Medicine.

Results: Comparing 3.5-MHz and 7-MHz images respectively showed category 2 (benign), 19% (11 cases) vs. 72% (42 cases); category 3 (difficult to distinguish), 17% (10) vs. 12% (7); and category 4 (malignancy suspected), 64% (37) vs. 16% (9). Category 2 (benign) was more frequent for 7-MHz than that for 3.5-MHz images (P < 0.001). Judgment category C (repeat sonographic examination required) accounted for 26% (15) vs. 79% (46). Judgment category D2 (close follow-up required) accounted for 74% (43) vs. 21% (12); this was significantly less frequent for 7-MHz than that for 3.5-MHz images (P < 0.001). Compared to 3.5-MHz images, 7-MHz image quality was rated as 0 (worse) in two cases; 1 (equivalent) in 15, 2 (better) in 25, and 3 (much better) in 16. In 71% of cases (41 of 58), 7-MHz images were considered better and much better.

Among patients with GBD definitively diagnosed by ultrasonography, the final diagnosis was gallbladder adenomyomatosis in 45 patients, diffuse gallbladder wall thickening in five patients, and gallbladder polyps in four patients. Among four patients with suspected gallbladder tumors who underwent surgical resection, two confirmed to have cholesterol polyps; one gallbladder adenomyomatosis and one adenoma.

Conclusion: Using the high-frequency probe, we obtained good-quality ultrasonographic images in patients with GBD, enabling more accurate clinical judgment in abdominal ultrasound for cancer screening.

We studied the effectiveness of and issues associated with a program that sent re-recall letters to people who had not received a diagnostic examination after colorectal cancer screening with a fecal immunochemical test (FIT). This program has been running in Maebashi since 2014. In addition, we looked at process indicators for organized screening. After receiving the re-recall letter, 17.4-25.6% of patients who had not received a diagnostic examination went on to do so, resulting in the detection of 3-12 cases of colorectal cancer. We found inter-hospital variations in the proportion of individuals who received diagnostic examinations, as healthcare providers did not define an agreed FIT cut-off value. It is crucial to educate the community about the importance of colorectal cancer screening and the examination method used. It is also critical to define a cut-off value for administering FIT. An efficient screening program should be conducted, using the measures described above, including the re-recall letter.

There has been no recovery at all in Iwate Prefecture community gastric cancer screening examinees influenced to COVID-19, with a significant decrease from 88,534 in 2019 before COVID-19 to 78,621 in 2020 (11% decrease) and 82,450 in 2021 (7% decrease).

The number of gastric cancers detected decreased significantly from 102 in 2019, of which 70 were early stage gastric cancers, in 2020, 72 out of 101 were early stage cancers, and in 2021, 55 out of 95 were early stage cancers. There was no significant difference by advanced or early stage cancer.

The decrease in the number of examinees also resulted in a negative balance for the Iwate Cancer Society’s screening.

The results of Iwate Prefecture’s regional gastric cancer screening for the past three years showed that the number of examinees aged 85 years or older, the detection rate of gastric cancer, and the detection rate of early stage gastric cancer were 30 cases (18 cases of early stage gastric cancer) out of 5761 persons aged 85 years or older, and 268 cases (179 cases of early stage gastric cancer) out of 243844 persons aged under 85 years, significantly more gastric cancers are detected in those older than 85 years. There was no significant difference in the detection of early gastric cancer. Although a South Korean report on gastric cancer screening for the elderly over 85 years of age suggests that it may be harmful, we do not think it is possible to restrict screening in Iwate Prefecture in general.

We want to make sure that gastric cancer screening is safe and secure even with COVID-19 disasters while preventing serious accidents.