Since malignant neoplasms are the most frequent cause of death among workers, cancer control should be the most important health issue for workers. On the other hand, the legal system regarding workers’ health management is based on the Industrial Safety and Health Act, so it covers diseases related to work, and cancers are excluded as they fall within the scope of personal injuries and illnesses. However, in recent years, guidelines have been issued to support return to work, and in the context of ‘data health plans’ imposed on medical insurers, insurers and businesses collaborate to manage the health of employees. Cancer screenings are also being discussed as a health measure in the workplace. However, cancer screening in the workplace is carried out as part of welfare benefits, and is basically only provided as an opportunity, and there is no attempt to evaluate the business as a ‘screening program.’ In addition, since cancer screening is treated as a non-statutory medical examination, we have to ensure that health information is handled within the company, especially sensitive health information such as cancer screening results (e.g., suspected cancer), based on labor laws and personal protection laws. This issue has been avoided on various fronts and has become the biggest impediment to quality control for cancer screening programs. In this manuscript, we identified the current status and issues of cancer screening in the workplace and discuss the possibility of building a system in the workplace that can manage the accuracy of cancer screening as part of screening evaluation.

Objective: More than half of the American population undergoes colorectal cancer (CRC) screening via total colonoscopy (TCS). It is anticipated that there will be an increase in the rate of CRC screening using TCS in Japan. However, many challenges, such as determining appropriate screening intervals and handling of colorectal tumors, remain to be addressed. This study explores these issues to investigate the potential of appropriate TCS screening.

Subjects & Methods: We examined 120 patients diagnosed with CRC via multiple TCS procedures conducted at our hospital or related facilities. We analyzed (1) TCS intervals based on cancer progression, cutoff values of TCS intervals determined via receiver operating characteristic analyses, and survival periods according to the obtained cutoff values and (2) the management of colorectal tumors, such as the presence or absence of endoscopic resection histories, sizes and numbers of colon tumors left behind in previous TCS procedures, and the impact of these residual tumors on patients’ survival periods.

Results: (1-1) The mean TCS intervals for early-stage CRC (69 cases) and advanced CRC (51 cases) were 47.0 ± 33.1 months and 78.2 ± 45.5 months, respectively. The intervals for the advanced group were significantly longer, with a cutoff value of 54 months. (1-2) In the cases without metastasis (99) and with metastasis (21), the intervals were 54.5 ± 38.6 months and 87.5 ± 45.8 months, respectively. The metastasis group had significantly longer intervals, with a cutoff value of 56 months. (1-3) The group with intervals of <5 years (66 examples) had significantly longer survival periods after cancer diagnosis compared with the group with intervals of ≥5 years. (2) The presence or absence of a history of endoscopic resection at TCS, along with the number of residual colorectal tumors (adenomas) based on their sizes, was investigated. It was found that when three or more adenomas measuring >6 mm were left behind, there was a significant (p < 0.005) decrease in the survival period.

Conclusion: The appropriate TCS interval for CRC screening in high-risk patients is thought to be 5 years. Tumors measuring >6 mm should be actively removed, especially when multiple tumors are present.

Background: Proton pump inhibitors (PPIs) are effective drugs; however, there are concerns about overprescription. This study investigated whether screening esophagogastroduodenoscopy may cause PPI overprescription.

Subjects and methods: Among participants scheduled to undergo opportunistic screening esophagogastroduodenoscopy, we conducted a questionnaire survey among those who were prescribed PPIs for gastroesophageal reflux disease (GERD). The questionnaire enquired about PPI medication status (frequency and dose), reason for starting medication, duration of medication, and GERD symptoms. Participants who were overtreated with PPIs were defined as those having all of the following: previous screening esophagogastroduodenoscopy diagnosis of reflux esophagitis (RE) with RE severity that did not require PPI administration, but the diagnosis of RE was the trigger for PPI administration; subjective symptoms that were not the reason for the PPI administration; and daily PPI administration for more than 1 year even in the absence of worrisome GERD symptoms.

Results: Sixteen patients (10.8%, 95% confidence interval 6.3-17.0%) met the definition of overprescription. The Los Angeles classification at the time of PPI administration was grade M in six patients, grade A in six patients, and grade B in four patients. The median duration of PPI administration was 4.5 years.

Conclusion: Opportunistic screening esophagogastroduodenoscopy may cause overprescription of PPIs.