Third Department of Internal Medicine Nihon University School of Medicine We studied the utility of and problems associated with stomach cancer testing by pepsnogen (PG) method and anti Helicobacter pylori (Hp) assay simultaneously, on 1, 011 subjects (mean age: 50±9.55years; male: 701; females: 310) examined at the General Examination Center at Nihon University School of Medicine form January 10 to August 31, 2001. Anti Hp assay was peformed by urinary anti Hp assay (chromatography). ELISA also revealed a correlation between urinary anti Hp assay and serum anti Hp titration (HM-CAP method). This was thus a useful test method for health screening. Although there were two cases of stomach cancer detected among positive cases by both PG method and anti Hp antibody, there were no cases of stomach cancer seen among the 517 negative cases to both PG method and urinary anti Hp antibody. In the testing of stomach cancer. Age and locality need to be studied for setting a stomach cancer high-risk group by PG method and anti Hp assay simultaneously, but it is possible to set a stomach cancer low-risk group.

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Considering the current status of population aging, it is important to reassess the gastric mass survey for the elderly people. In this study, we investigated the record of gastric mass survey for the elderly people and cited some problems and further directions. In result, we cosidered that the elderly people are high risk group of gastric carcinoma and that mass survey is used efficiently for detection of the early lesions in especially 70's. In terms of the features of early gastric carcinomas and check-up history, treatment with endoscopic mucosal resection is expected to increase in the elderly. As to advanced carcinomas, the elderly groups are becoming to receive aggressive treatment similar to that in the under age of 70 due to recent therapeutic progress. However, death rate from gastric carcinoma in the elderly remain high. We would like to emphasize that the advise the elderly persons who have never check for cancer to undergo a X-ray mass examination is required and that the introduction of mass suvey by using endoscopy should be discussed. Additionally for the future, it is important to create a new mass survey system according to the needs of the elderly people.

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[in Japanese]

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Only about 60% of subjects whose screening tests are positive have diagnostic examination in mass screening for colorectal cancer in Japan. To improve the compliance with diagnostic examination, we performed following four strategies: 1) to organize community meetings to explain about diagnostic examination for subjects whose screening tests are positive; 2) to provide opportunities to make appointments for diagnostic examinations at the community meetings; 3) to shorten the interval from screening test to diagnostic examination: and 4) to encourage subjects who did not have diagnostic examinations within about three months after notice of the test results to receive the examinations. During April, 1993 through March, 2001, a total of 421674 immunological fecal occult blood tests were performed and 15136 (3.6%) were tested positive. Among the subjects with positive results, 95.3% of them had diagnostic examinations. Although in a certain area the method of diagnostic examination was changed from flexible sigmoidoscopy and barium enema to total colonoscopy, the compliance rate for diagnostic examination did not decrease. These results suggest that these four strategies are important in order to improve the compliance with diagnostic examination, and that total colonoscopy is acceptable as the method of diagnostic examination.

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Mass-screening of colon cancer in our country has been going on as an established program regionally and at workplaces as well, thus achieving a certain level of success in detecting earlystage cancer. Although the subjects intended for this kind of mass-screening are, in most cases, middle aged people, in our country, where society as a whole has been ageing, it is absolutely necessary to include elderly people in any mass-screening effort, since a higher morbidity rate related to colon cancer is found among them. In the mass screening conducted for colon cancer by the Tochigi Public Health Service Association between the years 1996 and 2000, those subjects over 75 years of age (a senior age group) accounted for 1.6% to 4.5% of the total number of people who joined the mass-screening project yearly, indicating a gradual increase with time. The number of detected colon cancer cases in the senior age group each year ranged from 0 to 8, accounting for a detection rate of between 0% and 0.39%, which was significantly higher during the past two years than that of the age group of 74 years old and younger (a non-senior age group). In addition, many early-stage cancer cases were found in the senior-age group.
In recent years, the number of senior colon cancer patients who we treated at our Department of Surgery has increased. According to a histopathological study, we have found no difference in the degree of histological cancer development between the senior age group and the non-senior age group. This meant that patients in the senior age group simply needed early-stage cancer detection. Among the curative operation cases, the 5-year cumulative survival rates were 89.3% for colon cancer, and 82.3% for rectal cancer in the senior age group, while they were 81.3% for colon cancer and 72.7% for rectal cancer in the non-senior age group. Although the rates in the senior age group did not show any statistically significant difference from those in the non-senior age group, the outcome was acceptable.

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We studied the outcomes of 114 patients with hepatocellular carcinoma (HCC) detected during clinical follow-up for chronic liver diseases. In these patients, ultrasonography was performed at 3- to 4-month intervals and tumor markers were measured at 1- to 4-months intervals. The patients were divided into three groups according to the ages at the time of diagnosis (group I: 59 years or less, group II: 60-69 years, group III: 70 years or more). The 7-year survival rates in patients in groups I, II and III were 41.7%, 21.9% and 13.3%, respectively. In liver cirrhosis C or chronic hepatitis C, the 7- year survival rates in patients with solitary small (3.0cm or less in diameter) HCC nodule in groups I, II and III were 41.7%, 43.1% and 15.0%, respectively. The outcome of the patients in group III was significantly worse than those of the patients in other groups. Although the patients with HCC detected in small size (solitary nodule, 3.0cm or less in diameter) in groups I and II had a significantly better chance for long survival, the early detection of HCC in group III did not improve the chance for good prognosis.

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