The results of individual medical screening system for gastric cancer in Toyohashi city from 1998 to 2002 fiscal year were examined. The contrast media of X ray inspection was unified to use high concentration low viscosity barium. And the number of sheeted X ray photography was unified into nine in principle. The number of enrolled persons of an individual medical screening system increased from 3528 in 2000 to 8500 in 2002. The total number enrolled with an indirect X-ray mass screening system was amounted to 12428 in 2002 from 5464 in 1998. The subjects had most levels of 60 years old, and 68.2% of them were women. The rate of the person who needed the close examination was 5.3-7.8% except the first year, and the rate of the person who actually underwent the close examination was as high as 94.7%. The total number of the discovered gastric cancer was 49 and the rate of discovery of gastric cancer was 0.2%. Twenty-three of them were early cancers pathologically. Besides then, we discovered two gastric malignant lymphomas and two esophageal cancers. Invasion depths of discovered cancers were intramucosal layer in 30%, submucosal layer in 8%, proper muscular layer in 10%, and subserosal or serosal layer in 52% respectively. In the whole gastric cancers 17.5% were located in the posterior wall and as high as 40% in the lesser curvature. In addition, early cancers occupied as high as 71.4% in C area and 85.7% in the posterior wall. Conclusion: The total number of enrolled persons who consulted mass screening system for gastric cancer increased by the start of an individual screening system. The fact that the rate of the person who actually underwent the close examination was as high as 94.7% was noteworthy.

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High-density contrast media have been used in recent years for upper gastrointestinal tract X-ray examinations, resulting in an improvement of visualization. Through contiguous operation and remote control of the direct X-ray examination, we have evaluated the change in visualization obtained by the use of high-density contrast media. For the remote control examination, we have compared the visualization ability with high-density contrast media between the conventional method and the new standard method. In addition, we have reviewed the difference in visualization ability between 180 and 200W/V % for the new standard method. Under eithercontiguous operation or remote control, no increase of dyscrasic shadow was noted. After adoption of the new standard method for the remote control direct X-ray examination, an improvement of visualization was achieved for the body and upper part of the stomach. However, the contrast media tended to debouch rapidly from the stomach into the small intestine, and the quantity of air tended to decrease. A comparison between 180 and 200W/V% for the new standard method showed that 200W/V% was slightly superior in visualization of the body and upper part of the stomach.

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We investigated changes in a utonomic nervous function in response to postural change of the upper gastrointestine by analysis of R-R intervals in electrocardiograms obtained during headup tilt (90°C HUT) and head-down tilt (-35°C HDT). Holter electrocardiograms were obtained from 12 persons at rest (horizontal prone position), during and after HUT and HDT, for frequency-domain analysis of change in the heart rate. During HUT and HDT, the high frequency spectral power (HF power; 0.15 to 0.40Hz), which reflects parasympathetic nervous activity, decreased to significantly less than those at rest or at rest after postural changes (p<0.05). During HUT and HDT, the low frequency spectral power (LF power; 0.04 to 0.15Hz), which reflects the balance of sympathetic and parasympathetic nervous activity, and the LF/HF ratio, which reflects sympathetic nervous activity, increased to significantly more than those at rest or at rest after postural changes (p<0.01). The present study suggests that enhanced sympathetic nervous activity and reduced parasympathetic nervous activity are evoked by postural changes of HUT and HDT. There are reports that enhanced sympathetic activity induces arrhythmias, while enhanced parasympathetic nervous activity has an antiarrhythmic effect. Therefore, we conclude that during upper gastrointestinal movements, a reduced angle or time of postural changes is necessary in elderly people and “highrisk” subjects to prevent cardiovascular complications.

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Replacing x-ray examinations, endoscopy has become the mainstream method applied to the detection of gastric cancers. However, failures can still occur. In order to investigate the accuracy of gastroscopy, 88,535 gastroscopic examinations conducted between 1984 and 1995 have been investigated for comparison with the most accurate case in the local governmental population-based cancer registry data in Japan. In the case of 343 examinations, no patients were initially diagnosed as having gastric cancer, and later these patients were diagnosed as having gastric cancer within three years after the initial examinations (false-negatives). For the same period, 1,201 examinations were identified as true-positives. Thus, the false-negative rate over the three-year period was 22.2 percent. This rate was significantly higher for the latter half of the period. Also, a higher rate was found among male subjects and among those who were examined by intern endoscopists with less than 10 years' experience. The percentage of advanced gastric cancers identified among those who had been diagnosed as false-negative was higher for tumors located in the cardia-fornix or upper gastric body than for those in other regions. It has been concluded that the false-negative rate associated with the detection of gastric cancer by means of endoscopy is higher than expected. We emphasize that endoscopists should be provided with adequate training in order to enable them to examine all parts of the stomach so that they can detect even small or flat lesions, and can conduct sufficiently competent biopsies as well.

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We reviewed the pros and cons of the serum pepsinogen test as a mass screening modality for gastric cancer. The serum pepsinogen test was performed preoperatively in 217 gastric cancer cases. The results were (+): 58.9%, (+-): 15.7%, (-): 25.4% of all cases. There were no significant differences among age, depth of invasion, lymph node metastasis, curative grade, histological type, tumor location and tumor size. In the asymptomatic group, 75.8% of cases were referred from mass screening. There was only one case (0.46%) of asymptomatic advanced gastric cancer. Three cases had been overlooked by mass screening using barium X-rays, but all of these cases were positive for the serum pepsinogen test. In conclusion, the serum pepsinogen test may provide a distinct index of the high risk group for gastric cancer, and it is useful for detection of cases overlooked by conventional mass screening. Also the serum pepsinogen test is considered to be an objective and minimally invasive examination, and thus it might contribute to improve the participation rate of mass screening for gastric cancer.

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In Japan, colorectal cancer screening is performed in subjects 40 years old or older, however, in other countries, subject age is 50 years or older or 50 to 69 years. We investigated whether subjects ranging from 40 to 49 years in age or subjects 70 years old or older were candidates for screening based on the incidence of colorectal cancer and survival rate. According to the Fukui Cancer Registry, the incidences of colorectal cancer with respect to age distribution(40-49 years, 50-69 years, 70 years or older)in 1998 were 40.3,140.7, and 319.6, respectively. In subjects ranging from 40 to 49 years in age, the incidence was very low. By Kaplan-Meier analysis, 5-year survival rates with respect to age distribution were 91.1%, 89.4%, and 77.1%, respectively. In subjects 70 years old or older, the survival rate was significantly lower than that in subjects ranging from 50 to 69 years in age(P=0.048). When subjects 70 years old or older were divided into subgroups, the 5-year survival rate in subjects 75 years old or older was low(68.8%). However, in subjects ranging from 70 to 74 years in age, the 5-year survival rate was 85.1%, and was not markedly different from that in subjects ranging from 50 to 69 years in age. The risk of death was investigated using Cox's proportional hazard model. There were no significant differences in the risk ratio among the 3 age groups. In conclusion, subjects 40 to 49 years old should be further investigated ; however, colorectal cancer screening should be more aggressively recommended for subjects 70 to 74 years old than previously done.

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The mass screening of upper abdominal organs such as the liver, gall bladder, pancreas, spleen, and kidney by an ultrasonic method (hereinafter, referred to as “US”), commenced in Kagoshima Prefecture in 1984, has been conceived so as to achieve specific results. However, its effectiveness for pancreatic diseases is lower than for the rest of the organs mentioned. In this study, we have investigated the current status of pancreatic cancer cases, with our main emphasis on cystic pancreatic cancer cases with a relatively good prognosis, and have also discussed relevant future measures.
As a result, we can present the following findings: 1) Only 4 out of the 9 cases of cystic pancreatic cancer were originally detected as having cystic mass. 2) The post-operative size of cystic pancreatic cancer was found to be actually larger than the size of a cystic lesion reported at the time of the mass screening. 3) Various kinds of thorough examination methods were involved, depending on individual institutions (for example, at specialized hospitals, US+CT in 105 cases from a total of 265 cases, ERCP in 71 cases from a total of 265 cases, EUS in 28 cases from a total of 265 cases, whereas at other hospitals US only in 43 cases from a total of 148 cases, or CT only in 27 cases from a total of 148 cases). 4) A great difference in the rate of successful detection of cystic cancer between specialized hospitals and general hospitals was recognized: 71.7% and 48.6%, respectively.
In conclusion, it is critically important for us to enhance our capacity to accurately read pancreas images at the US mass screening, and also to improve the accuracy of those thorough examinations involved thorough the application of a system management to them.

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