We have studied the results of the screening for gastric cancer in Maebashi City, conducted from 1985 to 2002. The number of examinees increased from year to year, and especially the number of male examinees above 50 years of age increased in the past few years. The method of direct gastric radiography available in Maebashi City was not enough to detect small cancers with slight depressions, and cancers on the anterior wall and the upper part of the stomach. The detection rate of early cancer increased through the use of high-concentration, low-viscosity barium sulfate, but a modification of the direct gastric radiography method was needed in order to improve detection of cancers on the anterior wall and the upper part of the stomach. The required rate of detailed examination had to be lowered through agreement among committee members engaging in the reading of x-ray images regarding standardized criteria for image interpretation. The new direct gastric radiography method using high-concentration, low-viscosity barium sulfate is must to improve the effectiveness and efficiency of screening for gastric cancer in Maebashi City.

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Although high accuracy of mass screening for gastric cancer using endoscopy is necessary in order to further promote the screening program, it is recognized that many problems inherent in this method are yet to be solved, and that suitable countermeasures are yet to be provided.
In this paper, the current status and problems of mass screening for gastric cancer using endoscopy are investigated with the help of the records of a one-day complete physical checkup undertaken at JA Kohseiren Medical Health Care Center in Kagoshima.
Screening tests for diseases of the esophagus, the stomach and the duodenum were performed for 71, 939 subjects over a period of 5 years, from 1997 to 2001. Only 5.6% of cases had endoscopy performed, while the others (94.4%) underwent direct fluororadiography.
The records of the screening for gastric cancer us ing endoscopy were compared with those for which radiography (direct and indirect) was used.
The results were as follows:
1) The rate of checkup for gastric cancer by endoscopy was 0.24%, by direct fluororadiography 0.10%, and by indirect fluororadiography 0.12%.
2) More staff was required for screenings using endoscopy than for those using radiography. For screening 80 persons in a single day using endoscopy, almost 2,610,000 yen were required, while only 1,040,000 yen were required for indirect gastrointestinal-fluororadiography.
In conclusion, accuracy of mass screening using endoscopy is high, but efficiency is low. Henceforth, the education of staff dealing with endoscopy and the construction of better systems displaying higher accuracy are required for making mass screening for gastric cancer using endoscopy a standard procedure.

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To enable the more common use of endoscopic examinations for gastric cancer, problems including tolerability, processing capacity and accuracy control must be addressed. In this report, we present the actual situation of endoscopic examinations for gastric cancer performed over the last 7 years in our hospital during health screening (hospitalization: one night, two days), and assess the problems. In addition, we compared these endoscopic examinations with the combination examinations in which direct gastric radiography and the pepsinogen method were conducted on the same day. In our hospital, because sedative drugs are used for endoscopic examinations, tolerability was assumed to pose no problems. However, for mass examinations, it might be necessary to take some preventative measures against discomfort from examinations. In addition, because the processing capacity of one institute is limited, it was assumed that the coordination of multiple institutes and the aggregation of examination subjects would be necessary to enable the more common use of endoscopic examinations. During endoscopic examinations, early gastric cancers (especially, mucosal gastric cancers) are characteristically and frequently identified. Therefore, endoscopic examinations are significant because they reveal cancers that can be endoscopically removed. Moreover, when endoscopic films of 18 patients in whom gastric cancers were identified were comparatively evaluated using endoscopic films obtained at the most recent examinations, the importance of annual examinations was suggested.

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To elucidate the usefulness of mass screening for colorectal cancers, we analyzed 972 cases with colorectal cancer detected during a mass screening in Nagano prefecture. A total of 872, 807 mandays went into the mass screening held between 1988 and 2000. All subjects were screened by means of immunological occult blood tests in order to establish the high-risk group. If the test results for a subject were positive, we would recommend further examination, such as total colonoscopy or sigmoidoscopy plus X-ray examination of barium enema. The survival rate was analyzed through Kaplan-Meier analysis with the log-rank test. The rate of detected colorectal cancers across all groups was 0.12% (men: 0.15%; women: 0.09%), and colorectal cancers were most frequently detected in subjects in their seventies (0.23%). Early colorectal cancer (439 cases) accounted for 58.6% of all determined colorectal cancers (749 cases). Endoscopic therapy was performed in 36.4% of all determined colorectal cancer cases. Judging from the results of the analysis of tumor sizes, it has been suggested that active endoscopic therapy need not be performed in cases with protuberant lesions under 5 mml. The cause-specific 5- and 10-year survival rates were 92.6% and 88.4%, respectively. Kaplan-Meier analysis of the probability of cause-specific survival in patients with colorectal cancer according to depth of tumor infiltration showed significant differences between sm, mp, ss, and se or a (p<0.05). On the other hand, there was no significant difference between m and sm (p>0.05). Conclusion: The long-term survival rate of patients with colorectal cancer detected during mass screening was almost satisfactory. Mass screening using immunological occult blood makes it possible to detect colorectal cancer in its early stages, and may reduce mortality from colorectal cancer. Active endoscopic therapy is not recommended in cases with polypoid lesions under 5mm except special types.

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In this study, the relationship between fatty liver disease (Group FL, 94 subjects) diagnosed by ultrasonography, metabolic syndrome and insulin resistance (IR) was assessed and compared with the data of a normal liver group (Group N, 319 subjects). In a comparison of Group FL to Group N, statistically significant values were obtained for fasting plasma glucose level (p<0.0001), triglycerids (p<0.0001), HDL-cholesterol (p<0.0001), LDL-cholesterol (p<0.0001) and diastolic blood presure (p=0.018) in men, and triglycerids (p<0.0001) and HDL-cholesterol (p<0.05) in women. The average value of the homeostasis model assessment insulin resistance index (HOMA-IR) was statistically higher in Group FL than in Group N in men (2.1±1.0 vs 1.2±0.1, p<0.0001). Also, in women, the average value of HOMA-IR was statistically higher in Group FL than in Group N (1.6±0.9 vs 1.1±0.5, p=0.008). In men, the percentage of IR was statistically higher in Group FL than in Group N (30% vs 4%, p<0.0001) and in women, the value of IR was statistically higher in Group FL than in Group N (18% vs 1%, p=0.01). These findings suggest that fatty liver disease diagnosed by ultrasonography may manifest insulin resistance and be closely related to metabolic syndrome.

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Multilocular cyst, unilocular cyst and dilatation of the pancreatic duct were found in 0.23%, 0.72% and 0.46% respectively on ultrasonographic screening. The incidence of unilocular cyst or dilatated pancreatic duct increased with aging and increased sharply in more than 60 years of age. The proportion of unilocular cyst was high in females, while that of dilated pancreatic duct was high in males. Neoplastic diseases were discovered in 0.6% of the cases with cyst or dilatation of the pancreatic duct without solid mass lesion. When the US findings of 104 cases of malignant tumor of pancreas in the past 15 years were studied retrospectively, there were 6 cases in which pancreatic cyst or dilatation of the pancreatic duct had been pointed out before discovery of malignant tumor. In the IPMT or MCT cases it took several years before diagnosis of neoplastic cyst was made, while in carcinoma of the pancreatic duct advanced cancer was discovered within 1 year after these signs appeared. That is, when pancreatic cyst or dilatation of the pancreatic duct appeared for the first time, a close checkup is considered necessary to rule out carcinoma of the pancreatic duct. Even when carcinoma of the pancreatic duct has been negated, there is a possibility of other neoplastic cysts being discovered later. Therefore, regular follow-up observations should be made.

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[in Japanese]

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