On the hypothesis that atrophic gastritis is a precancerous condition of gastric cancer, the serum pepsinogen (PG) test was developed as a method of screening the gastric cancer high-risk group using serum PG levels. This research involved subjects who underwent mass screening of the stomach at the workplace. It has reported that patients suffering from atrophic gastritis caused by a Helicobacter pylori (Hp) infection belong to the gastric cancer high-risk group and that serum PG levels serve as a sensitive marker of atrophic gastritis. Moreover, interleukin 1-beta (IL-IB) polymorphisms were said to affect gastric acid secretion and to participate in the generation of gastric cancer.
The workplace medical checkups of the stomach provided ample information on the efficacy of current inspection methods in establishing a link between atrophic gastritis caused by Hp infection and high risk of gastric cancer. The result of the experiment was that serum PG I/II ratio of the IL-IB-511T/T genotype was insiginificantly lower than the PG I/II ratio of other IL-IB-511 polymorphisms. Furthermore, subjects with a serum PG I level of less than 70ng/ml and a PG I/II ratio of less than 3.0 were not deemed Hp-positive.
Therefore, we assume subjects with atrophic gastritis who have the IL-IB-511T/T genotype and are PG positive for Hp infection might belong to the gastric cancer high-risk group, and might help shed light on the effects of Hp eradication on the risk level of gastric cancer.

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The results of gastric mass survey in the employee using serum pepsinogen test from 1998 to 2000 fiscal year were examined. In 7557 employee, 941 were positive for pepsinogen test and 6616 negative. The endoscopic examinations were performed in 728 out of the 941 cases. On these occasions, 13 gastric cancer cases were detected. Afterwards during 3 to 6 years, the other 7544 (7557-13) were examined mainly in indirect gastro-fluororadiography. As a result, 7 gastric cancers were detected out of 928 (941-13) positive for pepsinogen test cases and 20 out of 6616 negative. Finally, 20 gastric cancers were detected out of positive as many as negative for pepsinogen test cases. The people who were positive for pepsinogen test were in the higher rate of discovery of gastric cancer than the people who were negative, but in the same number as these.
In conclusion, the study of the combination of serum pepsinogen test and indirect gastrofluororadiography is absolutely indispensable in gastric mass survey.

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As an attempt to define the appropriate age group for colorectal cancer screening, we compared survival rates between screen-detected and clinically diagnosed colorectal cancer. During 1993-1999, 12114 cases of malignant neoplasm of colorectum were registered to the Miyagi Prefectural Cancer Registry. We excluded 4600 cases in which information was derived only from death certificates, histological types of lesions were not carcinoma (e. g. malignant lymphoma, sarcoma and carcinoid tumor), depth of lesions were limited into the mucosa, dates of diagnosis were unknown, or reasons of diagnosis were not distinguished whether screening or not. After these exclusions, 7514 cases of colorectal cancer remained for the analyses (1522 screen-detected and 5992 clinically diagnosed cases). After stratification by gender and 5-year age class, screen-detected group and clinically diagnosed group were compared for the state of performing operation, the stage of disease and the survival rate (observed, cause-specific and relative survival rates). For men and women 40-79 years of age, survival rates were significantly better in screen-detected groups than in clinically diagnosed groups. In contrast, we did not observe significant survival benefit in screendetected groups for men and women 80-89 years of age. These results suggest that screening for colorectal cancer is effective for people 40-79 years of age but not for those aged 80 years and older. Because the number of cases aged 80 years and older was relatively small in this study, our results require confirmation in further studies.

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We examined the usefulness of two methods as screening tests for colorectal cancer, and compared their usefulness to that of the fecal occult blood test (FOBT). The first method was the detection of the K-ras gene mutation in feces as a related genetic marker. The second method was the measurement of fecal lactoferrin (Lf) as a related inflammatory marker. The K-ras gene mutation was not detected in normal control subjects (0/20), and it was detected in only 13 out of 31 cancers. Therefore, it was determined that the sensitivity of this detection is less than that of the FOBT. Also, this method implies complicated procedures which require more than 2 days to complete, so it cannot be utilized as a screening test, like the FOBT. Measurement of Lf had a higher sensitivity (61.1%) than the FOBT (50.0%) for colorectal cancers, and its sensitivity was 3times higher than that of the FOBT in early-stage colorectal cancer (35.8%/11.8%). For mass screenings at the work place, the positive rate of Lf was 2.5%, lower than that of the FOBT (3.3%). This suggests that measurement of Lf can decrease the check-up rate and increase detection of cancers. The positive rate of Lf measurement and the FOBT combined was 0.4% in mass screenings at the work place. Lf can be measured by an automatic analyzer, so this method would easily increase the efficiency of mass screenings for colorectal cancer, whether it is used alone or in combination with the FOBT.

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The burden of follow-up studies using total colonoscopy for patients with colorectal adenoma has been growing due to an increase in morbidity for colorectal neoplasia. We are therefore proposing a new follow-up scheme to address this problem. This scheme classifies patients into two categories according to the findings of colonoscopy following a positive result of fecal occult blood test (FOBT). One of them includes patients with mildly or moderately atypical protruding-type adenoma with a diameter of less than 5 mm (Group A). The other includes patients with severely atypical or surfaced-type adenoma (Group B). The former group was followed up with rounds of total colonoscopy every five years combined with annual FOBT. and the latter was checked every one to three years with total colonoscopy. Patients in Group A and B participated in a mass screening in 1997 and underwent total colonoscopy as a diagnostic examination. For comparison, we identified patients with adenoma who participated in a mass screening in 1996 and underwent a diagnostic examination as well (Group C). They were followed up with rounds of total colonoscopy every one to three years, irrespective of the size of their lesions. We tracked those groups up to the year 2002 and compared the intervening time before the next colonoscopy, compliance with the examination, and the extent of colorectal lesions that required therapeutic interventions (carcinoma, adenoma with a diameter of more than 5 mm or with severely atypical change). There were no significant differences between three groups in the compliance of patients with the follow-up study (80.9% in Group A, 85.3% in Group B and 83.0% in Group C). The intervening period of Group A (31.1 months) was significantly longer than that of the other two groups (21.2 months in Group B and 18.7 months in Group C). The hazard ratio for detecting lesions that required therapy was 0.41 for Group A vs. Group C and 1.45 for Group B vs. Group C. These findings indicate that our new scheme can identify patients with low potentiality for further colorectal adenoma and can decrease the burden borne by the patient. It can also enable physicians to pay more attention to patients who required more cautious follow-up studies.

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Sophia Health Improvement Center introduced the hospital information system with perfect film-less and paper-less in 2001. Successful results indicate benefits in the examination process of health checking system. Further, gastric virtual endoscopy (VE) was developed. MD-Row-CT (16ch) images of the abdomen with 1mm thickness were first obtained and reconstructed to VE images by surface and volume rendering. Results indicated VE images were able to show subtle alteration of mucosal folds. Gastric cancer, polyp, ulcer, erosion and gastritis were clearly visualized. By comparison studies between VE and gastric fiberscopy (GF), sensitivity 92.7%, specificity 90.9% were calculated. As 3D MD-CT examination of the stomach is noninvasive except radiation exposure, it will be expected to become a new technique of the stomach examinations.

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In order to decrease mortality rate of gastrointestinal (GI) tract cancer, its prevention is just as important, if not more so, as its early recognition. It is well-known that smoking, meal rich in meat, and lack of exercise are all contributing to cause GI tract cancer.
Seventh-Day Adventist (a Christian denomination) has practiced life-style free of smoking, vegetarian diet, and proper exercise for more than one hundred years, and its healthy lifestyle has been highly regarded from preventive medicine standpoint.
Kobe Adventist Hospital recommends such lifestyle to anyone who enrolls to its Human Dock program. In the program, a smoker is strongly recommended to quit smoking, and is referred to Smoking Cessation Clinic. Meal provided for overnight Dock program consists of lacto-ovo-vegetarian diet. Outpatient Dock program offers a lunch at on-campus vegetarian restaurant. Next to the hospital is a spa, where a trainer advises the examinee how to exercise on one-on-one basis. Healthy lifestyle consisting of smoke-free life, vegetarian diet, and proper exercise is necessary for prevention of GI tract cancer, as noted in Diet and Health Guidelines for Cancer Prevention by World Cancer Research Fund and American Institute for Cancer Research.

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