Since 2000, endoscopic examination has been carried out for the individual screening program for gastric cancer in Fukuoka city. The aim of this study was to evaluate the efficacy of endoscopic screening program in comparison to X-ray based screening programs for gastric cancer. During a period from 2000 to 2002, 67162 subjects who received any of three types of screening program for gastric cancer, that is, endoscopic individual screening (EIS group, n=15774), X-ray individual screening (XIS group, n=23546), or indirect X-ray mass screening (XMS group, n=27842), were comparatively analyzed. Among three groups, no difference was observed in gender, while the number of subjects with 70 years or older was greater in EIS groups than in other two groups. The detection rate of gastric cancer in EIS group (0.51%) was significantly higher than in XIS group (028%) or XMS group (0.14%)(p<0.0001). Positive predictive value in EIS group (9.7%) was also higher than in XIS group (2.8%) or XMS group (1.7%)(p<.0001). The rates of early gastric cancer in EIS, XIS and XMS groups were 77.5%, 64.6% and 56.4%, respectively. The cost for detecting one gastric cancer patient was calculated to be 2,810,000 yen in EIS group, 5,250,000 yen in XIS group, and 4, 020, 000 yen in XMS group. These results indicate that the individual screening using endoscopy is the most useful screening program for detecting gastric cancer.

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The results of mass screenings for gastric cancer done during the past 10 years were reviewed. The subjects were divided into two groups: Group I (from 1993 to 1997) and Group II (high-density barium was used in mass screenings from 1998 to 2002).
The total number of enrolled persons was 553,478. The rate of persons recommended for detailed examination decreased from 14.6% in Group I to 13.0% in Group II. The total number of gastric cancers was 587 and the detection rate of gastric cancers increased from 0.10% to 0.11%, while the rate of early gastric cancers increased from 67.8% to 77.8%. Furthermore, the rate of early gastric cancers less than 1 cm in size increased from 14.4% to 21.1%. The false-negative rate was 28.2% in early gastric cancers in Group II.
In conclusion, recent mass screenings for gastric cancer using high-density barium have been useful, but they still have some limitations.

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A previous comparison study of colorectal cancer detection sensitivity by the simultaneous method in the colorectal cancer screening in Suminoe-District Osaka in 1991 showed a detection sensitivity of 80.0% for EIA and 42.5% for RPHA. We added patients with colorectal cancer detected in screenings after 1992 and those detected by checking with the cancer registry in Osaka Prefecture, and measured again the colorectal cancer detection sensitivity of EIA and RPHA in the screening in 1991. When the follow-up period was changed (1, 2, and 3 years), the detection sensitivity was 67.9% for EIA and 35.8% for RPHA by 1-year follow up, 58.2% for EIA and 28.4% for RPHA by 2-year follow up, and 54.8% for EIA and 26.0% for RPHA after 3-year follow up. Though the detection sensitivity decreased, the relationship in relative sensitivity between EIA and RPHA did not change.

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