The purpose of this study was to assess the adaptability of new standard method in gastric cancer screening for regional population, particularly in older individuals. 833 subjects were experimentally examined with new standard method from April, 2003 to March, 2004. The questionnaire for new standard method (high density barium, the rolling and the head-down tilting) was distributed to all subjects and 640 (76.8%) of them completed and returned their forms. They consisted of 373 respondents under 70 years of age and 268 respondents of 70 years and upward. 318 (86%) of the respondents under 70 years of age reported the rolling to be ‘easy’ or ‘acceptable’, while 97 (36%) of the respondents of 70 years and upward replied the rolling ‘too hard’. In contrast, more than 90% of all respondents answered that the head-down tilting was ‘easy’ or ‘acceptable’. High density barium was acceptable for many respondents, while the aspiration rate (0.6%) of high density barium was remarkably higher than that (0.04%) of low density barium in conventional method for other regional population at same period. This result suggested that the prevention and the measures for aspiration of barium were necessary in new standard method with high density barium.

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The subjects, consisting of 108 individuals (92 men and 16 women) who had no gastroduodenal lesions on workplace health screening, were divided into groups with or without Helicobacter pylori (H. pylon) infection, and examined for changes in the positive rate of pepsinogen (PG) test biennially for 6 years. In the anti-H. pylori antibody-positive subjects, the PG test positive rate was 13.7% at the initial examination, but increased to 29.4%, 31.4%, and 35.3% at 2, 4, and 6 years, respectively. PG test was negative in 58.8% of these subjects three times (for 4 years) and in 54.9% four times (for 6 years). On the other hand, none of the anti-H. pylori antibody-negative subjects were positive for PG test in the first 4 years, and only 1.8% were positive at 6 years. These results suggest that, in health screening by PG, subjects should be simultaneously examined for serum anti-H. pylori antibodies, that anti-H. pylori antibody-positive subjects should be tested for PG preferably at intervals of less than 4 years, and that anti-H. pylori antibody-negative subjects may be tested for PG at intervals of more than 6 years.

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We compared the clinicopathological characteristics of pepsinogen (PG) method-negative and Helicobacter pylori (HP)-positive gastric cancer (PG(-) HP(+)group) by tissue type to a PG(+) group. The result was that, of 226 cases of gastric cancer, the PG(-) HP(+) group accounted for 29.6% and the PG(+) group accounted for 63.3%. Cancer was frequently the undifferentiated type in the PG(-) HP(+) group and the differentiated type in the PG(+) group; early-stage cancer was frequently found in the PG(-) HP(+) group, although there were no significant differences. The PG(-) HP(+) group was younger than the PG(+) group, and the undifferentiated type tended to be found frequently in women. With regard to site, the differentiated type in the PG(+) group tended to be found frequently in the L region and in the M region in the PG(-) HP(+) group. The proportion of differentiated M cancer of less than 2cm suited to EMR was 21.7% for the PG(+) group. In contrast, it was higher at 29.9% for the PG(-) HP(+) group and, compared to the PG(+) group, cancer predominated in the M region, most were the depressed type, and there was a high rate of tub2 cases. This cancer is surmised to be one having a character close to that of an undifferentiated type. Thus, early detection of gastric cancer in the PG(-) HP (+) group is considered to be significant. To that end, individuals at risk for gastric cancer must be narrowed down considering use of PG measurements as well and they must be induced to undergo an endoscopic exam.

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The aim of this study was to clarify the usefulness of combined uses of serum pepsinogen (PG) method and Helicobacter pylori (Hp) antibody value as a screening method for gastric cancer. The evaluation was performed on 5032 people (3497 male, 1535 female, 24-89 y. o., mean age; 51.2 y. o.) who underwent all of PG method, Hp antibody value test and endoscopy on the same day. We defined those subjects as positive for PG as those who had levels of PG I lower than 70ng/ml and a PG I/II ratio of less than 3.0. Consequently, all the subjects were classified into 3 groups on the basis of the blood test results in Hp antibody and PG method judgments;“A” group is the subjects who had Hp antibody (-), PG method (-),“B” group is the subjects who had Hp antibody (+), PG method (-),“C” group is the subjects who had PG method (+). Thirty-three cases of gastric cancer subjects were found by the endoscopy performed on the same day with the blood test, of which 27 cases were those classified in the “C” group, 5 cases were in the “B” group, and 1 case was in the Hp indeterminate group, and any gastric cancer subject was not found in the “A” group. Gastric cancer detection rate was 2.27% in the “C” group, which was significantly higher than that either in the “A” group (0%) and the “B” group (0.22%). The detection rate of hyperplastic polyp among the subjects was the highest in the “C” group, and 9 cases of gastric adenoma were all found in the “C” group subjects. Peptic ulcer (including the scar) was found in the highest rate among the “B” group subjects. The detection rate of peptic ulcer in “A” group subjects was very low. These results suggest that combined uses of serum PG method and HP antibody are useful for gastric cancer screening. And it is considered that evaluation of the gastric health levels for the subjects may be possible by checking up the presence of Hp infection and gastric mucosal atrophy with the blood test.

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In order to elucidate the effectiveness of colorectal cancer screening, we compared 5-year relative survival rates between screening-detected and clinically diagnosed colorectal cancer. Between 1984 and 1996, 9,554 cases of colorectal cancer were registered to the Fukui Prefectural Cancer Registry. After excluding 3,151 cases of which the information was derived only from death certificates or not able to be followed-up, we analyzed 6, 240 cases (362 mass screen-detected and 5,878 clinically diagnosed cases). The relative survival rates were analyzed through Ederer-II method with the log-rank test. The relative survival rates were significantly higher in mass screening-detected groups than in clinically diagnosed groups with same depth of lesions, same clinical stages and same histological types. We also observed significant survival benefit in mass screening detected groups for 50-79 years of age. These results suggest that mass screening using immunochemical fecal occult blood test makes it possible to reduce mortality from colorectal cancer.

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There have been a few evidence-based studies concerning the relationship between the length of the screening interval of two-day immunological fecal occult blood testing (IFOBT) and the risk of colorectal cancer (CRC). The aim of the present retrospective study was to assess the appropriate interval of two-day IFOBT for CRC screening. The study included subjects in whom the initial twoday IFOBT was negative and a second two-day IFOBT was subsequently performed. The detection rates for cancer among those who underwent screenings at various intervals between the initial and second screening were assessed. Among the 76, 337 subjects, 57 invasive cancer cases and 46 mucosal cancer cases were found. The odds ratio (OR) for mucosal or invasive cancer was significantly elevated among the subjects in whom the interval was over 4 years (OR: 2.13, 95% confidence interval: 1.19 to 3.81) in comparison with that of the subjects in whom the interval was 1 year. Because the prolongation of the interval between initial and the second two-day IFOBT to up to 3 years did not result in any change in cancer risk among persons who were at average risk for CRC, it is presumed that three years is an adequate interval for two-day IFOBT in mass screenings for CRC.

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The new method of occult blood examination using two stools from the same day has been introduced for the first time in Japan in Tottori Prefecture in 2003, and has been used since then. The result of this new method was assessed in comparison with the previous one, in which two stools from different days were examined. The new method was superior to the previous one from the following aspects. First, the detection rate for colon cancer tended to be higher. Second, the rate of sample-registration was higher than for the previous method, and the compliance of the examinees improved. Third, the new method is expected to lead to an increase in the number of examinees, because it is simpler. The introduction of this new method will solve the troublesome matters, such as preserving stool samples and preventing the decay of hemoglobin (Hb) on the stool surface, which takes place as time passes. Therefore, the new method of occult blood examination using two stools from the same day is simpler and much better than the previous one, in the view of promoting the detection of colon cancer in colon cancer surveillances. However, these results are based on a short-term study (one year), and more data from many examinees need to accumulate before the validity of this new method can be properly assessed.

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[in Japanese]

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