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BackgroundThere is a lack of agreement on which gastric cancer screening method is the most effective in the general population. The present study compared the relative performance of upper-gastrointestinal series (UGIS) and endoscopy screening for gastric cancer.MethodsA population-based study was conducted using the National Cancer Screening Program (NCSP) database. We analyzed data on 2,690,731 men and women in Korea who underwent either UGIS or endoscopy screening for gastric cancer between January 1, 2002 and December 31, 2005. Final gastric cancer diagnosis was ascertained through linkage with the Korean Central Cancer Registry. We calculated positivity rate, gastric cancer detection rate, interval cancer rate, sensitivity, specificity, and positive predictive value of UGIS and endoscopy screening.ResultsThe positivity rates for UGIS and endoscopy screening were 39.7 and 42.1 per 1,000 screenings, respectively. Gastric cancer detection rates were 0.68 and 2.61 per 1,000 screenings, respectively. In total, 2,067 interval cancers occurred within 1 year of a negative UGIS screening result (rate, 1.17/1,000) and 1,083 after a negative endoscopy screening result (rate, 1.17/1,000). The sensitivity of UGIS and endoscopy screening to detect gastric cancer was 36.7 and 69.0%, respectively, and specificity was 96.1 and 96.0%. The sensitivity of endoscopy screening to detect localized gastric cancer was 65.7%, which was statistically significantly higher than that of UGIS screening.ConclusionOverall, endoscopy performed better than UGIS in the NCSP for gastric cancer. Further evaluation of the impact of these screening methods should take into account the corresponding costs and reduction in mortality.

The incidence rate of cervical cancer in Korea is still higher than in other developed countries, notwithstanding the national mass-screening program. Furthermore, a new method has been introduced in cervical cancer screening. Therefore, the committee for cervical cancer screening in Korea updated the recommendation statement established in 2002. The new version of the guideline was developed by the committee using evidence-based methods. The committee reviewed the evidence for the benefits and harms of the Papanicolaou test, liquid-based cytology, and human papillomavirus (HPV) testing, and reached conclusions after deliberation. The committee recommends screening for cervical cancer with cytology (Papanicolaou test or liquid-based cytology) every three years in women older than 20 years of age (recommendation A). The cervical cytology combined with HPV test is optionally recommended after taking into consideration individual risk or preference (recommendation C). The current evidence for primary HPV screening is insufficient to assess the benefits and harms of cervical cancer screening (recommendation I). Cervical cancer screening can be terminated at the age of 74 years if more than three consecutive negative cytology reports have been confirmed within 10 years (recommendation D).

Recent reports have proposed endoscopy as an alternative strategy to radiography for gastric cancer (GC) screening. The current study presents the first reported population-based data from a large GC screening program that provided endoscopic examinations. A retrospective population-based study was conducted using the National Cancer Screening Program (NCSP) database. We evaluated GC detection rates, sensitivity, specificity, and the positive predictive value of an endoscopic screening program for the average-risk Korean population, aged 40 years and older, who underwent the NCSP from 2002 to 2005. The detection rates of GC by endoscopy in the first and subsequent rounds were 2.71 and 2.14 per 1000 examinations, respectively. Localized cancer accounted for 45.7% of screen-detected GC cases. The sensitivity of endoscopy was 69% (95% confidence interval [CI]: 66.3-71.8). The endoscopic screening was less sensitive for the detection of localized GC (65.7%, 95% CI = 61.8-69.5) than for regional or distant GC (73.6%, 95% CI = 67.4-79.8). In the multiple logistic models for localized GC and all combined GC, the odds ratio (OR) of sensitivity for the undifferentiated type was statistically significantly higher than that for the differentiated type, whereas the OR of sensitivity for the mixed type was lower than that for the differentiated type. The sensitivity of the endoscopic test in a population-based screening was slightly higher for the detection of regional or distant GC than for localized GC. Further evaluation of the impact of endoscopic screening should take into account the balance of cost and mortality reduction. (Cancer Sci 2011; 102: 1559-1564 G astric cancer (GC) is the fourth most common type of cancer (934 000 new cases, 8.6% of all new cancer cases in 2002), and the second most common cause of cancer death (700 000 deaths annually) in the world.(1) Several Asian countries, including China, Japan, and Korea, have the highest incidences of GC in the world.(1) Although the incidence of GC in Korea has declined in recent decades, it remains the most common cancer. (2) Because the prognosis of early GC is highly favorable, highprevalence countries, such as Japan and Korea, have sought to reduce the disease burden by providing GC screening to average-risk populations. Since 1960, Japan has conducted mass screening for GC with photofluorography (via indirect upper gastrointestinal series), achieving remarkable improvement in survival rates as a result of early detection, and consequently, higher cure rates. (3)(4)(5) This use of photofluorography for GC screening in Japan is based on the results of several case-control and cohort studies.(6) Although population-based photofluorography screening has been mandated as a public policy matter, other opportunistic screening methods have been used in the clinical setting, including endoscopy, serum pepsinogen testing, and Helicobacter pylori antibody testing.(6) However, the efficacy of these methods remains unclear. In Korea, national GC screening was instituted i...

Recipients used implants for an average of 5.6 years. The mean VAS, HUI, EQ-5D, and QWB score increased by 0.33 (from 0.27 before implantation to 0.60 at survey), 0.36 (0.29 to 0.65), 0.26 (0.52 to 0.78), and 0.16 (0.45 to 0.61), respectively. The discounted direct cost was 22,320 dollars, which yielded a cost-utility ratio of 19,223 dollars per QALY using VAS, 17,387 dollars per QALY using HUI, 24,604 dollars per QALY using EQ-5D, and 40,474 dollars per QALY using QWB.