Screening for gastric cancer in Japan

Tsubono, Yoshitaka; Hisamichi, Shigeru

doi:10.1007/pl00011692

Cited by 122 publications

(98 citation statements)

References 24 publications

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“…Regular screening has been shown to reduce long-term cancer mortality, (16,17) and a similar reduction or improvement of the prognosis for survival has been reported for GC. (9,18) Despite the importance of having routine cancer screening at the recommended intervals, there have been no published studies that have examined how many people attend repeat GC screening. An important goal of screening programs is not only to achieve high participation rates for the screening programs, but also to maintain these high rates at each subsequent round of screening.…”

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confidence: 99%

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Who participates in the gastric cancer screening and on‐time rescreening in the National Cancer Screening Program? A population‐based study in Korea

et al. 2011

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Gastric cancer (GC) screening is a major challenge in countries where the disease is highly prevalent. This study was conducted to identify the factors associated with participation in GC screening and on-time rescreening among the average-risk population in Korea. The study population was derived from the National Cancer Screening Program database. The population for this study was 22 913 618 individuals aged ‡40 years who had been invited to participate in a GC screening program from 2005 to 2006. We determined whether these individuals had attended the GC screening program and which method -an upper gastrointestinal series (UGIS) or endoscopy-they underwent. We followed the participants to determine whether they had a second GC screening after 2 years. The overall participation rate in the GC screening was 20.5%. More people underwent UGIS than endoscopy. Individuals who had been screened by endoscopy rather than UGIS were more likely to be younger, male, or those who were National Health Insurance (NHI) beneficiaries with a higher premium rate. Of those who underwent baseline screening, 59.4% participated in a rescreening program 2 years later. NHI beneficiaries with a higher premium rate were significantly more likely to be rescreened than medical aid recipients. The results from this study showed that the UGIS were more commonly used in organized GC screenings in Korea, and those who underwent UGIS were more likely to return for subsequent screening compared to those who underwent an endoscopy. (Cancer Sci 2011; 102: 2241-2247 G astric cancer (GC) is the fourth most common cancer behind lung cancer, breast cancer, and colorectal cancer, and in 2008 was the second most common cause of cancer deaths worldwide. (1) In Korea, GC is the most frequent type of cancer. (2,3) In countries where GC is highly prevalent, GC screening is offered to the average-risk population to reduce the disease burden. (4) Gastric cancer screening has shown improvements in survival rates as a result of early detection and consequently higher cure rates. (5) Therefore, many Asian countries with a high burden of GC have considered implementing GC screening for the general population. (6) Since 1960, Japan has implemented photofluorography (via an indirect upper gastrointestinal series [UGIS]) screening programs to detect GC in its early stages and prevent GC deaths. (6) The cohort studies conducted in Japan showed a significant GC mortality reduction with photofluorography screening. (5,7) In recent years, endoscopy has replaced photofluorography as the initial mass screening method in several cities in Japan. (8,9) This technique is increasingly useful for GC screening because of its high detection rate. In a study conducted in Niigata, Japan, the detection of GC by endoscopy was 2.7-4.6 times higher than that by direct or indirect UGIS. (10)(11)(12) Recently, Hosokawa et al. (13) reported an approximately 65% reduction in the GC death rate for participants screened with endoscopy. Despite this promising result, direct evidence for t...

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“…(5,7) In recent years, endoscopy has replaced photofluorography as the initial mass screening method in several cities in Japan. (8,9) This technique is increasingly useful for GC screening because of its high detection rate. In a study conducted in Niigata, Japan, the detection of GC by endoscopy was 2.7-4.6 times higher than that by direct or indirect UGIS.…”

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Who participates in the gastric cancer screening and on‐time rescreening in the National Cancer Screening Program? A population‐based study in Korea

et al. 2011

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“…The rate of secondary examination in the GI X-ray group was slightly higher than the average rate reported by the Japanese Society of Gastroenterology Cancer Screening. However, considering the mean age of the subjects in this RCT, the rate may not be so high compared to the number of Japanese citizens in their 60 0 s. In Japan GI X-ray using a barium meal is the method for mass gastric cancer screening and is available to asymptomatic individuals older than 40; this is the established nationwide program [8]. Upon positive findings in the barium meal examination [30] further investigation with GIE is recommended.…”

Section: Discussionmentioning

confidence: 99%

“…A meta-analysis of 3 case-control studies showed that screening by GI X-ray results in reduced mortality from gastric cancer [8]. Thus, Japanese guidelines established in 2006 recommended the population undergo gastric cancer screening using GI X-ray [9,10].…”

Section: Introductionmentioning

confidence: 99%

Randomized controlled trial comparing gastric cancer screening by gastrointestinal X-ray with serology for Helicobacter pylori and pepsinogens followed by gastrointestinal endoscopy

et al. 2014

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Background Based on the results of several case-control and cohort studies gastrointestinal X-ray (GI X-ray) has been recommended for use in the nationwide screening program for gastric cancer.. Although this was the only effective screening program when almost all of the Japanese population were Helicobacter pylori (H. pylori) positive, there has been concern whether an alternative effective screening system should be established for the future H. pylori-negative generation. We therefore conducted the first randomized controlled trial (RCT) comparing GI X-ray and gastrointestinal endoscopy (GIE) scheduled according to results of serological testing (ST); this was done to determine the potential for an alternative screening method. Methods Subjects who fulfilled the inclusion criteria were residents between the ages of 30 and 74 and who were able to receive gastric cancer screening in the Yurihonjo area. Participants were assigned to the GI X-ray group or the GIE-ST group by computer randomization. Subjects in each group were further subdivided into 4 categories according to their different risks for gastric cancer. The feasibility of stratified randomization was serologically assessed and detection rates of gastric cancer at entry by the different screening methods were also compared. Results Of the 2,962 subjects invited, 1,206 individuals (41 percent) were included in the first stage of this stratified RCT, and 604 and 602 individuals were assigned to the GI X-ray group and the GIE-ST group, respectively. There were no statistically significant differences in sex, age, height, body weight, smoking, alcohol intake and family history of cancer between the 2 groups. During ST the GI X-ray group showed a distribution that was not statistically different from that of the GIE-ST group. Although 3 cases of gastric cancer were detected in the GIE-ST group, there was no statistically significant difference between the 2 groups. One complication found was barium aspiration during the examination in the X-ray group. Conclusion We confirmed that baseline demographic features of the 2 groups were well balanced. We are now organizing the first RCT to compare the existing screening method and the alternative method (Clinical trial registration number: UMIN000005962).Electronic supplementary material The online version of this article

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“…The therapy of this cancer is early extirpation, whose outcome is closely related to the stage of disease progression. Japan, the country with the highest incidence in the world, has been broadly using X-ray screening to pick early gastric tumours since the 1960s (Inaba et al, 1999;Tsubono and Hisamichi, 2000). Some pilot programmes elsewhere sporadically used this Japanese technique as well (Llorens, 1991;Pisani et al, 1994).…”

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X-ray screening seems to reduce gastric cancer mortality by half in a community-controlled trial in Costa Rica

Rosero-Bixby

Sierra

2007

Br J Cancer

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X-ray screening of gastric cancer is broadly used in Japan, although no controlled trial has proved its effectiveness. This study evaluates the impact of an X-ray screening demonstrative intervention to reduce gastric cancer mortality in a Costa Rican region. The evaluation follows a quasi-experimental, community-controlled design, with measures before and after. About 7000 individuals participated by invitation in the two-wave screening programme. X-ray screening was followed by videoendoscopy and gastric biopsies. Treatment included resection with or without lymph node dissection. Comparisons with two control groups estimate that gastric cancer mortality was halved in the period from 2 to 7 years after the first screening visit. Validity of X-rays as used in this intervention had 88% sensitivity, 80% specificity, and 3% predictive value for individuals with two screening visits. Incidence in the screened group increased up to four times. Case survival was 85% in the intervention group after 5 years, compared to 12% among the controls before the intervention and 35% among the controls in the same region after the intervention. Although X-ray mass screening seems able to reduce stomach cancer mortality, its high cost may be an obstacle for scaling up this intervention in a nonrich country like Costa Rica.

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Screening for gastric cancer in Japan

Cited by 122 publications

References 24 publications

Who participates in the gastric cancer screening and on‐time rescreening in the National Cancer Screening Program? A population‐based study in Korea

Who participates in the gastric cancer screening and on‐time rescreening in the National Cancer Screening Program? A population‐based study in Korea

Randomized controlled trial comparing gastric cancer screening by gastrointestinal X-ray with serology for Helicobacter pylori and pepsinogens followed by gastrointestinal endoscopy

X-ray screening seems to reduce gastric cancer mortality by half in a community-controlled trial in Costa Rica

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