title: Prospective study of screening for stomach cancer in Japan.
abstract: Although screening for stomach cancer is a widespread community service in Japan, the benefits of the screening program remain unclear. Our study investigated prospectively the relation between participation in stomach-cancer screening during the past 12 months and subsequent deaths. Data was derived from the Japan Collaborative Cohort Study, in which 480 stomach-cancer deaths were identified during an 8-year follow-up period. Cox proportional hazard regression was used to estimate the relative risk of death from stomach cancer and that from other causes while adjusting for potential confounding factors. In men, screening participation was associated significantly with a reduced risk of death from stomach cancer (relative risk [RR] = 0.54; 95% confidence interval [CI] = 0.41-0.70). The extent of the risk reduction was greater than potential health selection (for deaths other than stomach, RR = 0.71). The adjustment for potential confounding variables, however, attenuated the difference in risk of death (stomach cancer, RR = 0.65; other causes, RR = 0.71). In women, the magnitude of the association between screening participation and death from stomach cancer (RR = 0.74; 95% CI = 0.52-1.07) was equal to that for deaths from non-stomach cancers (RR = 0.74). Subgroup analysis showed that women with a parental history of stomach cancer had a reduced risk of death from stomach cancer associated with screening (RR = 0.32; 95% CI = 0.12-0.87). The present results underline the potential for selection bias in observational studies, and thus it remains an open question whether screening for stomach cancer is effective.
authors.affiliation: Department of Preventive Medicine, Graduate School of Medical Sciences, Kyushu University, Japan. mizoue@phealth.med.kyushu-u.ac.jp
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Mizoue
authors.forename: Takesumi
authors.initials: T
authors.lastname: Yoshimura
authors.forename: Noritaka
authors.initials: N
authors.lastname: Tokui
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Hoshiyama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yatsuya
authors.forename: Kiyomi
authors.initials: K
authors.lastname: Sakata
authors.forename: Takaaki
authors.initials: T
authors.lastname: Kondo
authors.forename: Shogo
authors.initials: S
authors.lastname: Kikuchi
authors.forename: Hideaki
authors.initials: H
authors.lastname: Toyoshima
authors.forename: Norihiko
authors.initials: N
authors.lastname: Hayakawa
authors.forename: Akiko
authors.initials: A
authors.lastname: Tamakoshi
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Ohno
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Fujino
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kaneko
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D013997:Time Factors