title: Gastric cancer screening of a high-risk population in Japan using serum pepsinogen and barium digital radiography.
abstract: With the aim of developing more efficient gastric cancer screening programs for use in Japan, we studied a new screening program that combines serum pepsinogen (PG) testing and barium digital radiography (DR). A total of 17 647 middle-aged male subjects underwent workplace screening over a 7-year period using a combination of PG testing and DR. This program's effectiveness, as well as other characteristics of the program, was analyzed. Forty-nine cases of gastric cancer were detected (comprising 88% early cancer cases). The detection rate was 0.28%, and the positive predictive value was 0.85%. The PG test detected 63.3% of cases, DR detected 69.4% of cases, and both tests were positive in 32.7% of cancer cases. The two methods were almost equally effective, and were considerably more effective than conventional screening using photofluorography. Each screening method detected a distinct gastric cancer subgroup; the PG test efficiently detected asymptomatic small early cancer with intestinal type histology, while DR was efficient at detecting cancers with depressed or ulcerated morphology and diffuse type histology. The cost for the detection of a single cancer was much less than that for conventional screening. In fact, it is possible to further reduce the cost of detecting a single cancer to a cost comparable to that of surgically resecting a single gastric cancer. Thus, it is probable that a highly efficient gastric cancer screening system can be implemented by combining the two screening methods. Such a screening program would be beneficial in a population at high risk for gastric cancer.
authors.affiliation: Second Department of Internal Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama-city, Wakayama 641-0012, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ohata
authors.forename: Masashi
authors.initials: M
authors.lastname: Oka
authors.forename: Kimihiko
authors.initials: K
authors.lastname: Yanaoka
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Shimizu
authors.forename: Chizu
authors.initials: C
authors.lastname: Mukoubayashi
authors.forename: Kouichi
authors.initials: K
authors.lastname: Mugitani
authors.forename: Masataka
authors.initials: M
authors.lastname: Iwane
authors.forename: Hideya
authors.initials: H
authors.lastname: Nakamura
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Tamai
authors.forename: Kenji
authors.initials: K
authors.lastname: Arii
authors.forename: Hiroya
authors.initials: H
authors.lastname: Nakata
authors.forename: Noriko
authors.initials: N
authors.lastname: Yoshimura
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Takeshita
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Miki
authors.forename: Osamu
authors.initials: O
authors.lastname: Mohara
authors.forename: Masao
authors.initials: M
authors.lastname: Ichinose
mesh_terms: D001464:Barium; D014408:Biomarkers, Tumor / Q000097:blood*; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D020116:Pepsinogen A / Q000097:blood*; D011237:Predictive Value of Tests; D011856:Radiographic Image Enhancement; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D017132:Workplace
chemical_list: D014408:Biomarkers, Tumor; D001464:Barium; D020116:Pepsinogen A