The Japanese guidelines for gastric cancer screening.
BACKGROUND
Gastric cancer is the leading cause of death from cancer in Japan. In 2004, there were 50 562 deaths from gastric cancer; they accounted for 15.8% of the total number of cancer deaths. Since 1983, under the Health Service Law for the Aged, gastric cancer screening has been conducted nationwide for all residents aged 40 years and over.


METHODS
On the basis of the standardized method developed for the Japanese Guidelines for Cancer Screening, the efficacies of various methods for gastric cancer screening were evaluated and the guideline was developed.


RESULTS
Four methods for gastric cancer screening were evaluated: photofluorography, endoscopy, serum pepsinogen testing and Helicobacter pylori antibody testing. On the basis of the analytic framework involving key questions, 1715 articles, published from January 1985 to February 2005, were selected using MEDLINE, the Japanese Medical Research Database and other methods. After the systematic literature review, 10 articles were identified as direct evidence and 49 articles as indirect evidence. The studies that evaluated mortality reduction from gastric cancer included five case-control and two cohort studies for radiographic screening. On the basis of the balance of benefits and harms, the recommendations for population-based and opportunistic screening were formulated. Gastric cancer screening using photofluorography was recommended for both screening programs. The other methods were not recommended for population-based screening due to insufficient evidence.


CONCLUSIONS
The guideline for gastric cancer screening guideline was developed based on the previously established method. Gastric cancer screening using photofluorography is recommended for population-based and opportunistic screening in Japan.
Hamashima
Chisato
C
Cancer Screening Technology Division, Research Center for Cancer Prevention and Screening, National Cancer Center, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan. chamashi@ncc.go.jp
Shibuya
Daisuke
D
Yamazaki
Hideo
H
Inoue
Kazuhiko
K
Fukao
Akira
A
Saito
Hiroshi
H
Sobue
Tomotaka
T
D000907:Antibodies, Bacterial / Q000097:blood; D005188:False Negative Reactions; D005189:False Positive Reactions; D005773:Gastroscopy; D016480:Helicobacter pylori / Q000276:immunology; D006801:Humans; D007564:Japan; D008403:Mass Screening / Q000379:methods*; D020116:Pepsinogen A / Q000097:blood; D010779:Photofluorography; D017410:Practice Guidelines as Topic; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000201:enzymology / Q000453:epidemiology / Q000517:prevention & control
D000907:Antibodies, Bacterial; D020116:Pepsinogen A