Correlation between Atrophic Gastritis Prevalence and Gastric Cancer Mortality among Middle-aged Men in 5 Areas in Japan

Abstract

The suggested association between atrophic gastritis as a precursor lesion and subsequent high risk of gastric cancer was examined at the population level in a cross-sectional study of men 40 to 49 years of age in 5 populations with different gastric cancer mortalities. Subjects toltalled 634 men, randomly selected from each population of about 100, 000, whose atrophic gastritis was diagnosed serologically based on a combination of the serum pepsinogen I (PG I) level <70 ng/ml and pepsinogen I/pepsinogen 11 (PG I/PG II) ratio<3.0. The number of atrophic gastritis cases discriminated was 121 among 624 evaluated men (19.4% overall) and its prevalence rates in 5 areas (range : 9.4-26.8%) correlated almost perfectly (r=0.999, p<0.0001) with age-adjusted mortality rates averaged for 1985-89 for gastric cancer (range : 17.3-49.1 per 100, 000). Although some misclassifications could not be denied, especially in discriminating mild/moderate cases, which were separated from severe ones diagnosed more definitively under stricter criteria of PG I< 30 ng/ml and PG I/PG II ratio<2.0, it was unlikely that they affected the above correlation significantly, since a similar good correlation was observed even when a criterion of PG I/PG II ratio<2.5 alone, for which high specificity and sensitivity are known, was applied. Thus, the strong correlation found in the present study not only suggests that the number of middle-aged men with atrophic gastritis may be a basis on which gastric cancer mortality in an area can be determined almost exclusively but also that the serologiccal diagnosis is useful in screening of a group of high risk for gastric cancer. Therefore, this diagnostic method provides a practical method of gastric cancer prevention, although a combination with other methods to diagnose particularly mild/moderate atrophic gastritis is recommended for following-up the high-risk group on an individual basis. J Epidemiol, 1993; 3 : 35-39.