Early Detection of Asymptomatic Gastric Cancers using Gastric Cancer-Risk A, B, C, D Gastritis Screening (ABC Screening)

Abstract

Purpose: The present investigation was made to assess the feasibility of gastric cancer-risk A, B, C, D gastritis screening (ABC screening) based on the results of the two serologic tests, anti-Helicobacter pylori (Hp) IgG antibody titer and the pepsinogen (PG) I and II levels. Methods: Hp and PG levels were measured in the total number of 71,416 asymptomatic individuals (about 14,000 per year; majority participants checked every year) at a work place in Tokyo as a primary screening between April 2007 and March 2012. Subjects were classified into 1 of 4 groups (A to D) based on the results of the Hp and PG levels; Group A [Hp (-) PG (-)], infection free or mild subjects; Group B [Hp (+) PG (-)], chronic atrophic gastritis free; Group C [Hp (+) PG (+)], chronic atrophic gastritis; and group D [Hp (-) PG (+)], severe chronic atrophic gastritis with extensive intestinal metaplasia, respectively. Group B, C, and D were recommended to undergo secondary endoscopic examination every 3 years, 2 years, and every year, respectively, and we examined the detection rate of gastric cancers and details of detected cancers. Results: In a total of 71,416 participating individuals, the ratio of Group A, B, C, and D were 75.6%, 14.4%, 8.7%, and 1.3%, respectively. The ratio of Group A was increasing gradually (70.6% in 2007, 72.7% in 2008, 75.8% in 2009, 77.9% in 2010, and 81.2% in 2011), and the increasing ratio of Group A was estimated about 2 to 3% per year. In a total of 5,359 endoscopic examinations, gastric cancer was detected in 30 patients, which corresponded to 0.04% of all participants and to 0.56% of those with endoscopic examinations. Early stage cancers accounted for 76.7% of all the detected cancers, and the ratio of intestinal type and diffuse type were 56.7% and 43.3%, respectively. Although 7 patients were diagnosed with the advanced gastric cancers in this screening program, it turned out that they had not undergone the endoscopic examination at recommended intervals or not informed us of the past history of the eradication of Hp, except in the case of their first screening program. Conclusion: Although ABC screening is useful to detect not only intestinal type but also diffuse type cancers effectively, it is necessary to undergo the endoscopic examination at recommended intervals, and to obtain accurate medical history for the detection of gastric cancers in early stage.