Gastric Cancer Screening in Japan

Abstract

The past, present, and future of gastric cancer screening in Japan are introduced. Gastric cancer screening was started with barium X-ray examination (upper gastrointestinal series, UGIS) in 1950s. The main characteristic is the double-contrast method with barium sulfate and carbon dioxide gas. Those who are suspected of having gastric cancer are recommended further examination with endoscopy. The effect of UGIS screening on the death of gastric cancer is significant. Recently those who are suspected with H. pylori infection are diagnosed with UGIS and recommended endoscopic examination followed by eradication therapy. Because UGIS has problems such as X-ray exposure, it should be updated with risk evaluation to reduce X-ray exposure and the cost for low-risk subjects. On the other hand, endoscopic screening was started in 1980s. The effect of endoscopic screening on the death of gastric cancer was also significant, and the effect was superior to that of UGIS screening. However, endoscopic screening has some problems to perform in a large population such as cost and capacity. Since H. pylori infection rate and gastric cancer death rate are decreasing, gastric cancer screening with an image test (UGIS or endoscopy) should be updated to include gastric cancer risk evaluation to be more efficient. Serum tests have merits to screen high-risk subjects for gastric cancer, but the tests are not perfect to rule out 100% gastric cancers. We have to know the limitations. A combination of an image test and serum tests may be useful for covering the weakness of each other.