world cancer report - iarc
world cancer report - iarc
world cancer report - iarc
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SCREENING FOR STOMACH<br />
CANCER IN JAPAN<br />
There has been a long history of<br />
screening for stomach <strong>cancer</strong> in Japan.<br />
Screening by indirect X-ray examination<br />
started in around 1960 and has<br />
been part of the “Health and Medical<br />
Service Law for the Aged” since 1983.<br />
The Ministry of Health and Welfare in<br />
Japan <strong>report</strong>ed that in 1997 4,273,000<br />
residents participated in screening programmes<br />
provided by local governments<br />
based on this law. Moreover, the<br />
Japanese system of annual health<br />
check-ups in the workplace has provided<br />
an opportunity for screening; about<br />
16.7% of an estimated 6,759,000<br />
employees were screened for stomach<br />
<strong>cancer</strong> in 1997. In addition, screening<br />
for stomach <strong>cancer</strong> is also undertaken<br />
during the so-called “Human Dry Dock”,<br />
which incorporates multiple screening<br />
procedures, including measurement of<br />
blood pressure, urine analysis, blood<br />
tests, chest X-ray examination and<br />
stomach X-ray examination.<br />
Consequently, at least 11,032,000 individuals<br />
(8.7% of the Japanese population)<br />
are estimated to have participated<br />
in screening for stomach <strong>cancer</strong> in<br />
1997.<br />
The main technique used to screen for<br />
stomach <strong>cancer</strong> in Japan is an indirect<br />
X-ray examination by the double contrast<br />
method, “double” referring to barium<br />
and air. When barium is swallowed,<br />
a small amount of air is also taken into<br />
the stomach. The barium makes the<br />
positive contrast and the air the negative<br />
contrast; this allows the detailed<br />
morphological patterns of the gastric<br />
surface to be visualized. This is usually<br />
conducted in a specially designed<br />
mobile unit equipped with a photofluorographic<br />
apparatus. This enables peo-<br />
Study author<br />
Kaibara<br />
Ohizumi<br />
Abe<br />
Ueda<br />
0 20 40 60 80<br />
Early stage <strong>cancer</strong>s (%)<br />
Fig. 4.55 Percentage of tumours detected at an early stage in Japanese patients diagnosed with stomach<br />
<strong>cancer</strong>, either during a screening programme or on the basis of presentation of symptoms.<br />
ple to participate in screening near their<br />
homes or workplaces. Seven X-ray photographs<br />
are usually taken according to<br />
the standard method of the Japanese<br />
Society of Gastroenterology. Record linkage<br />
between participants in the screening<br />
and the lists of population-based<br />
<strong>cancer</strong> registry indicated that the sensitivity<br />
and the specificity of an indirect Xray<br />
method by image intensifier were<br />
88.5% and 92.0%, respectively<br />
(Murakami R et al., Cancer 65: 1255-<br />
1260, 1990).<br />
Measurement of serum pepsinogen I and<br />
II levels has recently been introduced in<br />
Japan as a further method of screening<br />
for stomach <strong>cancer</strong> (Miki K, Annual<br />
<strong>report</strong> 1997 of the research committee<br />
of studies on study of gastric <strong>cancer</strong><br />
screening system using serum pepsinogen<br />
test, 1998). However, a welldesigned<br />
epidemiological evaluation of<br />
the efficacy of the pepsinogen method<br />
has not yet been conducted.<br />
Randomized controlled trials to evaluate<br />
the effectiveness of screening for stom-<br />
Diagnosed on basis of<br />
symptoms<br />
Diagnosed on the<br />
basis of screening<br />
ach <strong>cancer</strong> have not been undertaken in<br />
Japan. There have however been many<br />
other types of studies, such as casecontrol<br />
studies, cohort studies, and<br />
time trend analyses to evaluate the<br />
effectiveness of screening for stomach<br />
<strong>cancer</strong> (Hisamichi S et al., Evaluation of<br />
mass screening programme for stomach<br />
<strong>cancer</strong> in Japan, in UICC Cancer<br />
Screening, eds. Miller AB et al.,<br />
Cambridge University Press, 1991;<br />
Inaba S et al., Evaluation of a screening<br />
program on reduction of gastric <strong>cancer</strong><br />
mortality in Japan: Preliminary results<br />
from a cohort study. Prev Med, 29: 102-<br />
106, 1999). There is an absolute confidence<br />
among most Japanese people<br />
that screening provides benefit. This<br />
confidence might be a product of the<br />
success of screening programmes for<br />
tuberculosis during the decades following<br />
the Second World War.<br />
Stomach <strong>cancer</strong> prevention and screening<br />
177