Mass screening for gastric cancer: how to select patients for endoscopic examination

Gastroendoscopy (GS) has recently been applied in mass screening for gastric cancer, instead of X-ray examination, to improve the quality of the screening. However, as there are currently limitations in the application of endoscopy in all types of screening for gastric cancer, patients must be selected for mass screening by endoscopy. We investigated how to select individuals for endoscopic examination of gastric cancer screening and the effectiveness of X-ray primary screening before endoscopy. All 7942 patients who underwent upper endoscopy for gastric cancer screening at our hospital between April 2005 and March 2008 were divided into two groups: an X-ray screening group (2782 subjects, endoscopy following primary X-ray screening), and a GS direct group (5160 subjects, endoscopy only). Thirty-seven carcinomas were detected among the 2782 subjects in the X-ray screening group undergoing endoscopy, representing a cancer detection rate of 1.33%. In the GS direct group, 23 carcinomas were detected in the 5160 subjects undergoing endoscopy, representing a cancer detection rate of 0.45%. However, our results suggested that the gastric cancer detection rate by endoscopy was three times higher when it was performed following X-ray screening. There are various conflicting demands for future screening. Our results suggest that it is appropriate to perform an initial X-ray examination followed by endoscopy in prospective screening for gastric cancer.