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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Gastric cancer mortality related to direct radiographic and endoscopic screening: A retrospective study
Hiroaki Hagiwara, Fumitaka Moki, Yukiko Yamashita, Kazuki Saji, Keigo Iesaki, Hiromitsu Suda
Hiroaki Hagiwara, Department of Internal Medicine, Hagiwara Clinic, Maebashi 379-2106, Gunma, Japan
Hiroaki Hagiwara, Fumitaka Moki, Yukiko Yamashita, Kazuki Saji, Keigo Iesaki, Hiromitsu Suda, Maebashi Medical Association, Maebashi 371-0035, Gunma, Japan
Fumitaka Moki, Gunma Health Foundation, Maebashi 371-0005, Gunma, Japan
Yukiko Yamashita, Department of Internal Medicine and Surgery, Yamashita Clinic, Maebashi 371-0016, Gunma, Japan
Kazuki Saji, Department of Internal Medicine, Saji Clinic, Maebashi 371-0133, Gunma, Japan
Keigo Iesaki, Department of Internal Medicine, Iesaki Clinic, Maebashi 371-0805, Gunma, Japan
Hiromitsu Suda, Department of Pediatrics, Suda Kids Clinic, Maebashi 371-0813, Gunma, Japan
Author contributions: Hagiwara H designed the study, collected data, and wrote the paper; Moki F performed the follow-up survey and conducted the statistical analysis; Yamashita Y, Saji K, Iesaki K, and Suda H provided clinical advice.
Institutional review board statement: This study was reviewed and approved by the Gunma Prefecture Health and Welfare Department and Maebashi Medical Association.
Informed consent statement: Written informed consent to use screening results for research purposes was obtained from all participants of gastric cancer screening in Maebashi City, Japan.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Hiroaki Hagiwara, MD, Director, Department of Internal Medicine, Hagiwara Clinic, 1585-2 Arakomachi, Maebashi 379-2106, Gunma, Japan. hagiwaras@dab.hi-ho.ne.jp
Received: April 6, 2021
Peer-review started: April 6, 2021
First decision: June 24, 2021
Revised: July 9, 2021
Accepted: August 12, 2021
Article in press: August 12, 2021
Published online: September 7, 2021
BACKGROUND
Despite its decreased incidence in Japan, gastric cancer continues among the leading causes of cancer-related deaths in both men and women. Accordingly, efforts are still required to lower the mortality rate of gastric cancer in Japan. Maebashi City introduced endoscopic gastric cancer screening in 2004, and participants are able to choose between direct radiography and endoscopy. Hence, we expected to see a decrease in mortality rate from gastric cancer after introducing endoscopic screening and a difference in mortality rate reduction between screening methods.
AIM
To evaluate the impact on gastric cancer mortality rate of two types of gastric cancer screening in Maebashi City, Japan.
METHODS
Participants aged 40 to 79 years of the Maebashi City gastric cancer screening program in 2006 who were screened by direct radiography (n = 11155) or endoscopy (n = 10747) were included. Participants were followed until March 31, 2012, by cross-referencing their data against the Gunma Prefecture cancer registry data. We compared the detection rate of gastric cancers. Then, we compared the mortality rate between the two groups. The Cox proportional hazards model was used to estimate the hazard ratio (HR) of gastric cancer death. Finally, the reduction in gastric cancer mortality rate associated with each screening method was evaluated.
RESULTS
Gastric cancer was detected in 22 participants undergoing direct radiography (detection rate, 0.20%) and in 52 participants undergoing endoscopy (detection rate, 0.48%). However, most gastric cancers detected by endoscopic screening were early cancers that may not have resulted in death. We found no significant difference in gastric cancer mortality rate between participants receiving annual screening and those who do not. When the number of gastric cancer deaths in the direct radiography group was set as 1 in the Cox proportional hazard analysis, the HR of gastric cancer death was 1.368 (95%CI: 0.7308–2.562) in the overall group of participants. The results showed no significant difference between the two screening methods in any of the analysis groups.
CONCLUSION
Although endoscopic screening detected more gastric cancer than direct radiographic screening, no significant difference in the reduction of gastric cancer mortality rate between the two screening methods was found.
Core Tip: Although the incidence rate has declined in Japan, gastric cancer is still the leading cause of cancer-related deaths in men and women. Therefore, Japan still needs to work hard to reduce the death rate of gastric cancer. Maebashi City introduced endoscopic gastric cancer screening in 2004. Endoscopic screening detects more gastric cancer than direct radiographic screening does, but both screening methods have similar effects on reducing the mortality rate from gastric cancer.
