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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
ARTICLE HIGHLIGHTS
Research background
Gastric cancer is among the leading causes of cancer mortality worldwide, including in Japan. Initiatives have been implemented to lower the mortality rate of gastric cancer in Japan, including mass screening programs. In 2015, guidelines were revised to recommend endoscopy.
Research motivation
In Maebashi City, endoscopic gastric cancer screening was introduced in 2004, allowing eligible participants to choose between direct radiography and endoscopy. Comparing outcomes is essential to reduce gastric cancer mortality and ensure an effective and efficient screening program.
Research objectives
This study aimed to assess whether the mortality rate from gastric cancer decreased after the introduction of endoscopic screening in Maebashi City and compare gastric cancer mortality rates between screening methods.
Research methods
A retrospective analysis of the Maebashi City Gastric Cancer Screening Program in 2006 was conducted. Participants aged 40 to 79 were screened by direct radiography (n = 11155) or endoscopy (n = 10747) and followed until March 31, 2012. Data was cross-referenced against the Gunma Prefecture cancer registry data. The detection rate of gastric cancer and gastric cancer mortality rate were compared between the two screening groups.
Research results
Gastric cancer detection rate for direct radiography was 0.20% and 0.48% for endoscopy; however, endoscopic screening detected a higher number of early-stage cancers that may not have resulted in death. No significant difference in gastric cancer mortality rate was found between participants who underwent annual screening and those who did not. In addition, no significant difference was found in gastric cancer mortality rate between direct radiographic screening and endoscopic screening (P = 0.285). The five-year survival by the Kaplan-Meier method was 0.998 (95%CI: 0.998–0.999) in individuals who underwent direct radiography and 0.998 (95%CI: 0.997–0.999) in individuals who underwent endoscopy.
Research conclusions
No significant difference in gastric cancer mortality rate was found between direct radiographic screening and endoscopic screening. Screening programs should address gaps in endoscopists’ skill levels across screening institutions to ensure the quality of endoscopic examination. Finally, an efficient gastric cancer screening system should consider gastric cancer risk by combining endoscopic and radiographic screening.
Research perspectives
Further research with a larger number of participants and high-quality cancer incidence data is needed to better clarify the usefulness of population-based endoscopic screening.
