Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Feb 24, 2024; 15(2): 271-281
Published online Feb 24, 2024. doi: 10.5306/wjco.v15.i2.271
Population-based X-ray gastric cancer screening in Hiroshima prefecture, Japan
Nhu Thi Hanh Vu, Yuji Urabe, Duc Trong Quach, Shiro Oka, Toru Hiyama
Nhu Thi Hanh Vu, Duc Trong Quach, Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh 700000, Viet Nam
Nhu Thi Hanh Vu, Department of Endoscopy, Hiroshima University Hospital, Hiroshima 734-8551, Japan
Yuji Urabe, Department of Gastrointestinal Endoscopy and Medicine, Hiroshima University Hospital, Hiroshima 734-8551, Japan
Shiro Oka, Department of Gastroenterology, Hiroshima University Hospital, Hiroshima 734-8551, Japan
Toru Hiyama, Health Service Center, Hiroshima University, Higashihiroshima 739-8514, Japan
Author contributions: Hiyama T, Vu NTH contributed to the study’s conception; Vu NTH, Hiyama T, and Urabe Y conducted data curation; Hiyama T, Vu NTH, Oka S, Quach DT, and Urabe Y performed data analysis; Oka S, Hiyama T, and Quach DT supervised the study; Vu NTH drafted the initial manuscript; Hiyama T, Quach DT, Urabe Y, and Oka S reviewed and edited the manuscript.
Institutional review board statement: Ethical approval for this study was obtained from the Ethical Committee of Hiroshima University, Japan (approval No. E2023-0018).
Informed consent statement: Patients were not required to give informed consent because the study was a population-based retrospective study. The data were derived from the aggregated data of the Hiroshima Regional Health Medical Promotion Organization, and the analysis used anonymous data.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Toru Hiyama, MD, PhD, Professor, Health Service Center, Hiroshima University, 1-7-1 Kagamiyama, Higashihiroshima 739-8514, Japan. tohiyama@hiroshima-u.ac.jp
Received: October 23, 2023
Peer-review started: October 23, 2023
First decision: November 29, 2023
Revised: December 11, 2023
Accepted: January 10, 2024
Article in press: January 10, 2024
Published online: February 24, 2024
Processing time: 119 Days and 10.9 Hours
ARTICLE HIGHLIGHTS
Research background

Gastric cancer (GC) is the fifth most common cancer worldwide and has the fourth highest mortality rate. In Japan, population X-ray GC screening has been shown to decrease mortality. This screening has been performed in Hiroshima Prefecture since 1983; however, the time trends and the efficacy of the method over 39 years have not been assessed.

Research motivation

The updated version of the Japanese Guidelines for GC Screening recommended both radiographic screening and endoscopic screening for population-based GC screening. Although more cases of GC have been detected with endoscopic rather than radiographic screening, some studies reported that the reduction in GC mortality was not significantly different between the two screening methods. Endoscopic screening also has some limitations, including complications and overdiagnosis. Therefore, it may be necessary to continue using radiographic examinations with a high processing capacity for population-based GC screening.

Research objectives

This study aimed to evaluate the trends and efficacy of population-based X-ray GC screening in Hiroshima Prefecture for the last 39 years, from 1983 to 2021, to identify the challenges and develop future solutions. These findings may provide valuable insights for early detection, improving treatment outcomes, evaluating and improving screening programs, and enhancing public health awareness and education about GC.

Research methods

This was a population-based retrospective study. The data were derived from the aggregated data of the Hiroshima Regional Health Medical Promotion Organization, Hiroshima, Japan. High-resolution double-contrast agents for the upper gastrointestinal tract were utilized for the X-ray examination in Hiroshima Prefecture. Participants with a suspicious X-ray abnormality (cancers or other gastric lesions such as ulcers) were recommended to undergo detailed examination with esophagogastroduodenoscopy (EGD).

Research results

The number of participants has decreased during the last four decades. The rate of those requiring EGDs decreased significantly in recent years. The number of participants diagnosed as having GC has also declined. However, the rate of cases diagnosed as GC among the participants remained around 0.1%, and the positive predictive value increased significantly in recent years. The number and rate of accidentally detected esophageal cancers have risen recently.

Research conclusions

GC screening in Hiroshima Prefecture continues to be efficient. However, one of the challenges is the cost. Therefore, risk stratification may be needed, such as eliminating from screening participants never infected with Helicobacter pylori and those without gastric mucosal atrophy. Esophageal cancers may also need to be considered because they have gradually increased in recent years.

Research perspectives

It is crucial to conduct multicenter, prospective, and follow-up studies to determine the efficacy of population-based X-ray GC screening and propose suitable solutions to improve GC screening in Japan.