Published online Feb 24, 2024. doi: 10.5306/wjco.v15.i2.271
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
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.
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.
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.
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).
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.
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.
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.