Gastric Cancer Risk A, B, C, D Gastritis Screening (ABC Screening) Using the Combination Assay of Serum Anti-Helicobacter pylori IgG Antibody and the Serum Pepsinogen Levels

Purpose: The aim of present study was to investigate the feasibility of gastric cancer-risk A, B, C, D gastritis screening (ABC screening) based on the results of the two serologic tests, anti-Helicobacter pylori (Hp) IgG antibody titer and the pepsinogen (PG) I and II levels. Methods: Hp and PG levels were measured in the total number of 61,106 asymptomatic individuals (about 15,000 per year; majority participants checked every year) at a work place in Tokyo as a primary screening between April 2007 and March 2011. Subjects were classified into 1 of 4 groups (A to D) based on the results of the Hp and PG levels; Group A [Hp (-) PG (-)], infection free or mild subjects; Group B [Hp (+) PG (-)], chronic atrophic gastritis free; Group C [Hp (+) PG (+)], chronic atrophic gastritis; and group D [Hp (-) PG (+)], severe chronic atrophic gastritis with extensive intestinal metaplasia, respectively. Group B, C, and D were recommended to undergo endoscopic examination every 3 years, 2 years, and every year, respectively, and we examined the detection rate of gastric cancers and details of detected cancers. Results: In a total of 61,106 participating individuals, the ratio of Group A, B, C, and D were 73.2%, 16.4%, 9.3%, and 1.1%, respectively. The ratio of Group A was increasing gradually (70.1% in 2007, 72.7% in 2008, 75.8% in 2009, and 77.9% in 2010), and the increasing ratio of Group A was estimated about 3% per year. For the total of 8,199 planned examination (13.4% of all participants), 4,658 individuals underwent endoscopic examination. Gastric cancer was detected in 24 patients, which corresponded to 0.04% of all participants and to 0.51% of those with endoscopic examination. Although the ratio of diffuse type to detected gastric cancers was increasing gradually (25.0% in 2007, 62.5% in 2008, and 100% in 2009 and 2010), early stage cancers and intestinal-type intramucosal cancers accounted for 79.2% and 50.0% of all the detected cancers, respectively. Conclusion: ABC screening was useful to detect not only intestinal type but also diffuse type cancers in early stage. The increase of the ratio of Group A at a rate of about 3% per year can contribute to a further reduction in the number of individuals who are advised to undergo the secondary endoscopic examination, and make this screening program more efficient in the future.