The Efficacy of Gastric Cancer Risk A, B, C, D Gastritis Screening (ABC Screening) for the Detection of the PG-Negative Gastric Cancer

Introduction: The aim of the present study was to investigate the efficacy of gastric cancer risk A, B, C, D gastritis screening (ABC screening) by combined assay for serum anti-Helicobacter pylori (Hp)-IgG antibody and serum pepsinogen (PG) levels for the detection of the PG-negative gastric cancer. Methods: Hp and PG levels were measured as a primary screening in the total number of 61,106 asymptomatic individuals (about 15,000 per year; majority participants checked every year) between April 2007 and March 2011 at a work place where the screening system using PG method alone (duration of endoscopic examination: PG-positive, 2 years; PG-negative, 5 years) had been adopted before then. Subjects were classified into 1 of 4 groups based on the results of Hp and PG levels: Group A, B, C, and D, and PG-negative was divided into 2 groups: Group A, Hp-negative; Group B, Hp-positive. Group A was excluded from endoscopic examination because the risk or gastric cancer is very low in this group, and Group B was recommended to undergo endoscopic examination every 3 years. We examined the percentages of individuals and details of detected cancers in Group A and B. Results: In a total of 61,106 participating individuals, the ratio of Group A and B were 74.2%, 15.5%, respectively, and the percentage of individuals in Group A in 2007, 2008, 2009, and 2010 was 70.6%, 72.7%, 75.8%, and 77.9%; that in Group B was 19.4%, 16.7%, 13.5%, and 12.2%, respectively. Four thousand, six hundred eighty-one of all the individuals in Group B (49.4%) were advised to undergo endoscopic examination, and 2,490 actually underwent endoscopy. Of all individuals in Group B, 16 were found to have gastric cancer (detection rate of gastric cancer in Group B: 0.17%), and in individuals who had a routine checkup in the screening system using PG method alone or ABC screening at this work place, all detected cancers were early stage. During this study of 4 years, there was no report of detected cancer in Group A, which was excluded from endoscopic examination. Conclusion: In ABC screening, Group A, which accounted to about 3 quarters of all participating individuals, and in which endoscopic examination would have been performed once in 5 years by the screening system using PG method alone, was excluded from endoscopic examination, and Group B, in which detection rate of gastric cancer was 0.17% and in which endoscopic examination would have been performed only once in 5 years by the screening system using PG method alone, were recommended to undergo endoscopic examination every 3 years; therefore, this screening method was considered more efficient to detect PG-negative gastric cancers than PG method alone.