A More Efficient System for Gastric Cancer Screening Using the Combination Assay of Serum Anti-Helicobacter pylori IgG Antibody and the Serum Pepsinogen Levels

Purpose: Recent evidence may show the usefulness of serum pepsinogen (PG) measurement for gastric cancer screening. A high-risk and low-risk population of gastric cancer could be identified using the serum anti-Helicobacter pylori IgG antibody (Hp) and serum PG levels. The aim of this study was evaluate a new more efficient system for gastric cancer screening program using the combination assay of the serum Hp and PG test method. Methods: Serum Hp and PG levels were measured in 31,123 asymptomatic individuals (a ratio of man to woman=3.6, a mean age of 48.5 years) at a previously reported work place in Tokyo as a primary screening between April 2007 and March 2009. We classified into 1 of 4 groups (A to D) based on the results of the serum Hp and PG levels; group A [Hp(-) PG(-)], infection free subjects (71.7%); group B [Hp (+) PG (-)], chronic atrophic gastritis (CAG) -free gastritis (18.0%); group C [Hp (+) PG (+)],CAG (9.3%), and Group D [Hp (-) PG (+)], severe CAG with extensive intestinal metaplasia (1.0%), respectively. Group A, group B, group C, and group D were recommended to undergo endoscopic examination every 5 years, every 3 years, every 2 years, and every year, respectively. Results: In a total of 31,123 participating individuals, 5,500 planned to undergo endoscopic examination (17.6%). For the total of planned examination, 3,162 individuals underwent endoscopic examination (57.4%). Gastric cancer was detected in 20 patients, which corresponded to 0.06% of all participants and of 0.63 of those with endoscopic examination. Among 20 cancers, early stage cancers and intestinal type intramucosal cancers which were curable by endoscopic resection accounted for 85% and 60%, respectively. In a total of 20,820 after group A individuals, which was measured both Hp and PG in 2001 and 2002, no gastric cancer developed during 7 years follow-up period using previous individual records. The annual increasing ratio of group A per year was estimated about 3% and the decreasing rate of group B and C was about 1% and 2% per year, respectively. Conclusion: A mass screening for gastric cancer using the combination assays of the Hp and serum PG method was useful to select a high-risk and low-risk population of developing of gastric cancer, and to detect gastric cancer in early stage. A more efficient system for gastric cancer screening can be constructed.