Usefulness of a New Gastric Cancer Screening Program Using the Combination Assay of Serum Anti-Helicobacter pylori IgG Antibody and the Serum Pepsinogen Levels

Purpose: This study was performed to evaluate a new gastric cancer screening program using this combination assay of the serum Hp and PG test method. Methods: Serum Hp and PG levels were measured in the total number of 48073 asymptomatic individuals (about 16000 per year; majority participants checked every year) at a work place in Tokyo as a primary screening between April 2007 and March 2010 (a ratio of man to woman=3.6, a mean age of 47.4 years). We classified into 1 of 4 groups based on the results of the serum Hp and PG levels; group A [Hp (-) PG (-)] (73.2%), group B [Hp (+) PG (-)] (16.4%), group C [Hp (+) PG (+)] (9.3%), and group D [Hp (-) PG (+)] (1.1%), respectively. Group A, B, C, and D were recommended to undergo endoscopic examination every 5 years, 3 years, 2 years, and every year, respectively, and we examined the detection rate of gastric cancers and details of detected cancers. Simultaneously, we estimated the annual increasing or decreasing ratio of each group, comparing the ratio of each group in 2007, 2008, and 2009. Results: In a total of 48073 participating individuals, 6965 planned to undergo endoscopic examination (4202 in group B, 2346 in group C, and 417 in group D). For the total of planned examination, 3921 individuals underwent endoscopic examination (2244 in group B, 1436 in group C, and 241 in group D). Gastric cancer was detected in 23 patients (12 patients in 2007, 8 patients in 2008, and 3 patients in 2009), and 16 and 7 of them were detected from group B and C, respectively. 18 of them were early gastric cancers and 12 of them could be resected endoscopically. Although 5 advanced cancers were detected in this screening program, it was the first time for all of them to have this program for reasons such as mid-career hiring. Histopathologically, 47.8% of the detected cancers were diffuse type, and the ratio of diffuse type was increasing gradually (25.0% in 2007, 62.5% in 2008, and 100% in 2009). The ratio of group A in 2007, 2008, and 2009 was 70.7%, 72.7%, and 75.8%, and the ratio of group B was 19.4%, 16.7%, and 13.5%, respectively. Consequently, the annual increasing ratio of group A per year was estimated about 3% and the decreasing rate of group B was about 3% per year. Conclusion: A mass screening for gastric cancer using the combination assay of the serum Hp and PG test method was useful to select a high-risk and low-risk population of developing gastric cancers and to detect not only intestinal type but also diffuse type cancers in early stage. The number of individuals in group A will continue to increase at a rate of about 3%, which is expected to contribute to a further reduction in the number of individuals who are advised to undergo a mass screening method for gastric cancer in the future.