부산대학교 도서관

Endoscopic screening has not been recommended for population-based screening due to insufficient evidence showing its effectiveness in reducing the mortality due to gastric cancer, and it has been required for physicians to provide patients, who undergo opportunistic screening, with appropriate information regarding the lack of evidence of its effectiveness. We studied various efforts to decrease the rate of death due to gastric cancer after endoscopic screening compared with that after population-based X-ray screening, which is recommended by the guidelines based on its effectiveness. Asymptomatic subjects, 36,876 in number, were surveyed by X-ray in an organized screening program and 18,011 subjects by endoscopy in opportunistic screening programs. The subjects surveyed in these two types of screening program were cross-checked with the most accurate cancer registry in Japan, i.e., the cancer registry of Fukui Prefecture. Within five years after screening, 238 patients (1.3%) with gastric cancer were diagnosed in the endoscopic group and 245 patients (0.7%) in the X-ray group. When sex and age were adjusted for by logistic regression, significantly more patients were diagnosed as having gastric cancer in the endoscopic group (the odds ratio against the X-ray screening was 2.31, p<0.01). The rate of mortality from gastric cancer in the endoscopic group was significantly low, and the hazard ratio based on the 5-year survival in the endoscopy group as compared with that in the X-ray group was 0.23 when sex and age were adjusted for. It was concluded that endoscopy showed a noticeable effectiveness in decreasing the mortality due to gastric cancer. Therefore, it should be used in population-based screenings for gastric cancer.