Abstract
A considerable number of gastric cancers derive from stomach mucosa where chronic atrophic gastritis is severe and extensive. Based on the fact that the serum pepsinogen levels provide a precise measure of the extent of chronic atrophic gastritis, we have devised a mass screening method involving serum pepsinogen measurement to identify subjects at high risk of gastric cancer. In 1991, we screened 4,647 workers (male: 4,113, female: 534, mean age: 49.0 years) at a Japanese company using this method. Out of 875 subjects (18.8%) with a serum pepsinogen I level of less than 50 μg/liter and a pepsinogen I/II ratio of less than 3.0, 676 subjects (14.5%) were selected for further investigation by endoscopy. This led to the detection of four subjects (0.086%) with gastric cancer (three in an early stage) and four subjects with adenoma. The cancer detection rate of this new screening method was comparable, and in some respects superior, to that of the traditional barium X‐ray screening. Since the incidence of test‐positive subjects was as low as 10% amongst subjects aged less than 40, this screening method appears to be especially useful for screening of younger generations. The new method is less expensive than the traditional barium X‐ray and subjects experience little discomfort. Further, many serum samples can be quickly measured simultaneously. The results of this study have indicated that serum pepsinogen screening provides a valuable method for detecting gastric cancers.
Keywords: Pepsinogen, Mass screening, Gastric cancer
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REFERENCES
- 1).Segi , M. , Aoki , K. and Kurihara , M.World cancer mortality . Gann Monogr, Cancer Res. , 26 , 121 – 250 ( 1981. ). [Google Scholar]
- 2).Correa , P.The gastric precancerous process . Cancer Surv. , 2 , 437 – 450 ( 1983. ). [Google Scholar]
- 3).Kawachi , T. , Kurisu , M. , Numanyu , S. , Sasajima , K. , Sano , T. and Sugimura , T.Precancerous changes in the stomach . Cancer Res. , 36 , 2673 – 2677 ( 1976. ). [PubMed] [Google Scholar]
- 4).Imai , T. , Kubo , T. and Watanabe , H.Chronic gastritis in Japanese with reference to high incidence of gastric carcinoma . J. Natl. Cancer Inst. , 47 , 179 – 195 ( 1971. ). [PubMed] [Google Scholar]
- 5).Cheli , R. , Simon , L. , Aste , H. , Figus , I. A. , Nicolo , G. , Bajuti , A. and Puntoni , R.Atrophic gastritis and intestinal metaplasia in asymptomatic Hungarian and Italian populations . Endoscopy , 12 , 105 – 108 ( 1980. ). [DOI] [PubMed] [Google Scholar]
- 6).Bock , O. A. A. , Arapakis , G. , Witts , L. J. and Richards , C. D.The serum pepsinogen level with special reference to the histology of the stomach mucosa . Gut , 4 , 106 – 111 ( 1963. ). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7).Mirsky , I. A. , Futterman , P. and Kaplan , S.Blood plasma pepsinogen II. The activity of plasma from normal subjects, patients with duodenal ulcer and patients with pernicious anemia . J. Lab. Clin. Med. , 40 , 188 – 199 ( 1952. ). [PubMed] [Google Scholar]
- 8).Samloff , I. M. , Varis , K. , Ihamaki , T. , Siurala , M. and Rotter , J. I.Relationship among serum pepsinogen I, serum pepsinogen II and gastric mucosal histology: a study in relatives of patient with pernicious anemia . Gastroenterology , 83 , 204 – 209 ( 1982. ). [PubMed] [Google Scholar]
- 9).Miki , K. , Ichinose , M. , Shimizu , A. , Huang , S. C. , Oka , H. , Furihata , C. , Matsushima , T. and Takahashi , K.Serum pepsinogens as a screening test of extensive chronic gastritis . Gastroenterol. Jpn. , 22 , 133 – 141 ( 1987. ). [DOI] [PubMed] [Google Scholar]
- 10).Ichinose , M. , Miki , K. , Furihata , C. , Kageyama , T. , Hayashi , R. , Niwa , H. , Oka , H. , Matsushima , T. and Takahashi , K.Radioimmunoassay of serum group I and group II pepsinogens in normal controls and patients with various disorders . Clin. Chim. Acta. , 126 , 183 – 191 ( 1982. ). [DOI] [PubMed] [Google Scholar]
- 11).Miki , K. and Ichinose , M.Chronic atrophic gastritis and serum pepsinogen levels . Jpn. J. Cancer Clin. , 38 , 221 – 229 ( 1992. ) ( in Japanese ). [Google Scholar]
- 12).Miki , K. , Ichinose , M. , Kawamura , N. , Matsushima , M. , Ahmad , H. B. , Kimura , M. , Sano , J. , Tashiro , T. , Kakei , N. , Oka , H. , Furihata , C. and Takahashi , K.The significance of low serum pepsinogen levels to detect stomach cancer associated with extensive chronic gastritis in Japanese subjects . Jpn. J. Cancer Res. , 80 , 111 – 114 ( 1989. ). [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13).Kimura , K.Chronological transition of the fundic‐pyloric border determined by stepwise biopsy of the lesser and greater curvatures of the stomach . Gastroenterology , 63 , 584 – 592 ( 1972. ). [PubMed] [Google Scholar]
- 14).Kuroyanagi , C.Reports on gastric mass screening in workplaces . In “ Annual Reports on Kanagawa Health Service Association in 1991 ,” ed. Iwataki N. , pp . 103 – 107 ( 1991. ). Kanagawa Health Service Association; , Yokohama ( in Japanese ). [Google Scholar]
- 15).Tada , M. , Shimada , M. , Murakami , F. , Mizumachi , M. , Arima , K. , Yanai , H. , Oka , S. , Shigeeda , M. , Aibe , T. , Okazaki , Y. , Takemoto , T. , Murata , M. , Ogino , M. , Kinoshita , Z. and Kboshita , K.Development of the strip‐off biopsy . Gastroenterol. Endosc. , 26 , 833 – 839 ( 1984. ) ( in Japanese ). [Google Scholar]
- 16).Howson , C. P. , Hiyama , T. and Wynder , E. L.The decline in gastric cancer: epidemiology of an unplanned triumph . Epidemiol. Rev. , 8 , 1 – 27 ( 1986. ). [DOI] [PubMed] [Google Scholar]
- 17).Cheli , R. , Santi , L. , Ciancameria , G. and Canciani , G.A clinical and statistical follow‐up study of atrophic gastritis . Dig. Dis. , 18 , 1061 – 1066 ( 1973. ). [DOI] [PubMed] [Google Scholar]
- 18).Siurala , M. and Seppala , K.Atrophic gastritis as a possible precursor of gastric carcinoma and pernicious anemia: results of follow‐up examination . Acta Med. Scand. , 166 , 455 – 474 ( 1960. ). [DOI] [PubMed] [Google Scholar]
- 19).Hisamichi , S. , Doi , T. , Iwasaki , M. , Arisue , T. , Yamada , T. , Yoshikawa , K. , Kita , S. , Koga , M. , Ono , Y. and Hojoh , K.Current status of the gastric mass survey in Japan—an annual report in 1988 . Jpn. J. Gastric Mass Surv. , 85 , 180 – 201 ( 1989. ) ( in Japanese ). [Google Scholar]