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Tanaka K, Sobue T, Zha L, Kitamura T, Sawada N, Iwasaki M, Inoue M, Yamaji T, Tsugane S. Effectiveness of Screening Using Fecal Occult Blood Testing and Colonoscopy on the Risk of Colorectal Cancer: The Japan Public Health Center-based Prospective Study. J Epidemiol 2023; 33:91-100. [PMID: 34053963 PMCID: PMC9794451 DOI: 10.2188/jea.je20210057] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Few cohort studies have used multiple surveys of screening attendance to simultaneously evaluate the effectiveness of fecal occult blood test (FOBT) and colonoscopy. METHODS We analyzed data of 30,381 middle-aged Japanese adults from a population-based prospective cohort study. Information on FOBT and colonoscopy was obtained from three questionnaire surveys (every 5 years). We classified the subjects into three groups: the FOBT (15,649 subjects), screening colonoscopy (2,407 subjects), and unscreened (12,325 subjects) groups. We used the unscreened group as the reference group to compare the mortality and incidence of colorectal cancer (CRC). RESULTS During the 14-year follow-up, 64, 12, and 104 CRC deaths were identified in the FOBT, screening colonoscopy, and unscreened groups, respectively. The risk of CRC death reduced with increasing the number of FOBTs (P for trend = 0.02) and was reduced by 44% in the subjects screened twice or thrice using FOBT (hazard ratio [HR] 0.56; 95% confidence interval [CI], 0.33-0.94). Significant decreases were seen for the incidence of CRC but not seen for the incidence of non-advanced CRC in the FOBT group. Concerning the screening colonoscopy, subjects screened at the start of follow-up showed a 69% reduced risk of CRC death (HR 0.31; 95% CI, 0.10-0.9996). Significant decreases were also seen for the incidence of CRC and non-advanced CRC in the subjects screened at the start of follow-up. CONCLUSION FOBT, depending on the number of FOBTs, and colonoscopy, depending on recency, reduced the risk of death due to CRC and the incidence of CRC.
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Affiliation(s)
- Kenta Tanaka
- Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tomotaka Sobue
- Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Ling Zha
- Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Norie Sawada
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Motoki Iwasaki
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Manami Inoue
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Taiki Yamaji
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
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2
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Narii N, Sobue T, Zha L, Kitamura T, Iwasaki M, Inoue M, Yamaji T, Tsugane S, Sawada N. Effectiveness of endoscopic screening for gastric cancer: The Japan Public Health Center-based Prospective Study. Cancer Sci 2022; 113:3922-3931. [PMID: 36002149 PMCID: PMC9633299 DOI: 10.1111/cas.15545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 11/28/2022] Open
Abstract
Upper gastrointestinal endoscopy for gastric cancer screening has been implemented in Japan. However, its effectiveness for gastric cancer prevention has not been fully studied. We aimed to investigate the effectiveness of endoscopic screening to reduce mortality from gastric cancer. In a large prospective population‐based cohort study including 80,272 participants, we compared the risk of mortality and incidence of gastric cancer among participants who underwent endoscopic or radiographic screening compared with those who did not undergo any screening using multivariable Cox proportional hazards models. In the 1,023,364 person‐year observation period (median; 13.0 years), 1977 cases of gastric cancer were diagnosed, and 783 patients with gastric cancer died. In the endoscopic screening group, the mortality from gastric cancer and incidence of advanced gastric cancer were reduced by 61% (hazard ratio [HR] = 0.39 [95% CI: 0.30–0.51]) and 22% (HR = 0.78 [95% CI: 0.67–0.90]), respectively. The radiographic screening reduced the mortality from gastric cancer (HR = 0.63 [95% CI: 0.54–0.73]), but its effectiveness was lower than that of endoscopic screening. In conclusion, endoscopic screening reduced the incidence of advanced gastric cancer and mortality from gastric cancer in the Japanese population.
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Affiliation(s)
- Nobuhiro Narii
- Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tomotaka Sobue
- Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Ling Zha
- Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Motoki Iwasaki
- Division of Cohort research, National Cancer Center Institute for Cancer Control, Tokyo, Japan.,Division of Epidemiology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Manami Inoue
- Division of Cohort research, National Cancer Center Institute for Cancer Control, Tokyo, Japan.,Division of Prevention, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Taiki Yamaji
- Division of Epidemiology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Shoichiro Tsugane
- Division of Cohort research, National Cancer Center Institute for Cancer Control, Tokyo, Japan.,National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan
| | - Norie Sawada
- Division of Cohort research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
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3
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Yashima K, Shabana M, Kurumi H, Kawaguchi K, Isomoto H. Gastric Cancer Screening in Japan: A Narrative Review. J Clin Med 2022; 11:4337. [PMID: 35893424 PMCID: PMC9332545 DOI: 10.3390/jcm11154337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/22/2022] [Accepted: 07/24/2022] [Indexed: 12/16/2022] Open
Abstract
Gastric cancer is the second leading cause of cancer incidence in Japan, although gastric cancer mortality has decreased over the past few decades. This decrease is attributed to a decline in the prevalence of H. pylori infection. Radiographic examination has long been performed as the only method of gastric screening with evidence of reduction in mortality in the past. The revised 2014 Japanese Guidelines for Gastric Cancer Screening approved gastric endoscopy for use in population-based screening, together with radiography. While endoscopic gastric cancer screening has begun, there are some problems associated with its implementation, including endoscopic capacity, equal access, and cost-effectiveness. As H. pylori infection and atrophic gastritis are well-known risk factors for gastric cancer, a different screening method might be considered, depending on its association with the individual's background and gastric cancer risk. In this review, we summarize the current status and problems of gastric cancer screening in Japan. We also introduce and discuss the results of gastric cancer screening using H. pylori infection status in Hoki-cho, Tottori prefecture. Further, we review risk stratification as a system for improving gastric cancer screening in the future.
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Affiliation(s)
- Kazuo Yashima
- Division of Gastroenterology and Nephrology, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago 683-8504, Japan; (H.K.); (K.K.); (H.I.)
| | - Michiko Shabana
- Sanin Rosai Hospital, 1-8-1 Kaikeshinden, Yonago 683-8605, Japan;
| | - Hiroki Kurumi
- Division of Gastroenterology and Nephrology, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago 683-8504, Japan; (H.K.); (K.K.); (H.I.)
| | - Koichiro Kawaguchi
- Division of Gastroenterology and Nephrology, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago 683-8504, Japan; (H.K.); (K.K.); (H.I.)
| | - Hajime Isomoto
- Division of Gastroenterology and Nephrology, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago 683-8504, Japan; (H.K.); (K.K.); (H.I.)
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4
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Azadnajafabad S, Saeedi Moghaddam S, Keykhaei M, Shobeiri P, Rezaei N, Ghasemi E, Mohammadi E, Ahmadi N, Ghamari A, Shahin S, Rezaei N, Aghili M, Kaviani A, Larijani B, Farzadfar F. Expansion of the quality of care index on breast cancer and its risk factors using the global burden of disease study 2019. Cancer Med 2022; 12:1729-1743. [PMID: 35770711 PMCID: PMC9883412 DOI: 10.1002/cam4.4951] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 04/12/2022] [Accepted: 06/07/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Breast cancer (BC), as the top neoplasm in prevalence and mortality in females, imposes a heavy burden on health systems. Evaluation of quality of care and management of patients with BC and its responsible risk factors was the aim of this study. METHODS We retrieved epidemiologic data of BC from the Global Burden of Disease (GBD) 1990-2019 database. Epidemiology and burden of BC and its risk factors were explored besides the Quality of Care Index (QCI) introduced before, to assess the provided care for patients with BC in various scales. Provided care for BC risk factors was investigated by their impact on years of life lost and years lived with disability by a novel risk factor quality index (rQCI). We used the socio-demographic index (SDI) to compare results in different socio-economic levels. RESULTS In 2019, 1,977,212 (95% UI: 1,807,615-2,145,215) new cases of BC in females and 25,143 (22,231-27,786) in males was diagnosed and this major cancer caused 688,562 (635,323-739,571) deaths in females and 12,098 (10,693-13,322) deaths in males, globally. The all-age number of deaths and disability-adjusted life years attributed to BC risk factors in females had an increasing pattern, with a more prominent pattern in metabolic risks. The global estimated age-standardized QCI for BC in females in 2019 was 78.7. The estimated QCI was highest in high SDI regions (95.7). The top countries with the highest calculated QCI in 2019 were Iceland (100), Japan (99.8), and Finland (98.8), and the bottom countries were Mozambique (16.0), Somalia (8.2), and Central African Republic (5.3). The global estimated age-standardized rQCI for females was 82.2 in 2019. CONCLUSION In spite of the partially restrained burden of BC in recent years, the attributable burden to risk factors has increased remarkably. Countries with higher SDI provided better care regarding both the condition and its responsible risk factors.
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Affiliation(s)
- Sina Azadnajafabad
- Non‐Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences InstituteTehran University of Medical SciencesTehranIran,Breast Disease Research CenterTehran University of Medical SciencesTehranIran,Department of SurgeryTehran University of Medical SciencesTehranIran
| | - Sahar Saeedi Moghaddam
- Non‐Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences InstituteTehran University of Medical SciencesTehranIran
| | - Mohammad Keykhaei
- Feinberg Cardiovascular and Renal Research InstituteNorthwestern University School of MedicineChicagoUSA
| | - Parnian Shobeiri
- Non‐Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences InstituteTehran University of Medical SciencesTehranIran
| | - Negar Rezaei
- Non‐Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences InstituteTehran University of Medical SciencesTehranIran,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences InstituteTehran University of Medical SciencesTehranIran
| | - Erfan Ghasemi
- Non‐Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences InstituteTehran University of Medical SciencesTehranIran
| | - Esmaeil Mohammadi
- Non‐Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences InstituteTehran University of Medical SciencesTehranIran
| | - Naser Ahmadi
- Non‐Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences InstituteTehran University of Medical SciencesTehranIran
| | - Azin Ghamari
- Non‐Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences InstituteTehran University of Medical SciencesTehranIran
| | - Sarvenaz Shahin
- Non‐Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences InstituteTehran University of Medical SciencesTehranIran
| | - Nazila Rezaei
- Non‐Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences InstituteTehran University of Medical SciencesTehranIran
| | - Mahdi Aghili
- Radiation Oncology Research CenterTehran University of Medical SciencesTehranIran
| | - Ahmad Kaviani
- Breast Disease Research CenterTehran University of Medical SciencesTehranIran,Department of SurgeryTehran University of Medical SciencesTehranIran,Department of Surgical OncologyUniversity of MontrealMontrealQuebecCanada
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences InstituteTehran University of Medical SciencesTehranIran
| | - Farshad Farzadfar
- Non‐Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences InstituteTehran University of Medical SciencesTehranIran,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences InstituteTehran University of Medical SciencesTehranIran
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5
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Mabe K, Inoue K, Kamada T, Kato K, Kato M, Haruma K. Endoscopic screening for gastric cancer in Japan: Current status and future perspectives. Dig Endosc 2022; 34:412-419. [PMID: 34143908 DOI: 10.1111/den.14063] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 12/18/2022]
Abstract
The revised 2014 Japanese Guidelines for Gastric Cancer Screening approved gastric endoscopy for use in population-based screening. Thus, it is expected that gastric cancer will be detected earlier, and gastric cancer mortality further decreased, with the widespread use of endoscopy and Helicobacter pylori eradication therapy. However, due to an increasingly aging population and relatively low gastric cancer screening rates, gastric cancer remains the leading cause of cancer death in Japan. While the era of endoscopic gastric cancer screening has begun, it does present challenges, such as limited/varying regional availability of endoscopists. This review describes the history of gastric cancer screening in Japan, achievements in endoscopic gastric cancer screening in Japan and Korea, efforts underway to improve screening by stratifying individuals according to gastric cancer risk, and initiatives by the Japan Gastroenterological Endoscopy Society aimed at improving screening, including the implementation of a board certification program for screening endoscopists.
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Affiliation(s)
- Katsuhiro Mabe
- Junpukai Health Maintenance Center-Kurashiki, Okayama, Japan
| | | | - Tomoari Kamada
- Department of Health Care Medicine, Kawasaki Medical School, Okayama, Japan
| | - Katsuaki Kato
- Cancer Detection Center, Miyagi Cancer Society, Miyagi, Japan
| | - Mototsugu Kato
- National Hospital Organization Hakodate National Hospital, Hokkaido, Japan
| | - Ken Haruma
- Junpukai Health Maintenance Center, Okayama, Japan.,Division of Gastroenterology, Department of Internal Medicine 2, Kawasaki Medical School, Okayama, Japan
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6
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Hamashima C, Yoshimura K, Fukao A. A study protocol for expanding the screening interval of endoscopic screening for gastric cancer based on individual risks: prospective cohort study of gastric cancer screening. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1604. [PMID: 33437803 PMCID: PMC7791261 DOI: 10.21037/atm-20-5949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background The Japanese government has recommended a 2-year endoscopic screening interval for gastric cancer. However, insufficient resources have constrained participation in endoscopic screening for gastric cancer. One way to avoid endoscopic screening harms and provide equal access is to define the appropriate screening interval. Methods To expand screening interval from more than 2 years for low-risk group, a single-arm cohort of endoscopic screening started. At the baseline screening, the participants underwent endoscopic screening for gastric cancer, Helicobacter pylori (H. pylori) antibody test, and serum pepsinogen test (first year), and followed after 2 and 4 years (within the first 5 years). We also assessed H. pylori infection and atrophy status on images of upper gastrointestinal endoscopy at the baseline. A new screening model will be developed by dividing the participants into high-risk and low-risk groups based on demographics, history of H. pylori eradication, serological testing, and endoscopic diagnosis. The cumulative gastric cancer incidence after negative results at baseline are compared between the low-risk group on the 3rd screening round after 4 years from baseline and the total screening group on the 2nd screening round after 2 years. If the cumulative gastric cancer incidence in the low-risk group on the 3rd screening round is lower than that in the total screening group on the 2nd screening round, the screening interval can be expanded to 4 years in the low-risk group. Discussion To reduce mortality from gastric cancer, a high participation rate of the target population is required. The screening interval of endoscopic screening can be changed if the individual risks for H. pylori infection are clarified. Our goal in this study is to obtain relevant data that can be used to improve the efficient use of endoscopic screening for gastric cancer by referring to individual risks in Japan. Trial registration UMIN000025839 (University Hospital Medical Information Network, Japan)
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Affiliation(s)
- Chisato Hamashima
- Health Policy Section, Department of Nursing, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
| | - Kenichi Yoshimura
- Future Medical Center, Hiroshima University Hospital, Hiroshima 734-8551, Japan
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7
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Affiliation(s)
- Chisato Hamashima
- Health Policy Section, Department of Nursing, Faculty of Medical Technology, Teikyo University, Tokyo, Japan
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8
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Yin J, Wu X, Li S, Li C, Guo Z. Impact of environmental factors on gastric cancer: A review of the scientific evidence, human prevention and adaptation. J Environ Sci (China) 2020; 89:65-79. [PMID: 31892402 DOI: 10.1016/j.jes.2019.09.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 09/17/2019] [Accepted: 09/17/2019] [Indexed: 06/10/2023]
Abstract
Globally, gastric cancer (GC) ranks fifth in prevalence and third in fatalities, and shows a distinct geographical distribution in morbidity and mortality. Such a spatial pattern indicates that environmental factors could be an important contributor to GC. We reviewed a total of 135 relevant peer-reviewed articles and other literature published 1936-2019 to investigate the scientific evidence concerning the effects of environmental factors on GC worldwide. Environmental factors affect GC from the aspects of water, soil, air, radiation, and geology. Risk factors identified include water type, water pollution, water hardness, soil type, soil pollution, soil element content, climate change, air pollution, radiation, altitude, latitude, topography, and lithology; and most of them have an adverse impact on GC. Furthermore, we found that their effects followed five common rules: (1) the leading environmental factors that affect GC incidence and mortality vary by region, (2) the same environmental factors may have different effects on GC in different regions, (3) some different environmental factors have similar effects on GC in essence, (4) different environmental factors often interact to have combined or synergistic effects on GC, and (5) environmental factors can affect human factors to have an impact on GC. Environmental factors have a great impact on GC. Human beings may prevent GC by controlling carcinogenic factors, screening high-risk populations and providing symptomatic and rehabilitative treatments. Furthermore, adaptation measures are recommended to reduce GC risk on private and public levels. Future studies should transcend existing empirical studies to develop causal relationship models and focus on vulnerable population analysis.
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Affiliation(s)
- Jie Yin
- State Key Laboratory of Remote Sensing Science, College of Global Change and Earth System Science, Beijing Normal University, Beijing 100875, China
| | - Xiaoxu Wu
- State Key Laboratory of Remote Sensing Science, College of Global Change and Earth System Science, Beijing Normal University, Beijing 100875, China.
| | - Suping Li
- The Second People's Hospital of Lanzhou City, Lanzhou 730046, China
| | - Chenlu Li
- State Key Laboratory of Remote Sensing Science, College of Global Change and Earth System Science, Beijing Normal University, Beijing 100875, China
| | - Zhiyi Guo
- State Key Laboratory of Remote Sensing Science, College of Global Change and Earth System Science, Beijing Normal University, Beijing 100875, China
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9
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Chiu PW, Sano Y, Uedo N, Singh R, Ng EK, Aang TL, Chiu HM, Ho SH, Banerjee R, Tanaka S, Li XB, Yao F, Lau JY, Yao K. Utility of a standardized training program for endoscopic diagnosis of early gastrointestinal neoplasia. Endosc Int Open 2019; 7:E452-E458. [PMID: 30931377 PMCID: PMC6428678 DOI: 10.1055/a-0854-3525] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 09/18/2018] [Indexed: 02/08/2023] Open
Abstract
Background and study aims Image enhanced endoscopy (IEE) allows endoscopists to improve recognition and characterization of gastrointestinal neoplasia. The Asian Novel Bio-Imaging and Intervention Group (ANBIG) conducted a standardized training program in endoscopic diagnosis and treatment of early gastrointestinal cancers in Asia. We embarked on a study to investigate the effect of this module on endoscopic diagnosis of early gastrointestinal neoplasia. Methods This prospectively collected database was from workshops conducted on training for endoscopic diagnosis of early gastrointestinal neoplasia. All workshops were conducted in a standardized format, which included a pretest, a learning phase consisting of didactic lectures, case discussion, and live demonstration followed by a post-test to assess knowledge gained. The pretest and post-training tests were standardized questions addressing four domains, including basic knowledge of imaging and diagnosis of esophageal, gastric, and colonic neoplasia. Results From November 2013 to November 2016, 41 ANBIG workshops were conducted in 13 countries. A total of 1863 delegates and 40 faculty participated in these workshops. Of the delegates, 627 completed both tests. There was a significant improvement after training in all domains of the tests. There was a trend in general lack of knowledge across all domains for delegates from "low" healthcare cost countries before training. All delegates demonstrated significant improvement in knowledge of all domains after the workshop irrespective of whether they were from "high" or "low" healthcare cost per capita countries. Conclusion A standardized teaching program on IEE improved the diagnostic ability and quality of endoscopists in recognizing early gastrointestinal neoplasia in Asia.
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Affiliation(s)
- Philip W. Chiu
- Department of Surgery, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong S.A.R., China,Corresponding author Prof. Philip WY Chiu Department of Surgery, Faculty of MedicineThe Chinese University of Hong Kong4th floor, Lui Che Woo Clinical Science Building, Prince of Wales Hospital30-32 Ngan Shing Street, Shatin, Hong Kong S.A.R.China+85226377974
| | - Yasushi Sano
- Gastrointestinal Center & iMEC (Institute of Minimally-invasive Endoscopic Care), Sano Hospital, Kobe, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Rajvinder Singh
- Department of Gastroenterology, Lyell McEwin & Modbury Hospitals, University of Adelaide, Australia
| | - Enders K.W. Ng
- Department of Surgery, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong S.A.R., China
| | - Tiing Leong Aang
- Department of Gastroenterology & Hepatology, Changi General Hospital, Singapore
| | - Han Mo Chiu
- Division of Gastroenterology, Department of Internal Medicine, National Taiwan University, Taiwan
| | - Shiaw-Hooi Ho
- Department of Gastroenterology, University of Malaya, Malaysia
| | - Rupa Banerjee
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Xiao Bo Li
- Department of Gastroenterology, Renji Hospital, Shanghai, China
| | - Fang Yao
- Department of Gastroenterology, Peking Union Medical College Hospital, Beijing, China
| | - James Y.W. Lau
- Department of Gastroenterology, Peking Union Medical College Hospital, Beijing, China
| | - Kenshi Yao
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
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10
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Hamashima C, Sano H. Association between age factors and strategies for promoting participation in gastric and colorectal cancer screenings. BMC Cancer 2018; 18:345. [PMID: 29587681 PMCID: PMC5870209 DOI: 10.1186/s12885-018-4244-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 03/19/2018] [Indexed: 11/21/2022] Open
Abstract
Background Despite the long history of cancer screening in Japan, the participation rates in gastric and colorectal cancer screenings have not increased. Strategies for improving the participation rates have been proposed, but differences in their effects among different age groups remain unclear. Methods The Japanese government conducted a national survey in all municipalities in Japan in 2010 to investigate whether the implementation of promotion strategies increased participation in cancer screening. We investigated the association between age factors and strategies for promoting participation in cancer screening based on this national survey. Multiple regression analysis with generalized linear model was performed using the participation rates in gastric and colorectal cancer screenings as dependent variables, and the following strategies for promoting participation as independent variables: 1) personal invitation letters, 2) household invitation letters, 3) home visits by community nurses, 4) screenings in medical offices, and 5) free cancer screening programs. Results One thousand six hundred thirty nine municipalities for gastric cancer screening and 1666 municipalities for colorectal cancer screening were selected for the analysis. In gastric and colorectal cancer screenings, the participation rates of individuals aged 60–69 years was higher than those of other age groups. Personal and household invitation letters were effective promotion strategies for all age groups, which encouraged even older people to participate in gastric and colorectal cancer screenings. Screening in medical offices and free screenings were not effective in all age groups. Home visits were effective, but their adoption was limited to small municipalities. Conclusions To clarify whether promotion strategies can increase the participation rate in cancer screening among different age groups, 5 strategies were assessed on the basis of a national survey. Although personal and household invitation letters were effective strategies for promoting participation in cancer screening for all age groups, these strategies equally encouraged older people to participate in gastric and colorectal cancer screenings. If resource for sending invitation letters are limited, priority should be given to individuals who are in their 50s and 60s for gastric and colorectal cancer screening.
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Affiliation(s)
- Chisato Hamashima
- Division of Cancer Screening Assessment and Management, Center for Public Health Science, National Cancer Center, 5-1-1 Tsukiji Chuo-ku, Tokyo, 104-0045, Japan.
| | - Hiroshi Sano
- Faculty of Economics, Shiga University, 1-1-1 Baba-cho, Hikone, Japan
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11
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Hamashima C. Cancer screening guidelines and policy making: 15 years of experience in cancer screening guideline development in Japan. Jpn J Clin Oncol 2018; 48:278-286. [PMID: 29315389 DOI: 10.1093/jjco/hyx190] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Affiliation(s)
- Chisato Hamashima
- Division of Cancer Screening Assessment and Management, Center for Public Health Science, National Cancer Center, Tokyo, Japan
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12
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Hamashima C, Narisawa R, Ogoshi K, Kato T, Fujita K. Optimal interval of endoscopic screening based on stage distributions of detected gastric cancers. BMC Cancer 2017; 17:740. [PMID: 29121881 PMCID: PMC5680820 DOI: 10.1186/s12885-017-3710-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 10/30/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Although Korea and Japan have a national gastric cancer screening program, their screening intervals are different. The optimal screening interval of endoscopic screening in Japan was investigated based on the stage distributions of screen-detected gastric cancers. METHODS Patients with gastric cancer detected by endoscopic and radiographic screenings were selected from the Niigata City Medical Association database. The stage distributions of the detected gastric cancers were compared among patients with different screening histories in both groups. Gastric cancer specific survival rates were analyzed using the Kaplan-Meier method with the log-rank test. RESULTS There were 1585 and 462 subjects in the endoscopic and radiographic screening groups, respectively. In the endoscopic screening group, the stage IV proportion was lower in patients with screening history 1 and 2 years before diagnosis than in patients without screening history. Stage IV development was significantly related to the absence of screening history (p < 0.001); however, there were no differences between patients who had endoscopic screening history 2 and 3 years before diagnosis. The survival rates were not significantly different between patients with endoscopic screening 1 and 2 years previously (p = 0.7763). The survival rates were significantly higher in patients with endoscopic screening history 1 and 2 years before diagnosis than in patients without screening history (p < 0.001), and in patients with endoscopic screaming 3 years before diagnosis (P < 0.0069). CONCLUSION The endoscopic screening interval for gastric cancer can be expanded to at least 2 years based on the stage distributions of detected cancers and the patient survival rates.
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Affiliation(s)
- Chisato Hamashima
- Division of Cancer Screening Assessment and Management, Center for Public Health Science, National Cancer Center, 5-1-1 Tsukiji Chuo-ku, Tokyo, 104-0045, Japan.
| | - Rintaro Narisawa
- Division of Gastroenterology, Niigata Cancer Center Hospital, 2-15-3 Kawagishi-Cho Chuo-ku, Niigata, 951-8566, Japan
| | - Kazuei Ogoshi
- Cancer Registry Section, Niigata Cancer Center Hospital, 2-15-3 Kawagishi-Cho Cyuo-ku, Niigata, 951-8566, Japan
| | - Toshiyuki Kato
- Committee of Gastrointestinal Cancer Screening, Niigata City Medical Association, 3-3-1 Shichikuyama Chuo-ku, Niigata, 950-0914, Japan
| | - Kazutaka Fujita
- Committee of Gastrointestinal Cancer Screening, Niigata City Medical Association, 3-3-1 Shichikuyama Chuo-ku, Niigata, 950-0914, Japan
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Hamashima C, Fukao A. Quality assurance manual of endoscopic screening for gastric cancer in Japanese communities. Jpn J Clin Oncol 2016; 46:1053-1061. [PMID: 27589938 DOI: 10.1093/jjco/hyw106] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/14/2016] [Accepted: 07/05/2016] [Indexed: 12/16/2022] Open
Abstract
The Japanese government introduced endoscopic screening for gastric cancer in 2015 as a public policy based on the Japanese guidelines on gastric cancer screening. To provide appropriate endoscopic screening for gastric cancer in Japanese communities, we developed a quality assurance manual of endoscopic screening and recommend 10 strategies with their brief descriptions as follows: (i) Formulation of a committee responsible for implementing and managing endoscopic screening, and for deciding the suitable implementation methods in consideration of the local context; (ii) Development of an interpretation system that leads to a final judgement to standardize endoscopic examination and improve its accuracy; (iii) Preparation of management and reporting systems for adverse effects by the committee for safety management; (iv) Obtaining informed consent before operation following adequate explanations regarding the benefits and harms of endoscopic screening; (v) Avoidance of frequent screenings to reduce false-positive results and overdiagnosis. As a reference, the target age group is ≥50 years, and the screening interval is 2 years; (vi) Keeping the biopsy rate within 10% as post-biopsy bleeding may occur. Before endoscopic screening, any history of antithrombotic drug usage should be checked; (vii) Nonadministration of sedation in endoscopic screening for safety management; (viii) Adherence to proper endoscopic cleaning and disinfection to reduce infection; (ix) Use of a checklist to achieve optimal program preparation when municipal governments introduce endoscopic screening; (x) Identification of the aims and roles by referring to a checklist if primary care physicians decide to participate in endoscopic screening.
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Affiliation(s)
- Chisato Hamashima
- Division of Cancer Screening Assessment and Management, Center for Public Health Science, National Cancer Center, Tsukiji, Chuo-ku, Tokyo
| | - Akira Fukao
- Department of Public Health, School of Medicine, Yamagata University,Yamagata, Japan
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Hamashima C. Benefits and harms of endoscopic screening for gastric cancer. World J Gastroenterol 2016; 22:6385-92. [PMID: 27605874 PMCID: PMC4968120 DOI: 10.3748/wjg.v22.i28.6385] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 05/18/2016] [Accepted: 06/13/2016] [Indexed: 02/06/2023] Open
Abstract
Gastric cancer has remained a serious burden worldwide, particularly in East Asian countries. However, nationwide prevention and screening programs for gastric cancer have not yet been established in most countries except in South Korea and Japan. Although evidence regarding the effectiveness of endoscopic screening for gastric cancer has been increasingly accumulated, such evidence remains weak because it is based on results from studies other than randomized controlled trials. Specifically, evidence was mostly based on the results of cohort and case-control studies mainly conducted in South Korea and Japan. However, the consistent positive results from these studies suggest promising evidence of mortality reduction from gastric cancer by endoscopic screening. The major harms of endoscopic screening include infection, adverse effects, false-positive results, and overdiagnosis. Despite the possible harms of endoscopic screening, information regarding these harms remains insufficient. To provide appropriate cancer screening, a balance of benefits and harms should always be considered when cancer screening is introduced as a public policy. Quality assurance is very important for the implementation of cancer screening to provide high-quality and safe screening and minimize harms. Endoscopic screening for gastric cancer has shown promising results, and thus deserves further evaluation to reliably establish its effectiveness and optimal use.
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15
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Hamashima C. Have we Comprehensively Evaluated the Effectiveness of Endoscopic Screening for Gastric Cancer? Asian Pac J Cancer Prev 2016; 16:3591-2. [PMID: 25921183 DOI: 10.7314/apjcp.2015.16.8.3591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Endoscopy has been increasingly used in clinical practice and as a standardized examination procedure for gastrointestinal diseases. However, only a few studies on endoscopic screening for evaluating mortality reduction from gastric cancer have been carried out. Even if a high detection rate is obtained in clinical practice, such a rate cannot be directly accepted as evidence providing the effectiveness of cancer screening. Endoscopic screening for gastric cancer is not an exception of possibility to detect overdiagnosis. If detection rate is used for the evaluation of the effectiveness of cancer screening, the possibility of overestimating the effectiveness of cancer screening cannot be ruled out. To avoid the effect of overdiagnosis and confirm the effectiveness of endoscopic screening, mortality reduction from gastric cancer must be carefully evaluated by conducting reliable studies. The burden of gastric cancer remains real and this cannot be ignored in Eastern Asian countries. To determine the best available method for gastric cancer screening, evaluation of its effectiveness is a must. Endoscopic screening for gastric cancer has shown promising results, and thus deserves further comprehensive evaluation to reliably confirm its effectiveness and how its optimal use can be strategically promoted.
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Affiliation(s)
- Chisato Hamashima
- Cancer Screening Assessment and Management Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan E-mail :
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16
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Hamashima C, Shabana M, Okada K, Okamoto M, Osaki Y. Mortality reduction from gastric cancer by endoscopic and radiographic screening. Cancer Sci 2015; 106:1744-9. [PMID: 26432528 PMCID: PMC4714659 DOI: 10.1111/cas.12829] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 09/24/2015] [Accepted: 09/26/2015] [Indexed: 12/17/2022] Open
Abstract
To evaluate mortality reduction from gastric cancer by endoscopic screening, we undertook a population‐based cohort study in which both radiographic and endoscopic screenings for gastric cancer have been carried out. The subjects were selected from the participants of gastric cancer screening in two cities in Japan, Tottori and Yonago, from 2007 to 2008. The subjects were defined as participants aged 40–79 years who had no gastric cancer screening in the previous year. Follow‐up of mortality was continued from the date of the first screening to the date of death or up to December 31, 2013. A Cox proportional hazards model was used to estimate the relative risk (RR) of gastric cancer incidence, gastric cancer death, all cancer deaths except gastric cancer death, and all‐causes death except gastric cancer death. The number of subjects selected for endoscopic screening was 9950 and that for radiographic screening was 4324. The subjects screened by endoscopy showed a 67% reduction of gastric cancer compared with the subjects screened by radiography (adjusted RR by sex, age group, and resident city = 0.327; 95% confidence interval [CI], 0.118–0.908). The adjusted RR of endoscopic screening was 0.968 (95%CI, 0.675–1.387) for all cancer deaths except gastric cancer death, and 0.929 (95%CI, 0.740–1.168) for all‐causes death except gastric cancer death. This study indicates that endoscopic screening can reduce gastric cancer mortality by 67% compared with radiographic screening. This is consistent with previous studies showing that endoscopic screening reduces gastric cancer mortality.
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Affiliation(s)
- Chisato Hamashima
- Cancer Screening Assessment and Management Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Michiko Shabana
- Department of Internal Medicine, San-in Rosai Hospital, Yonago, Japan
| | - Katsuo Okada
- Tottori Prefecture Health Promoting Council, Tottori, Japan
| | - Mikizo Okamoto
- Cancer Center, Tottori University Hospital, Yonago, Japan
| | - Yoneatsu Osaki
- Division of Environmental and Preventive Medicine, Department of Social Medicine, Faculty of Medicine, Tottori University, Yonago, Japan
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Hamashima C, Ohta K, Kasahara Y, Katayama T, Nakayama T, Honjo S, Ohnuki K. A meta-analysis of mammographic screening with and without clinical breast examination. Cancer Sci 2015; 106:812-8. [PMID: 25959787 PMCID: PMC4520631 DOI: 10.1111/cas.12693] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 04/19/2015] [Accepted: 05/02/2015] [Indexed: 12/29/2022] Open
Abstract
Mammographic screening with clinical breast examination has been recommended in Japan since 2000. Although mammographic screening without clinical breast examination has not been recommended, its introduction is anticipated. The efficacies of mammographic screening with and without clinical breast examination were evaluated based on the results of randomized controlled trials. PubMed and other databases for studies published between 1985 and 2014 were searched. The study design was limited to randomized controlled trials to evaluate mortality reduction from breast cancer. Five studies were eligible for meta-analysis of mammographic screening without clinical breast examination. The relative risk for women aged 40-74 years was 0.75 (95% confidence interval, 0.67-0.83). Three studies evaluated the efficacy of mammographic screening with clinical breast examination. The relative risk for women aged 40-64 years was 0.87 (95% confidence interval, 0.77-0.98). The number needed to invite was always lower in mammographic screening without clinical breast examination than in mammographic screening with clinical breast examination. In both screening methods, the number needed to invite was higher in women aged 40-49 years than in women aged 50-70 years. These results suggest that mammographic screening without clinical breast examination can afford higher benefits to women aged 50 years and over. Although evidence of the efficacy of mammographic screening without clinical breast examination was confirmed based on the results of the randomized controlled trials, a Japanese study is needed to resolve local problems.
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Affiliation(s)
- Chisato Hamashima
- Cancer Screening Assessment and Management Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, Japan
| | - Koji Ohta
- Department of Surgery, Fukui Prefecture Hospital, Fukui, Japan
| | - Yoshio Kasahara
- Division of Breast Surgery, Fukui-ken Saiseikai Hospital, Fukui, Japan
| | - Takafumi Katayama
- College of Nursing Art and Science, University of Hyogo, Akashi, Japan
| | - Tomio Nakayama
- Center of Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Satoshi Honjo
- Department of Pediatrics, National Hospital Organization Fukuoka National Hospital, Fukuoka, Japan
| | - Koji Ohnuki
- Division of Breast Surgery, Iwate Prefectural Central Hospital, Morioka, Japan
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18
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Hamashima C, Ogoshi K, Narisawa R, Kishi T, Kato T, Fujita K, Sano M, Tsukioka S. Impact of endoscopic screening on mortality reduction from gastric cancer. World J Gastroenterol 2015; 21:2460-2466. [PMID: 25741155 PMCID: PMC4342924 DOI: 10.3748/wjg.v21.i8.2460] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 09/04/2014] [Accepted: 11/11/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate mortality reduction from gastric cancer based on the results of endoscopic screening.
METHODS: The study population consisted of participants of gastric cancer screening by endoscopy, regular radiography, and photofluorography at Niigata city in 2005. The observed numbers of cumulative deaths from gastric cancers and other cancers were accumulated by linkage with the Niigata Prefectural Cancer Registry. The standardized mortality ratio (SMR) of gastric cancer and other cancer deaths in each screening group was calculated by applying the mortality rate of the reference population.
RESULTS: Based on the results calculated from the mortality rate of the population of Niigata city, the SMRs of gastric cancer death were 0.43 (95%CI: 0.30-0.57) for the endoscopic screening group, 0.68 (95%CI: 0.55-0.79) for the regular radiographic screening group, and 0.85 (95%CI: 0.71-0.94) for the photofluorography screening group. The mortality reduction from gastric cancer was higher in the endoscopic screening group than in the regular radiographic screening group despite the nearly equal mortality rates of all cancers except gastric cancer.
CONCLUSION: The 57% mortality reduction from gastric cancer might indicate the effectiveness of endoscopic screening for gastric cancer. Further studies and prudent interpretation of results are needed.
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Hamashima C. Current issues and future perspectives of gastric cancer screening. World J Gastroenterol 2014; 20:13767-13774. [PMID: 25320514 PMCID: PMC4194560 DOI: 10.3748/wjg.v20.i38.13767] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 02/14/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Gastric cancer remains the second leading cause of cancer death worldwide. About half of the incidence of gastric cancer is observed in East Asian countries, which show a higher mortality than other countries. The effectiveness of 3 new gastric cancer screening techniques, namely, upper gastrointestinal endoscopy, serological testing, and “screen and treat” method were extensively reviewed. Moreover, the phases of development for cancer screening were analyzed on the basis of the biomarker development road map. Several observational studies have reported the effectiveness of endoscopic screening in reducing mortality from gastric cancer. On the other hand, serologic testing has mainly been used for targeting the high-risk group for gastric cancer. To date, the effectiveness of new techniques for gastric cancer screening has remained limited. However, endoscopic screening is presently in the last trial phase of development before their introduction to population-based screening. To effectively introduce new techniques for gastric cancer screening in a community, incidence and mortality reduction from gastric cancer must be initially and thoroughly evaluated by conducting reliable studies. In addition to effectiveness evaluation, the balance of benefits and harms must be carefully assessed before introducing these new techniques for population-based screening.
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20
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Oliver A. Health economic evaluation in Japan: a case study of one aspect of health technology assessment. Health Policy 2003; 63:197-204. [PMID: 12543532 DOI: 10.1016/s0168-8510(02)00066-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
There is a burgeoning literature in health economic evaluation, with this form of analysis becoming increasingly influential at the health policy making level in a number of countries. However, a search of the literature reveals that in Japan, the world's second largest health care market, very little health economic evaluation has been undertaken. The main reason for the lack of interest in economic evaluation is that the fee-for-service and strict price regulation that characterises the system of health care financing in Japan is not conducive to this form of analysis. Moreover, the government and many researchers are satisfied that the current organisation of health care has given long life and low infant mortality at low cost. Even if it is accepted that low health care costs and good health prevail in Japan, slower economic growth rates, an ageing population and the development of new medical technologies will place increasing pressure on health care resources and will necessitate a more rational use of these resources. Good economic evaluation, by weighing benefits against costs, has an important role to play.
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Affiliation(s)
- Adam Oliver
- LSE Health and Social Care, London School of Economics and Political Science, Houghton Street London WC2A 2AE, UK.
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21
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Abstract
The authors report on promising diagnostic methods of occult intestinal bleeding and discusses the potential new strategy of early detection of colorectal carcinomas in respect to old and new diagnostic measures available. Because of the limited sensitivity and specificity of classical methods used for the demonstration of occult fecal blood, the authors recommend the introduction of new techniques and markers in screening practice. It is presumed that new discoveries in molecular biology will improve the accuracy of early colorectal cancer prevention. Their implementation into routine screening, however, will not take place in the near future. Until their realization, improved screening efficacy is expected from the use of more specific and sensitive blood tests.
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Affiliation(s)
- S Ottó
- National Institute of Oncology, Department of Clinical Pathology, Budapest, Hungary.
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Inaba S, Hirayama H, Nagata C, Kurisu Y, Takatsuka N, Kawakami N, Shimizu H. Evaluation of a screening program on reduction of gastric cancer mortality in Japan: preliminary results from a cohort study. Prev Med 1999; 29:102-6. [PMID: 10446035 DOI: 10.1006/pmed.1999.0507] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Systematic population-based screening for gastric cancer is widely spread in Japan. However, the case-control study method has been the main method used to evaluate the effectiveness of the screen ing to reduce gastric cancer mortality in Japan. METHODS This article presents a population-based cohort study. A questionnaire about lifestyles and dietary habits was distributed to 36,990 residents in a city of Japan. The response rate to the questionnaire was 92.0%. After ineligible responders had been excluded, 24,134 subjects were classified into screened and un screened groups according to their self-reports of participation in the screening the previous year. We followed them up for 40 months and linked resident death records in the city. We compared mortality from gastric cancer and all other causes between the groups by us ing the Cox proportional hazard model. RESULTS The follow-up period was 78,156.6 person-years from September 1992 to December 1995. The multivariate relative risks for gastric cancer death of the screened group in comparison with the unscreened group were 0.72 (95% CI 0.31-1.66) among males and 1.46 (95% CI 0.43-4.90) among females. CONCLUSION Although our data are preliminary, we were unable to demonstrate a large contribution of the present screening program to decreasing gastric cancer mortality. Further follow-up is needed to in crease the precision.
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Affiliation(s)
- S Inaba
- Department of Public Health, Gifu University School of Medicine, 40 Tsukasa-machi, Gifu, 500-8705, Japan
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Kawazuma Y, Tanaka H, Tsukuma H, Ajiki W, Oshima A. Improvement of survival over time for colon cancer patients by anatomical sub-sites. Jpn J Cancer Res 1999; 90:705-10. [PMID: 10470281 PMCID: PMC5926132 DOI: 10.1111/j.1349-7006.1999.tb00804.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aims of this study are to describe and to evaluate improvement of survival over time for colon cancer patients by anatomical sub-sites. Data on 661 patients newly diagnosed as having colon cancer at Osaka Medical Center for Cancer and Cardiovascular Diseases from 1978 to 1991 were examined in this study. Corrected survival was calculated with the Kaplan-Meier method according to the period of diagnosis: early period (1978-84) and later period (1985-91). Factors concerning the difference in survival between the two periods were examined with the Cox proportional hazards regression model according to sub-site. Five-year corrected survival of the patients with left colon cancer improved significantly (60 to 72%; P < 0.01), probably due to advances in treatment, while that of patients with transverse colon cancer also improved significantly (39 to 67%; P < 0.01), mainly because of progress in diagnosis. The five-year corrected survival of those with right colon cancer did not increase (57 to 46%; P = 0.14), owing to lack of improvement in stage at diagnosis. Among the three sub-sites, the right showed the worst five-year survival in the later period. We concluded that survival of patients with right colon cancer, differing from the other anatomical sub-sites, did not improve, possibly because of lack of symptoms. The screening programs for colon cancer introduced in Japan in 1992 may be expected to improve the survival of patients with colon cancer, including that of the right colon.
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Affiliation(s)
- Y Kawazuma
- Department of Cancer Control and Statistics, Osaka Medical Center for Cancer and Cardiovascular Diseases.
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Abstract
Screening for colorectal cancer using the conventional Hemoccult test has been shown to reduce mortality associated with cancer by 33% through a randomized controlled trial. However, the magnitude of effectiveness is small in terms of cost-effectiveness. The recently developed immunochemical fecal occult blood test (IFOBT) provides a potential replacement for the Hemoccult test as a screening test, due to its superior performance characteristics such as higher sensitivity shown in preliminary studies and the fact that it does not require any dietary restriction. The IFOBT method is reviewed, especially in relation to its specificity. In known colorectal cancer subjects, IFOBTs have shown both higher sensitivity and specificity than the Hemoccult test. Similarly, IFOBT has demonstrated a higher sensitivity than Hemoccult for colorectal cancer in an asymptomatic population. A nationwide screening program in Japan has demonstrated the feasibility of this approach for large population screening. However, the positivity rate varied according to the conditions at each screening facility. Therefore, technical factors that influence the positivity rate of IFOBTs in the screening program are discussed. Case-control studies have strongly suggested that screening using IFOBT would reduce mortality from colorectal cancer by 60% or more. Several observational studies have provided support for this estimate. The feasibility and effectiveness of population-based screening by IFOBT are discussed.
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Affiliation(s)
- H Saito
- First Department of Internal Medicine, Hirosaki University School of Medicine, Japan
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Affiliation(s)
- J S Mandel
- School of Public Health-Environmental & Occupational Health, University of Minnesota, Delaware SE, Minneapolis 55455, USA
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Saito H, Soma Y, Koeda J, Wada T, Kawaguchi H, Sobue T, Aisawa T, Yoshida Y. Reduction in risk of mortality from colorectal cancer by fecal occult blood screening with immunochemical hemagglutination test. A case-control study. Int J Cancer 1995; 61:465-9. [PMID: 7759151 DOI: 10.1002/ijc.2910610406] [Citation(s) in RCA: 112] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Fecal occult blood testing by immunochemical hemagglutination has been shown to be superior to the Hemoccult test, both in sensitivity and in specificity. The test has been widely used as a tool for population screening in Japan, but there has been no study to evaluate the efficacy of screening using this test. A case-control study to evaluate the screening was conducted in study areas where no previous and no other concomitant colorectal cancer screening had been performed. Case series in the study were 193 cases who died of colorectal cancer. Three controls were selected randomly from the list of individuals who were alive at the time of diagnosis of the corresponding case and had been living in the same area as the case, matched by gender and by age. Odds ratios (OR) of dying of colorectal cancer for those screened within 1, 2 and 3 years of case diagnosis vs. those not screened were 0.40 [95% confidence interval (CI) 0.17-0.92], 0.41 (95% CI 0.20-0.82), and 0.48 (95% CI 0.25-0.92), respectively. OR increased towards 1.0 as the duration during which screening histories were compared was extended, and showed similar tendencies when analyzed by number of years since the most recent screening history. These results suggest that colorectal cancer screening by the immunochemical fecal occult blood test would reduce mortality from colorectal cancer.
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Affiliation(s)
- H Saito
- First Department of Internal Medicine, Hirosaki University School of Medicine, Japan
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