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Japanese Journal of Clinical Oncology Advance Access originally published online on March 14, 2008
Japanese Journal of Clinical Oncology 2008 38(4):259-267; doi:10.1093/jjco/hyn017
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© The Author (2008). Published by Oxford University Press. All rights reserved

The Japanese Guidelines for Gastric Cancer Screening

Chisato Hamashima1, Daisuke Shibuya2, Hideo Yamazaki3, Kazuhiko Inoue4, Akira Fukao5, Hiroshi Saito1 and Tomotaka Sobue6

1 Cancer Screening Technology Division, Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo
2 Cancer Screening Center, Miyagi Cancer Society, Miyagi
3 Osaka Cancer Prevention and Detection Center, Osaka
4 Matsue Red Cross Hospital, Matsue
5 Department of Public Health, Yamagata University School of Medicine, Yamagata
6 Cancer Information Services and Cancer Surveillance Division, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan

For reprints and all correspondence: Chisato Hamashima, Cancer Screening Technology Division, Research Center for Cancer Prevention and Screening, National Cancer Center, 5-1-1 Tsukiji Chuo-ku, Tokyo 104-0045, Japan. E-mail: chamashi{at}ncc.go.jp

Received November 13, 2007; accepted February 10, 2008

Background: Gastric cancer is the leading cause of death from cancer in Japan. In 2004, there were 50 562 deaths from gastric cancer; they accounted for 15.8% of the total number of cancer deaths. Since 1983, under the Health Service Law for the Aged, gastric cancer screening has been conducted nationwide for all residents aged 40 years and over.

Methods: On the basis of the standardized method developed for the Japanese Guidelines for Cancer Screening, the efficacies of various methods for gastric cancer screening were evaluated and the guideline was developed.

Results: Four methods for gastric cancer screening were evaluated: photofluorography, endoscopy, serum pepsinogen testing and Helicobacter pylori antibody testing. On the basis of the analytic framework involving key questions, 1715 articles, published from January 1985 to February 2005, were selected using MEDLINE, the Japanese Medical Research Database and other methods. After the systematic literature review, 10 articles were identified as direct evidence and 49 articles as indirect evidence. The studies that evaluated mortality reduction from gastric cancer included five case–control and two cohort studies for radiographic screening. On the basis of the balance of benefits and harms, the recommendations for population-based and opportunistic screening were formulated. Gastric cancer screening using photofluorography was recommended for both screening programs. The other methods were not recommended for population-based screening due to insufficient evidence.

Conclusions: The guideline for gastric cancer screening guideline was developed based on the previously established method. Gastric cancer screening using photofluorography is recommended for population-based and opportunistic screening in Japan.

Key Words: gastric cancer • cancer screening • guideline • recommendation • photofluorography


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