With the aim of developing more efficient
gastric cancer screening programs for use in Japan, we studied a new screening program that combines serum
pepsinogen (PG) testing and
barium digital radiography (DR). A total of 17 647 middle-aged male subjects underwent workplace screening over a 7-year period using a combination of PG testing and DR. This program's effectiveness, as well as other characteristics of the program, was analyzed. Forty-nine cases of
gastric cancer were detected (comprising 88% early
cancer cases). The detection rate was 0.28%, and the positive predictive value was 0.85%. The PG test detected 63.3% of cases, DR detected 69.4% of cases, and both tests were positive in 32.7% of
cancer cases. The two methods were almost equally effective, and were considerably more effective than conventional screening using photofluorography. Each screening method detected a distinct
gastric cancer subgroup; the PG test efficiently detected asymptomatic small early
cancer with intestinal type histology, while DR was efficient at detecting
cancers with depressed or ulcerated morphology and diffuse type histology. The cost for the detection of a single
cancer was much less than that for conventional screening. In fact, it is possible to further reduce the cost of detecting a single
cancer to a cost comparable to that of surgically resecting a single
gastric cancer. Thus, it is probable that a highly efficient
gastric cancer screening system can be implemented by combining the two screening methods. Such a screening program would be beneficial in a population at high risk for
gastric cancer.