SCREENING FOR GASTRIC CANCER

Helicobacter pylori infection and gastric atrophy are both risk factors for gastric cancer. We aimed to elucidate the natural history of gastric cancer development according to H pylori infection and gastric atrophy status. A total of 9,293 participants in a mass health appraisal programme were candidates for inclusion in the present prospective cohort study: 6983 subjects revisited the follow-up programme. Subjects were classified into four groups according to serological status at initial endoscopy. Group A (n = 3324) had "normal" pepsinogen and were negative for H pylori antibody; group B (n = 2134) had "normal" pepsinogen and were positive for H pylori antibody; group C (n = 1082) had ”atrophic" pepsinogen and were positive for H pylori antibody; and group D (n = 443) had "atrophic" pepsinogen and were negative for H pylori antibody. Incidence of gastric cancer was determined by annual endoscopic examination. Mean duration of follow-up was 4.7 years and the average number of endoscopic examinations was 5.1. The annual incidence of gastric cancer was 0.04% (95% confidence interval (CI) 0.02 – 0.09), 0.06% (0.03 – 0.13), 0.35% (0.23 – 0.57), and 0.60% (0.34 – 1.05) in groups A, B, C, and D, respectively. Hazard ratios compared with group A were 1.1 (95% CI 0.4 – 3.4), 6.0 (2.4 – 14.5), and 8.2 (3.2 – 21.5) in groups B, C, and D, respectively. Age, sex, and "group" significantly served as independent variables by multivariate analysis. The combination of serum pepsinogen and anti-H pylori antibody provides a good predictive marker for the development of gastric cancer.