CLINICAL-APPLICATION OF SERUM PEPSINOGEN-I AND PEPSINOGEN-II LEVELS FOR MASS-SCREENING TO DETECT GASTRIC-CANCER

A considerable number of gastric cancers derive from stomach mucosa wh ere chronic atrophic gastritis is severe and extensive. Based on the f act 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 usin g this method. Out of 875 subjects (18.8%) with a serum pepsinogen I l evel of less than 50 mug/liter and a pepsinogen I/II ratio of less tha n 3.0, 676 subjects (14.5%) were selected for further investigation by endoscopy. This led to the detection of four subjects (0.086%) with g astric cancer (three in an early stage) and four subjects with adenoma . The cancer detection rate of this new screening method was comparabl e, and in some respects superior, to that of the traditional barium X- ray screening. Since the incidence of test-positive subjects was as lo w as 10% amongst subjects aged less than 40, this screening method app ears to be especially useful for screening of younger generations. The new method is less expensive than the traditional barium X-ray and su bjects experience little discomfort. Further, many serum samples can b e quickly measured simultaneously. The results of this study have indi cated that serum pepsinogen screening provides a valuable method for d etecting gastric cancers.