胃がん検診ガイドラインの問題点

Problems Involved in the Official Guidelines for Public Screening of Gastric Cancer

要旨　平成16年度厚生労働省がん研究助成金「がん検診の適切な方法とその評価法に関する研究」班（祖父江班）から発表された胃がん検診ガイドラインにおいて，胃内視鏡検診は死亡率減少効果を証明する研究が行われていないことから，対策型検診としての実施は勧められないと評価されている．わが国における内視鏡の普及，国民の意識を考えると，胃X線検診の受診率向上は難しく，胃内視鏡検診の有効性を証明する研究を行うことが急務であるが，個人情報の問題や研究に長期を要することなど，一施設，一研究者の立場で行うことは困難であり，国策として行われることを要望する．将来的にはペプシノゲン法とHelicobacter pylori IgG抗体によるリスクに応じた胃内視鏡検診の有効性の確立が望まれる．

　We have not found any reports which prove an actual decrease in gastric cancer death as a result of endoscopic examination for mass screening of gastric cancer.

　Consequently, endoscopic examination has not been recommended as a population-based screening method for gastric cancer in the guidelines for cancer screening by the Japan Ministry of Health, Labour and Welfare. However, endscopy has been the popular method for gastric cancer screening in Japan, and citizens do not choose X-ray examination.

　We must prove as soon as possible an actual decrease in gastric cancer death as a result of endoscopic examination, but it is difficult to do so. We need a very long time to complete a study on this point. We also have to consider legal problems that may arise.

　In the future the use of assays of Helicobacter pylori antibody levels and the pepsinogen method for primary screening, followed by the use of endscopic examination for secondary screening is considered to be the recommended approach for gastric cancer.