早期胃癌の変貌―実地医家の立場から

Annual Change of Characteristics of Early Gastric Cancer: From a practitioner's point of view

　1945年（昭和20年）の第二次世界大戦の敗北まで，日本人の疾患構造の中心は感染症であり，それとの戦いであった．しかし敗戦を契機として，抗生物質，抗結核剤，そのほか栄養状態の改善などにより，結核その他の感染症が後退し，平均寿命の逐年上昇とともにこれにかわって悪性新生物の問題が登場してきた．悪性新生物は1950年に初めて日本人死因の第5位に台頭し，その後，1953年以来第2位に躍進し，そのまま今日まで第2位を保持し続けている¹⁾．なかんずくその悪性新生物による日本人の年間死亡者数の約半分を胃癌が占めることから，1950年ごろより諸学者の胃癌に対する積極的な挑戦が開始された．

　すなわち，1950年宇治達郎氏らにより胃カメラが開発され²⁾，同じく1950年に，白壁，市川，熊倉氏らにより開発された二重造影法³⁾によるX線診断学の進歩は，その後のわが国の消化器病診断学の飛躍的な進歩をうながした．

　1) Around 1950, an investigation of the gastric cancer was developed by research groups and they determined a definition and classification of the early gastric cancer in 1962. And it made our practitioner's purpose clear.

　2) Around 1962, a training how to make a diagnosis of early gastric cancer was started for our practitioner and by the beginning of 1970's, it had spreaded into doctor's associations in each district of Tokyo with a surprising rate.

　In 1979, when we investigated eastern nine districts' and other doctor's associations is Tokyo, it became clear there was synergistic effect between an improvement of quality and quantity of the mass survey and it started to show a result of man power approarch.

　3) From 1960's to the first half of 1970's, the training of the practitioners by research groups enhanced a detection of the early gastric cancer and that offerred new materials to the research groups and we believe that there was so called feed back cycle between them.

　4) It has gradually became a strong trend that our practitioners, who has more contact to the citizens of Tokyo, have been placed in charge of detecting early gastric cancer.

　5) In spite of increased number of detected relatively early gastric cancer (pm type cancer), there is still no decreased number of s type cancer. This seems to be due to a character of testees, less concern to the health and a state of mind which is afraid of discovering cancer in them. Therefore, from now on, our practitioner should aim to promote a campaign for enlightening local residents who have no opportuities to have mass survey such as occupational one.

We believe that such approach is the best way to control the gastric cancer in our country.