内視鏡検診の現状と課題─コホート研究をふまえて

Current Trends and Issues Relating to Endoscopic Screening for Gastric Cancer: Based on Data from a Cohort Study in Niigata City

要旨●2005年度版の有効性評価に基づく胃がん検診ガイドラインでは，内視鏡による胃がん検診は対策型として推奨されなかった．しかしながら，新潟市ではエビデンスを出すべく，2003年から胃癌の個別検診において内視鏡検診を実施し，症例の集積ならびにそれらの解析を行ってきた．新潟県地域がん登録データとの照合による解析で，内視鏡検診でも死亡率減少効果のエビデンスが得られた．他のエビデンスも加味し，改訂された2014年度版のガイドラインでは，内視鏡検診が対策型として新たに推奨された．この改訂を契機に，今後多くの自治体で対策型の胃がん内視鏡検診が始まると思われるが，その成否を決めるものは精度管理に尽きると言っても過言ではない．

　In 2006, the guidelines for screening of gastric cancer did not permit endoscopic screening as a public health measure. However, in Niigata City, this has been carried out since 2003; and therefore, there is considerable data available on many cases of endoscopic screening.

　Checking the data from endoscopic screening and comparing it with that of the cancer registry in Niigata Prefecture shows that endoscopic screening can reduce the mortality of gastric cancer. More than one study reported similar data; and therefore, endoscopic screening as a public health program was allowed from 2015. We hope that endoscopic screening of gastric cancer will spread as a public health program in Japan; however, we must be aware of the importance of accuracy in such programs.