胃がん検診におけるリスク層別化と対象者選別の問題点

Problems of Risk Classification and Selection of Subjects for Gastric Cancer Screening

要旨●胃癌スクリーニングに関して，対策型胃がん検診の現状から考察した．内視鏡検診のみではマンパワーが不足するため，対象の集約目的にABC（D）リスク分類が利用されるが，ABC分類によるリスク層別化には，A群が正確に判定されていない問題点があり，画像評価の組み合わせが必要である．また，検診対象外となる50歳未満の胃癌を検討したところ，女性，M領域，未分化型が多い傾向にあり，内視鏡治療可能な高齢者の分化型胃癌も50歳未満胃癌と同じ1例とみなし，発見効率に重きを置くのか，それとも発見された癌の内訳に重きを置くのかで考え方が異なるものと思われた．

　We discussed gastric cancer screening in terms of the current population-based gastric cancer screening status. The ABC（D）risk classification is used to aggregate subjects due to inadequate manpower for endoscopic screening alone. ABC（D）classification risk stratification has problems in accurately determining group A and requires a combination of image evaluation. A trend toward a higher number of females, M-region, and undifferentiated gastric cancer types are observed when examining patients with gastric cancers under 50 years old that were ineligible for gastric cancer screening.

　Is the undifferentiated type of gastric cancer in young people considered the same as the differentiated type of gastric cancer in older people who can be endoscopically treated? The approach was thought to differ based on the emphasis, whether detection efficiency or the breakdown of detected cancers.