胃癌の診断にX線検査は不要か―必須とする立場から：個別検診拾い上げ診断としての胃X線検査の活用

Usefulness of X-ray Examination for Individualized Stomach Cancer Screening by the Kanazawa Medical Association

要旨　金沢市医師会では1983年から胃集検の低受診率（1％台）をカバーする目的で，かかりつけ医を利用した直接撮影個別検診を行ってきた．1992年からはその精度を高めるために検診医の研修会，実施要項説明会，二次読影会そして症例検討会の参加義務，更に逐年検診の前年度比較読影，レフリー判定を加え，以下の結果を得た．①162病・医院で5年間の受診者数36,093人，発見癌95人，癌発見率0.26％，うち早期癌58人同比率61.3％であった．②この期聞の受診率は間接集検約4％に対し個別検診14～15％を得た．③要精検率が約6％にまで低下したにもかかわらず，癌発見率，早期癌比率に有意差を認めなかった．④当方式により検診医の撮影技術や読影能の向上に役立ち，また検診に対する意識の高揚が精検受診率を90％以上に向上させた．以上により精度管理の徹底されたX線個別逐年検診は，内視鏡集検に勝るとも劣らず“胃X線検査の活用”の一方法と考えられた．

　Since 1983, individualized screening systems for stomach cancer have been performed by the Kanazawa Medical Association in order make up for the low rate (2%) of examinees who utelized our mass examination by less. Furthermore, in order to establish the high quality of this screening system, a mass screening committee for stomach cancers has been used by Kanazawa Medical Association since 1992. On utilizing this new system, we employed several methods of educational programs, double check interpretation of x-ray films of the stomach, referee judgment by specialists, and comparison of the current year's x-ray films with those taken the year before. In this paper, we introduced the individualized screening system used by our medical association. The results obtained are as follows.

　1) During the past five years, 162 clinics and hospitals in our medical association had 36,093 examinees, and detected 95 cases of gastric cancer (a rate of 0.26%) with 58 cases of early gastric cancer (a rate of 61.3%).

　2) In this period, the number of examinees in our city rose by 14～15% in this individualized screening system compared to the 4% increase in mass examination by bus.

　3) Despite a lower rate of check up (6%) in the first screening, cancer rates and early cancer rates were not significantly different from previously.

　4) This system contributed to the improvement in the techniques of x-ray photographing and in the ability of film interpretation among our association's doctors. Therefore the rate of participated close examinees was over 90%.

　Our data indicates that our individualized x-ray screening system will be as useful as mass examination using endoscopy.