対策型胃内視鏡検診の現状と課題

Current Situation and Issues in Population-based Endoscopic Screening for Gastric Cancer

要旨●世界のがん検診の先駆けとして開始された胃がん検診を含めて，わが国のがん検診は国際水準には達していない．近年，対策型胃内視鏡検診も加わったが，無作為化比較対照研究の裏付けもなく，科学的根拠が示されたとは言えない．しかし，H. pylori感染者の減少が進み，そう遠くない未来には胃がん検診が癌対策として必要ない時期が到来すると予想される．高齢世代に胃癌高リスク群が残る現在は対策型胃内視鏡検診を高い精度で実施しなければならない．そのために検査医の内視鏡技量の向上とダブルチェック体制は必須と考える．

　In Japan, gastric cancer screening was initiated as a pioneer of all cancer screenings. However, Japanese cancer screenings are not at par with the international standards, which includes a recently added population-based endoscopic screening method for gastric cancer. The scientific basis of this new screening method was not proven through randomized controlled studies. Gastric cancer screening is expected to become unnecessary as a measure against cancer in the near future because of the gradual decrease in the number of people infected with Helicobacter pylori. Currently, the elderly constitute a high-risk group of gastric cancer, necessitating that in this population, the population-based endoscopic screening must be performed with high accuracy. It is therefore highly recommended that the endoscope skills of the examiners be improved and that a double check system be established for confirmatory screening.