Gastric Cancer Treatment in Japan

What is the trend in the incidence and death from gastric cancer in the Japanese population? How does this compare to the age standarized incidence rate of gastric cancer in the world? Gastric cancer in Japan was ranked as the most common cancer in the past, but this aspect has gradually been changing in recent years. In 1999, the leading cause of cancer death from gastric cancer was overtaken by that of lung cancer in men and colorectal cancer in women (1). The incidence of gastric cancer continues to be still highest among all cancers. Although age-standerized incidence and death rates have been declining for decades, the absolute number of gastric cancer cases have been showing an increasing trend. The data from Cancer Incidence in Five Continents (2) show that the annual age-standardized incidence rate in Japanease cancer registeries ranges from 50 to 80 per 100,000 among men and from 20 to 30 per 100,000 among women. These data on gastric cancer are much higher than the other countries in the world. How is the screening for gastric cancer performed in Japan? In Japan, mass screening for gastric cancer is performed with photofluography. This procedure began in 1960, and to date, over 6 million people have been screened annually. The five year survival rate is 15% better in screen-detected cancers than in symptom-diagnosed cases, though no randomised controlled trials have been reported (3). As an alternative screening method, the measurement of serum pepsinogens has recently been introduced for gastric cancer, but there is no evidence that the measurement of pepsinogens reduces gastric cancer mortality (3).