Background and Aim: In order to reduce gastric cancer death, mass screening for gastric cancer has been established in Japan for several decades. Only photofluorography is considered to be an acceptable screening method so far, but recent evidence may show the usefulness of serum pepsinogen (PG) measurement for gastric cancer screening. The aim of the present study was to elucidate the feasibility of measuring serum PG levels for detection of gastric cancers. Methods: Serum PG levels (PGI/PGII) were measured in asymptomatic middle-aged Japanese between 1991 and 2005. Those with a PGI ≤ 70 ng/mL and PGI/PGII ≤ 3 were defined as having a positive PG test. According to the obtained results of serum PG levels and previous individual records, those with a positive PG test and those with a negative PG test took gastroendoscopy every 2 and 5 years, respectively. Results: The total number of participating individuals was 101 892 (mean age of 48.7 years). In a total of 21 178 planned gastroendoscopies (20.8%), 13 789 (65.1%) underwent gastroendoscopy and 125 gastric cancers were detected, which corresponded to 0.12% of all participants and to 0.91% of those with gastroendoscopy. Early-stage cancers and intestinal-type intramucosal cancers accounted for 80% and 39% of all the detected cancers, respectively. Conclusions: Serum PG measurement for mass screening of gastric cancer enabled us to achieve high recruitment for gastroendoscopy in intended individuals, a favorable detection rate of gastric cancer and, in particular, an extremely high proportion of early-stage gastric cancer in all the detected cancers.
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