The Clinical Application of the Serum Pepsinogen I And II Levels as a Mass Screening Method for Gastric Cancer

Abstract

Gastric cancer, despite a recent decline in the incidence, is still a leading cause of death in Japan. For this reason, much effort has been directed to the early detection of the cancer through mass screening programs throughout the country. In most workplaces in Japan, an indirect X-ray examination, using 10 cm square film, is the conventional first screening step, after which those suspected of having some abnormalities in the gastric mucosa are further investigated either with a higher quality X-ray examination or by endoscopy. However, the sensitivity of the conventional X-ray screening step is by no means high. To improve the effectiveness of gastric cancer screening, we have devised a new screening method that utilizes measurement of serum pepsinogen (pepsinogen I and II) levels. This new screening system is based on the facts that a considerable part of gastric cancers develop in gastric mucosa affected by severe and extensive atrophic gastritis (1) and that serum pepsinogen levels serve as a sensitive marker of chronic atrophic gastritis (2). We report the first application of serum pepsinogen measurement for mass screening of gastric cancer at a certain workplace and compare the results with those of the conventional X-ray screening method.