Usefulness of gastric cancer screening using the serum pepsinogen test method

The measurement of serum pepsinogen has recently gained attention as a candidate for a new screening test for gastric cancer. This method is particularly attractive given its lower cost and simplicity to administer relative to photofluorography. To compare the accuracy between the two screening methods, and to elucidate the usefulness of the serum pepsinogen test method, we performed this study.

Mass screening for gastric cancer was performed using both the x-ray and pepsinogen test methods simultaneously on 286 company employees. The number of tests conducted was 5567 in total. The mean age was 48 yr in both men and women. Informed consent was taken individually. Fasting blood samples were collected, and measurement of the serum pepsinogen concentration was carried out by immunoradiometric assay.

The percentage of those screened, who needed further examination was 11.7% for the x-ray method and 23.6% for the pepsinogen test method. The percentage of those who required further investigation, as the second step of screening, using endoscopy, was 55.4% for the x-ray method and 51.9% for the pepsinogen test method, respectively. Ten gastric cancers were detected in total. The incidence was 0.05% in the x-ray method and 0.18% in the pepsinogen test method. The rate of early gastric cancer to advanced gastric cancer was 9 to 1, that is, 90% were in the early stages. The positive predictive value was 0.8% in the x-ray method and 1.4% in the pepsinogen test method.

The pepsinogen test method can be used as a screening test for high-risk subjects with atrophic gastritis, rather than as a tool for cancer itself. Systemic endoscopic surveillance of this group is also useful.