Early gastric cancer. Recent experience.

Area of Science:

• Gastroenterology
• Oncology
• Radiology

Background:

• Early gastric cancer (EGC) is defined by limited invasion to the mucosa or submucosa.
• The detection rate of EGC in the US has remained stagnant despite advancements in diagnostic tools.

Purpose of the Study:

• To evaluate the impact of advanced diagnostic techniques on EGC detection rates in symptomatic patients.
• To compare EGC detection trends in the US with those in Japan.

Main Methods:

• Retrospective analysis of pathologic examination records at the Hospital of the University of Pennsylvania (1965-1983).
• Comparison of EGC incidence before and after the widespread availability of double contrast radiography and fiberoptic endoscopy (1976).
• Literature review of EGC incidence in Japan correlating with diagnostic technique adoption and screening practices.

Main Results:

• EGC constituted 8.2% of gastric carcinomas (1965-1977) and 6% (1977-1983) at the study institution, showing no significant increase.
• Introduction of advanced endoscopic and radiographic techniques in 1976 did not improve EGC detection rates in symptomatic US patients.
• Japan experienced a rise in EGC incidence from 5% to 35% attributed to mass screening of asymptomatic populations.

Conclusions:

• Current diagnostic modalities applied to symptomatic patients in the US are insufficient for increasing early gastric cancer detection.
• The discrepancy in EGC detection rates between the US and Japan highlights the effectiveness of mass screening in high-prevalence populations.
• US radiologists and endoscopists should anticipate limited improvements in EGC detection without implementing widespread screening programs for asymptomatic individuals.