Potential capacity of endoscopic screening for gastric cancer in Japan

Abstract

In 2016, the Japanese government decided to introduce endoscopic screening for gastric cancer as a national program. To provide endoscopic screening nationwide, we estimated the proportion of increase in the number of endoscopic examinations with the introduction of endoscopic screening, based on a national survey. The total number of endoscopic examinations has increased, particularly in clinics. Based on the national survey, the total number of participants in gastric cancer screening was 3 784 967. If 30% of the participants are switched from radiographic screening to endoscopic screening, approximately 1 million additional endoscopic examinations are needed. In Japan, the participation rates in gastric cancer screening and the number of hospitals and clinics offering upper gastrointestinal endoscopy vary among the 47 prefectures. If the participation rates are high and the numbers of hospitals and clinics are small, the proportion of increase becomes larger. Based on the same assumption, 50% of big cities can provide endoscopic screening with a 5% increase in the total number of endoscopic examinations. However, 16.7% of the medical districts are available for endoscopic screening within a 5% increase in the total number of endoscopic examinations. Despite the Japanese government's decision to introduce endoscopic screening for gastric cancer nationwide, its immediate introduction remains difficult because of insufficient medical resources in rural areas. This implies that endoscopic screening will be initially introduced to big cities. To promote endoscopic screening for gastric cancer nationwide, the disparity of medical resources must first be resolved.

Keywords: Cancer screening; capacity; gastric cancer; medical resource; upper gastrointestinal endoscopy.

Figure 1

Trends in the total number of hospitals and clinics in Japan offering endoscopic examinations (a) and trends in the total number of endoscopic examinations in Japan per month (b) from 1996 to 2014, based on the Survey of Medical Institutions.7

Figure 2

Proportions of increase in endoscopic examinations in Japan after switching from radiographic screening to endoscopic screening for gastric cancer. All participants have been screened by radiographic screening. If 30% of the mass survey in radiographic screening is replaced by endoscopic screening, the total number of endoscopic examinations will increase by 8.6%. If the participation rate increased from 5% to 20%, the proportion of increase in endoscopic examinations needed is 34.3%.