Hamashima Chisato, Goto Rei
Division of Cancer Screening Assessment and Management, Center for Public Health Science, National Cancer Center, Tokyo, Japan.
Graduate School of Business Administration, Keio University, Yokohama, Japan.
Cancer Sci. 2017 Jan;108(1):101-107. doi: 10.1111/cas.13100. Epub 2016 Dec 12.
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.
2016年，日本政府决定将胃癌内镜筛查作为一项全国性项目推行。为在全国范围内开展内镜筛查，我们基于一项全国性调查，估算了引入内镜筛查后内镜检查数量的增加比例。内镜检查的总数有所增加，尤其是在诊所。根据全国性调查，胃癌筛查的参与者总数为3784967人。如果30%的参与者从放射学筛查转为内镜筛查，大约需要增加100万次内镜检查。在日本，47个都道府县的胃癌筛查参与率以及提供上消化道内镜检查的医院和诊所数量各不相同。如果参与率高而医院和诊所数量少，增加的比例就会更大。基于同样的假设，50%的大城市能够在不增加5%的内镜检查总数的情况下提供内镜筛查。然而，在不增加5%的内镜检查总数的情况下，只有16.7%的医疗区能够开展内镜筛查。尽管日本政府决定在全国范围内推行胃癌内镜筛查，但由于农村地区医疗资源不足，立即推行仍很困难。这意味着内镜筛查将首先在大城市开展。为在全国范围内推广胃癌内镜筛查，必须首先解决医疗资源的差距问题。
