Screening Center

Nozomu Kobayashi, Takahisa Matsuda, Masau Sekiguchi, Keiko Nakamura, Yasuo Kakugawa, Minori Matsumoto, Eriko Tsuruki, Masayoshi Yamada, Hiroyuki Takamaru, Takaaki Tsuchida, Masahiko Kusumoto, Gen Iinuma, Nachiko Uchiyama, Mari Kikuchi, Kimiteru Ito, Takahiro Morita, Hiroaki Kurihara, Miyuki Sone, Yasunori Mizuguchi, Hirokazu Watanabe, Mototaka Miyake, Shunsuke Sugawara, Yuko Kubo, Chihiro Ito, Nao Kikkawa, Shintaro Kimura, Sawako Kaku, Junji Omori, Mizuki Ozawa, Yuji Koretsune, Tomoyasu Kato, Mitsuya Ishikawa, Masaya Uno, Yasuhito Tanase, Mayumi Kato, Kenichi Nakamura, Hiroshi Katayama, Junko Eba
(Visiting Researcher) Koichi Nagata, Shungo Endo, Kazutomo Togashi, Noriaki Takahashi, Takaaki Yasuda, Masaki Matsuoka, Ken Takabayashi, Hidenori Kanazawa, Shuji Yamamoto, Hidetsugu Yamagishi, Kayoko Kasuya
(Special Research Assistant) Mika Mori

Introduction

In the Cancer Screening Center (former name: Research Center for Cancer Prevention and Screening; RCCPS), we have provided broad opportunistic cancer screening using newly developed modalities since 2004. Most of the staff doctors hold two positions concurrently in both the Cancer Screening Center and their own specialized department. Our department is in charge of multiphasic cancer screening using several imaging modalities to develop new cancer screening systems and to assess new screening tests.

The Team and What we do

1. Cancer screening courses: The basic plan for males consists of screening for cancer of the lungs, esophagus, stomach, colorectum, liver, gall bladder, pancreas, kidneys, and prostate. The basic plan for females consists of screening for cancer of the breast, uterus, and ovaries, in addition to the plan for males, excluding the prostate. In addition, PET (positron emission tomography) is provided as an option. In addition to multiphasic programs, an independent cancer screening program has been prepared for cancers of the lungs and female genitalia, including cancer of the uterus, ovaries, breast, and gastrointestinal tract. Blood samples are also obtained for biochemistry and tumor markers such as CA19-9, CEA, CA125, and PSA, as well as for genetic analysis.

2. Eligibility criteria for participants: Since 2013, the cancer screening program at the Cancer Screening Center has accepted applicants 40 years of age or older who give their written informed consent for the screening and blood samples for the genetic analysis and who take the survey regarding lifestyles. These study protocols have been approved by the Institutional Review Board (IRB). Applicants who have been diagnosed with cancer and/or have a history of cancer treatment, such as surgery, endoscopic mucosal resection, or chemotherapy within the previous one year, are excluded.

3. Cancer screening methods: On the first day, the multiphasic cancer screening programs (comprehensive cancer screening program) perform CT for lung cancer, abdominal US for cancer of the liver, gall bladder, pancreas, and kidneys, gynecological examinations with pap-smear and HPV test for uterine cancer, and MMG/tomosynthesis and US for breast cancer. On the following day, gastroscopy for cancer of the esophagus and stomach, and total colonoscopy for cancer of the colon and rectum are conducted. Moreover, from the beginning of December 2010, CT-colonography (CTC) has been provided as an option for cancer screening. FDG-PET/CT is offered on the first day as an option, if the participants wish to undergo the examination. Furthermore, FDG-PET/MRI has been provided as an optional examination since 2018.

4. Number of cancer screening participants: The number of cancer screening participants between April 2021 and March 2022 is shown in this report (Table 1). Due to the influence of COVID-19, the number of participants decreased remarkably. A total of 2,341 people underwent cancer screening at the Cancer Screening Center during this period. Most of the participants (90%; n=2,110) chose the comprehensive cancer screening course. Regarding the cancer detection rate data in each modality, we will report them in the near future.

Table 1.

Research activities

Study using colorectal cancer screening data from colonoscopy (CS)

Data from individuals who underwent endoscopic resection for ACN (advanced colorectal neoplasia) and received surveillance colonoscopy were analyzed. The cumulative incidence of metachronous ACN and clinically significant neoplasia (≥ 5 mm) in individuals with ACN at baseline (3-year incidence: 5.5% and 16.9%, respectively) was higher than that in individuals with no neoplastic lesions at baseline (P < 0.01 for both). The presence of advanced histology at baseline, ≥ 5 neoplastic lesions at baseline, and family history of colorectal cancer were identified as risk factors for the higher incidence of clinically significant neoplasia. (Sekiguchi M, et al. J Gastroenterol Hepatol 2021).

Amino-index (AICS) cancer screening accuracy evaluation study

Since the start of the research in July 2012, we have received plasma samples from 8,111 screening examinees and are proceeding with comprehensive amino acid analysis. This year, we confirmed the results of AICS in the patients with gastric cancer, using limited data of 1,253 individuals. Among five patients with gastric cancer, three were classified as rank B, and the other two as rank A. No one was classified as rank C, the highest risk group. However, we will proceed with further evaluation.

AI for digital breast tomosynthesis

A total of three breast specialist radiologists were asked to interpret 120 digital breast tomosynthesis examinations with and without the help of AI (60 each). This study revealed that an AI support system could reduce the reading time while keeping the same accuracy of diagnosis.

Clinical trials

We are conducting ongoing research based on the study protocol titled “Evaluation of effectiveness of cancer screening modality at the National Cancer Center”. The target modalities are as follows: 1) upper gastrointestinal endoscopy, 2) lower gastrointestinal endoscopy, 3) CT colonography, 4) chest computed tomography (CT), 5) sputum cytology, 6) mammography, 7) breast ultrasonography, 8) FDG-positron emission tomography (PET), 9) abdominal ultrasonography, and 10) serum tumor markers.

Future Prospects

Based on cancer screening data such as examination results, medical institution findings, follow-up findings, and the questionnaire survey concerning lifestyles for 10 years, we commenced with assessment with the support of the National Cancer Center Research and Development Fund.

List of papers published

Journal

1. Mizuguchi Y, Tanaka Y, Cho H, Sekiguchi M, Takamaru H, Yamada M, Sakamoto T, Matsuda T, Hashimoto T, Sekine S, Saito Y. Endoscopic features of isolated and traditional serrated adenoma-associated superficially serrated adenomas of the colorectum. Digestive endoscopy: official journal of the Japan Gastroenterological Endoscopy Society, 34:153-162, 2022

2. Sekiguchi M, Oda I, Matsuda T, Saito Y. Epidemiological Trends and Future Perspectives of Gastric Cancer in Eastern Asia. Digestion, 103:22-28, 2022

3. Sekiguchi M, Igarashi A, Mizuguchi Y, Takamaru H, Yamada M, Sakamoto T, Maltzman H, Falkén Y, Esaki M, Matsuda T, Saito Y . Cost-effectiveness analysis of endoscopic resection for colorectal laterally spreading tumors: Endoscopic submucosal dissection versus piecemeal endoscopic mucosal resection. Digestive endoscopy: official journal of the Japan Gastroenterological Endoscopy Society, 34:553-568, 2022

4. Takamaru H, Saito Y, Hammoud GM, Mizuguchi Y, Cho H, Sekiguchi M, Yamada M, Sakamoto T, Matsuda T. Comparison of postpolypectomy bleeding events between cold snare polypectomy and hot snare polypectomy for small colorectal lesions: a large-scale propensity score-matched analysis. Gastrointestinal endoscopy, 95:982-989.e6, 2022

5. Sekiguchi M, Oda I, Morita S, Katai H, Yano T, Terashima M, Kataoka T, Muto M. Management of elderly patients with early gastric cancer in Japan. Japanese journal of clinical oncology, 52:425-432, 2022

6. Saito Y, Ono A, García VAJ, Mizuguchi Y, Hisada I, Takamaru H, Yamada M, Sekiguchi M, Makiguchi M, Sekine S, Abe S . Diagnosis and treatment of colorectal tumors: Differences between Japan and the West and future prospects. DEN open, 2:e66, 2022

7. Tang RSY, Lee JWJ, Chang LC, Ong DEH, Chiu HM, Matsuda T, Kim HS, Sekiguchi M, Leong RW, Ho AMY, Lam TYT, Tse YK, Lin L, Yeoh KG, Lau JYW, Sung JJY. Two vs One Forward View Examination of Right Colon on Adenoma Detection: An International Multicenter Randomized Trial. Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association, 20:372-380.e2, 2022

8. Utano K, Nagata K, Honda T, Kato T, Lefor AK, Togashi K. Bowel habits and gender correlate with colon length measured by CT colonography. Japanese journal of radiology, 40:298-307, 2022

9. Iwasaki M, Kanehara R, Yamaji T, Katagiri R, Mutoh M, Tsunematsu Y, Sato M, Watanabe K, Hosomi K, Kakugawa Y, Ikematsu H, Hotta K, Kunisawa J, Wakabayashi K, Matsuda T. Association of Escherichia coli containing polyketide synthase in the gut microbiota with colorectal neoplasia in Japan. Cancer science, 113:277-286, 2022

10. Nakajima T, Sakamoto T, Hori S, Yamada S, Ikematsu H, Harada K, Chiu HM, Kiriyama S, Michida T, Hotta K, Sakamoto N, Abe T, Chino A, Fukuzawa M, Kobayashi N, Fukase K, Matsuda T, Murakami Y, Ishikawa H, Saito Y. Optimal surveillance interval after piecemeal endoscopic mucosal resection for large colorectal neoplasia: a multicenter randomized controlled trial. Surgical endoscopy, 36:515-525, 2022

11. Takamaru H, Saito Y, Sekiguchi M, Yamada M, Sakamoto T, Matsuda T, Sekine S, Ochiai H, Tsukamoto S, Shida D, Kanemitsu Y. Endoscopic Resection Before Surgery Does Not Affect the Recurrence Rate in Patients With High-Risk T1 Colorectal Cancer. Clinical and translational gastroenterology, 12:e00336, 2021

12. Kasuga K, Yamada M, Shida D, Tagawa T, Takamaru H, Sekiguchi M, Sakamoto T, Uraoka T, Sekine S, Kanemitsu Y, Saito Y. Treatment outcomes of endoscopic submucosal dissection and surgery for colorectal neoplasms in patients with ulcerative colitis. United European gastroenterology journal, 9:964-972, 2021

13. Mori Y, Kudo SE, Misawa M, Hotta K, Kazuo O, Saito S, Ikematsu H, Saito Y, Matsuda T, Kenichi T, Kudo T, Nemoto T, Itoh H, Mori K. Artificial intelligence-assisted colonic endocytoscopy for cancer recognition: a multicenter study. Endoscopy international open, 9:E1004-E1011, 2021

14. Tagawa T, Yamada M, Minagawa T, Sekiguchi M, Konda K, Tanaka H, Takamaru H, Sekiguchi M, Sakamoto T, Matsuda T, Kuchiba A, Yoshida H, Saito Y. Endoscopic characteristics influencing postpolypectomy bleeding in 1147 consecutive pedunculated colonic polyps: a multicenter retrospective study. Gastrointestinal endoscopy, 94:803-811.e6, 2021

15. Kobayashi N, Takeuchi Y, Ohata K, Igarashi M, Yamada M, Kodashima S, Hotta K, Harada K, Ikematsu H, Uraoka T, Sakamoto N, Doyama H, Abe T, Katagiri A, Hori S, Michida T, Yamaguchi T, Fukuzawa M, Kiriyama S, Fukase K, Murakami Y, Ishikawa H, Saito Y. Outcomes of endoscopic submucosal dissection for colorectal neoplasms: Prospective, multicenter, cohort trial. Digestive endoscopy: official journal of the Japan Gastroenterological Endoscopy Society, 2021

16. Sakamoto T, Nakashima H, Nakamura K, Nagahama R, Saito Y. Performance of Computer-Aided Detection and Diagnosis of Colorectal Polyps Compares to That of Experienced Endoscopists. Digestive diseases and sciences, 2021

17. Isohata N, Nagata K, Utano K, Nozaki R, Nozu S, Kato T, Kijima S, Matsumoto H, Majima K, Ryu Y, Hirayama M, Endo S. Recent trends in the prevalence and distribution of colonic diverticula in Japan evaluated using computed tomography colonography. World journal of gastroenterology, 27:4441-4452, 2021

18. Yoshida N, Mano Y, Matsuda T, Sano Y, Inoue K, Hirose R, Dohi O, Itoh Y, Goto A, Sobue T, Takeuchi Y, Nakayama T, Muto M, Ishikawa H. Complications of colonoscopy in Japan: An analysis using large-scale health insurance claims data. Journal of gastroenterology and hepatology, 36:2745-2753, 2021

19. Yokota T, Saito Y, Takamaru H, Sekine S, Nakajima T, Yamada M, Sakamoto T, Taniguchi H, Kushima R, Tsukamoto S, Shida D, Kanemitsu Y, Matsuda T. Spontaneous Regression of Mismatch Repair-Deficient Colon Cancer: A Case Series. Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association, 19:1720-1722.e3, 2021

20. Takamaru H, Kawaguchi Y, Oda I, Sekiguchi M, Yamada M, Abe S, Nonaka S, Suzuki H, Yoshinaga S, Saito Y. A new reliable acoustic respiratory monitoring technology during upper gastrointestinal tract therapeutic endoscopy with CO(2) insufflation. Journal of clinical monitoring and computing, 35:877-884, 2021

21. Inoki K, Abe S, Tanaka Y, Yamamoto K, Hihara D, Ichijima R, Nakatani Y, Chen HY, Takamaru H, Sekiguchi M, Yamada M, Sakamoto T, Nonaka S, Suzuki H, Yoshinaga S, Oda I, Matsuda T, Saito Y. Reduced Intravenous Fluorescein Dose for Upper and Lower Gastrointestinal Tract Probe-Based Confocal Laser Endomicroscopy. Clinical endoscopy, 54:363-370, 2021

22. Sekiguchi M, Kakugawa Y, Takamaru H, Yamada M, Sakamoto T, Saito Y, Matsuda T. Risk of metachronous neoplastic lesions during post-polypectomy surveillance in individuals with advanced colorectal neoplasia at initial screening colonoscopy. Journal of gastroenterology and hepatology, 36:2230-2238, 2021

23. Saito Y, Oka S, Kawamura T, Shimoda R, Sekiguchi M, Tamai N, Hotta K, Matsuda T, Misawa M, Tanaka S, Iriguchi Y, Nozaki R, Yamamoto H, Yoshida M, Fujimoto K, Inoue H. Colonoscopy screening and surveillance guidelines. Digestive endoscopy: official journal of the Japan Gastroenterological Endoscopy Society, 33:486-519, 2021

24. Tanaka S, Saitoh Y, Matsuda T, Igarashi M, Matsumoto T, Iwao Y, Suzuki Y, Nozaki R, Sugai T, Oka S, Itabashi M, Sugihara KI, Tsuruta O, Hirata I, Nishida H, Miwa H, Enomoto N, Shimosegawa T, Koike K. Evidence-based clinical practice guidelines for management of colorectal polyps. Journal of gastroenterology, 56:323-335, 2021

25. Okagawa Y, Abe S, Takamaru H, Sekiguchi M, Yamada M, Sakamoto T, Saito Y. A novel technique for adjusting traction direction during colorectal endoscopic submucosal dissection using S-O clip. Endoscopy, 53:E177-E178, 2021