Screening of gastric cancer in Asia.

In North-Eastern Asian countries, where incidence and mortality of gastric cancer remain very high, population-based gastric cancer screenings have been conducted under governmental subsidy in Japan and Korea. Reduction of gastric cancer mortality by the screening was documented in Japan, but the Japanese gastric cancer screening with the X-ray photofluorography is criticized for its high cost and a low uptake rate. Although the Korean program seems to achieve a high-rate of uptake with increasing use of endoscopy, the work load is substantial. In the meantime, more attention in the world turns to primary prevention through eradication of Helicobacter pylori. Indeed, fairly large-scale studies to examine the feasibility of mass-eradication to prevent gastric cancer are underway in China and Taiwan. In the future, gastric cancer screening should incorporate 'screen to treat' of H. pylori infection at younger age followed by endoscopic surveillance for subjects at risk.