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[2nd SI-HUG symposium & 26th Annual Meeting of the Korean College of Helicobacter and Upper Gastrointestinal Research]

ÀϽÃ: 2018³â 4¿ù 13ÀÏ (±Ý) - 14ÀÏ (Åä)

Àå¼Ò: ÄÜ·¡µåÈ£ÅÚ ¼­¿ï


1. Meet the professor session - Truth and falsity of gastric cancer screening (Room A) - ÀÌÁØÇà

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¿À´Ã °­ÀÇ Áß °¡Àå Áß¿äÇÑ ºÎºÐÀΠù partÀÇ °­ÀÇ ³»¿ëÀÔ´Ï´Ù.

This is a picture of Qin Shihuang, the first Chinese emperor. He searched for immortality magic drug, but failed. Everyone want to live forever, or live as long as possible, but actually, no one can live forever. We just try, but always fail. The modern version of Qin Shihuang¡¯s magic drug may be cancer screening. The organizing committee gave me a very difficult topic, the truth and falsity of gastric cancer screening. But, as you know, there is no magic answer for this challenging issue. Maybe I will fail, but I will try.

There are too similar terms which are quite confusing. One is °ËÁø, which usually means cancer screening; the other is °ÇÁø, which means general health check-up. In Korea, °ËÁø and °ÇÁø is widely used without clear definition or sometimes used interchangably. In my opinion, °ËÁø, cancer screening belongs to the science, and the Korean government already established a huge and successful cancer screening program. On the other hand, °ÇÁø, health check-up belongs to the public¡¯s hope or desire to live long with good health. A great parts of the general health check-up does not have a decent scientific evidence.

The aim of cancer screening is clear. We hope to detect cancers as early as possible and treat them completely. The outcome is to live longer or forever. But we should consider the cost-effectiveness issue in every cancer screening program.

Every screening is not always effective. A few years ago, I read an interesting article from New York Times by Richard J. Ablin, who discovered PSA, prostate specific antigen. He said the prostate cancer screening is an complete failure and he called his own scientific achievement as ¡°the great prostate mistake.¡± Quote¡¦

Another story. In Korea, thyroid cancer screening was a big issue. The thyroid cancer has been an epidemic due to widespread opportunistic sonographic screening. However, there was no change in the thyroid cancer mortality after a lot of thyroid surgeries. / Recently, thyroid cancer screening is not so much popular any more. New thyroid cancer patients are already decreasing.

There are two important biases in the cancer screening. The first one is very famous, the lead time bias. I think all individuals in this room already understand this type of bias. Even if we may detect cancers earlier, the overall survival gain is another issue due to the lead time bias.

The second bias is the length-time bias. It means cancers detected in the screening program may be less aggressive. This bias is especially important for the elderly population. If some cancers in the elderly people are very slow-growing, is there any reason that we need to find them?

From now on, I will show you three scenarios. Green bar means advanced cancers. Blue bar means early cancers. This is the first scenario. By the cancer screening, advanced cancers decreased, and the early cancers increased. But the numbers of decreased advanced cancers and the increased early cancers are same. As a result, the total number was not changed. This is an ideal scenario of every cancer screening program, but it never happens.

The second scenario is more realistic. OK. The advanced cancers decreased a little bit, but the number of early cancers increased much more than that. As a result, we can see a huge increase of the total number of the target cancer. The overall mortality may decrease. But, do we need to treat all the early cancers?

The third scenario is a kind of nightmare. A lot of early cancers are found, the number of advanced cancers is the same. The treatment outcome may be the same. In this scenario, the screening may be useless.

For more insights, I recommend two articles. The first one is an opinion in Nature journal. It¡¯s kind of a balanced idea.

The second one is a newspaper article from New York Times. It¡¯s the most pessimistic idea about cancer screening. Professor Welch argues that doctors should focus on sick patients, not the healthy people.


[2018-4-14. Ç︮ÄÚ¹ÚÅÍÇÐȸ meet the professor session¿¡¼­ Àü¼º¿ì ±³¼ö´ÔÀÇ Áú¹®]

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[2018-4-14. ÀÌÁØÇà ´äº¯]

ÁÁÀº Áú¹® °¨»çÇÕ´Ï´Ù. Íë°ú ÞçÀÇ ±¸ºÐ À̽´À̸鼭 individualizeÀÇ ¹®Á¦ÀÔ´Ï´Ù. Àü±¹¹ÎÀ» ´ë»óÀ¸·Î ¹Ý°­Á¦Àû °ËÁøÀ» pushÇϱâ À§Çؼ­´Â ÃæºÐÈ÷ ±Ù°Å°¡ ÀÖ¾î¾ß ÇÕ´Ï´Ù. µæº¸´Ù ÇØ°¡ ¸¹Àº °ÍÀ» Á¤ºÎ°¡ ±¹¹Î¿¡°Ô ±ÇÇϰųª °­Á¦ÇÏ¸é ¾ÈµÇ±â ¶§¹®ÀÔ´Ï´Ù. ±¹¹ÎÀÇ Ç÷¼¼·Î ÁøÇàµÇ´Â »ç¾÷¿¡¼­´Â ´õ´õ¿í ¸íÈ®ÇÑ ±Ù°Å°¡ ÀÖ¾î¾ß ÇÕ´Ï´Ù. 75¼¼ ÀÌ»ó Àü±¹¹ÎÀ» ´ë»óÀ¸·Î screening gastroscopy¸¦ ±ÇÇÏ´Â °ÍÀº ±Ù°Å°¡ ¾ø±â ¶§¹®¿¡ °¡À̵å¶óÀο¡¼­ ¾ð±ÞµÈ ¹Ù¿Í °°ÀÌ ´çÀå ÁߴܵǾî¾ß ¸¶¶¥ÇÑ ÀÏÀÔ´Ï´Ù.

75¼¼ ÀÌ»óÀÌ¶óµµ ÃæºÐÈ÷ °Ç°­ÇÏ°í expected survivalÀÌ 10³â ÀÌ»óÀÎ °æ¿ì´Â screening gastroscopy¸¦ ±ÇÇÒ ¼ö ÀÖ½À´Ï´Ù. À̸¦ À§Çؼ­´Â ¸Å¿ì Á¤±³ÇÑ Á¤Ã¥ÀÌ ÇÊ¿äÇϵ¥, ¿ì¸®³ª¶ó¿¡´Â ¾ÆÁ÷ À̸¦ À§ÇÑ data³ª ¹æ¹ý·ÐÀÌ È®¸³µÇ¾î ÀÖÁö ¾Ê½À´Ï´Ù.

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Çö ½ÃÁ¡¿¡¼­´Â more and more¸¦ Ãß±¸Çϱ⿡ ¾Õ¼­ Àá½Ã ¼Óµµ¸¦ ÁÙÀÌ°í µ¥ÀÌŸ¸¦ ¸ðÀ¸¸é¼­ Á¤Ã¥À» ´Ùµë¾î¾ß ÇÒ °ÍÀÔ´Ï´Ù. Screening ¹®Á¦¸¦ Á¤Ä¡ÀûÀ¸·Î Á¢±ÙÇÏ´Â ÇöÀçÀÇ °üÇà-ÀÌ ¶ÇÇÑ ÀûÆóÀÔ´Ï´Ù-À» û»êÇØ¾ß ÇÕ´Ï´Ù. ScreeningÀº °Ç°­ ¹®Á¦ÀÌ°í ÀÇÇÐ ¹®Á¦ÀÔ´Ï´Ù. ÆÛÁÖ±â´Â °ï¶õÇÕ´Ï´Ù. 90¼¼°í 100¼¼°í ¹«Á¶°Ç °ËÁø µüÁö¸¦ º¸³»´Â °ÍÀº ±¹°¡ Æø·ÂÀ̶ó°í »ý°¢ÇÕ´Ï´Ù.


2. H. pylori and gastric carcinogenesis (David Y. Graham)

Abstract: Until recently gastric cancer was the most common cause of cancer deaths in the world. The discovery that gastric cancers were etiologically related to infection with H. pylori led to the realization that H. pylori eradication would prevent most gastric cancers. Gastric cancer is an inflammation-associated cancer with H. pylori infection being the cause of ongoing inflammation, rapid cell turnover and production of tissue damaging reactive oxygen and nitrogen species produced. Devolopment of cancer is related to progressive genetic instability which is one outcomes of chronic inflammation from any cause. The H. pylori organism itself is also directly involved in carcinogenesis through its ability to induce breaks in double-strand DNA, cause abnormal DNA methylation, and alter expression of microRNAs. The infection also stimulates activation-induced cytidine deaminase which can alter nucleotides. As one might expect, infections with strains causing a greater inflammatory response, such as those with an intact Cag pathogenicity island, are more often associated with development of cancer. However, infections with strains lacking all known virulence factors develop cancer. No proven cancer promoting bactrial factor has yet been discovered. Whether there is an important role of the infection in altering the local immune response to the cancer remains unknown but is suspected. Cancer risk is related to the degree and reversibility of gastric mucosal damage. After atrophy has developed the patient will have an increased risk of gastric cancer despite H. pylori eradication. The degree of risk increases exponentially with time, however the process can be stopped and partially reversed by H. pylori eradication. Gastric cancer can be largely eliminated by preventing H. pylori infection. Among those with H. pylori infection, the risk of developing gastric cancer can be also markedly reduced by treatment especially before the development of atrophic gastritis.


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© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.