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Comment: Early Detection

Philip Rubin, MD
JAMA. 1974;228(7):894-896. doi:10.1001/jama.1974.03230320058043.
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EARLY detection must be distinguished from early cancer because cure is feasible only when early detection results in a diagnosis of cancer in its superficial and localized state. It is unfortunate that most malignant neoplasms are discovered in the upper portion of the alimentary tract (ie, stomach and esophagus) are advanced and remain highly lethal. The term early gastric cancer implies a 60% to 95% curability rate by means of gastric resection; the resection of a gastric cancer generally provides 20% to 40% of patients with long-term survival.

As statistical studies have shown, the incidence of stomach cancer has declined, but the death rate is unaltered.1 The accessibility of the upper gastrointestinal tract and the existence of techniques for evaluation of its mucosal surface make this site a unique challenge. It is time to reassess seriously the science of early detection, particularly with the achievements of the Japanese medical


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