Is an annual stomach x-ray (barium meal) an acceptable radiation risk for a resident of Japan?
I live in Japan. Here, it is common for an annual health checkup to include a barium meal stomach x-ray, especially for people over 35, but sometimes younger.
A gastroenterologist told me that this is equivalent to about 20 normal x-rays, and is a completely unnecessary level of radiation exposure. He suggested an endoscopy was preferred if checking the inside of the stomach was required.
There are no exposure warnings that come with these checkups, and I understand Japan has higher than average stomach cancer rates due to a high-sodium diet (for example, this source says about 1 in 1000 tested are positive), but the same gastroenterologist also told me that Japan has abnormally high, but not well recorded, rates of cancer caused by diagnostic imaging itself.
Is an annual stomach x-ray an acceptable level of radiation exposure for a resident of Japan, considering the risk of stomach cancer?
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Update version of the Japanese Guidelines for Gastric Cancer Screening (Japanese Journal of Clinical Oncology, 2018)
Radiographic screening is recommended for population-based and
opportunistic screenings as its benefits outweigh its harms
(Recommendation Grade B). Endoscopic screening is also recommended for
population-based and opportunistic screenings as its benefits outweigh
its harms (Recommendation Grade B). Both screenings are recommended to
individuals aged 50 years and older.
These guidelines do not mention how often should the checkup be done, but another source recommends annual screening by gastroscopy only to people 70 years or older.
The optimal screening interval for gastric cancer using esophago-gastro-duodenoscopy in Japan (BMC Gastroenterology, 2012)
A screening for gastric cancer using esophago-gastro-duodenoscopy may
be appropriate annually for healthy people over 70 years old, every
two or three years for people 60–69 years old and every four years for
people 50–59 years old. People younger than 50 years old may only need
repeat screenings every five years or more.
BARIUM SWALLOW RADIATION EXPOSURE
Examples of radiation doses during various radiological investigations (See the table here: Mayo Clinic Proceedings, 2010):
Barium swallow: 1.5 mSv (which equals 6 months of radiation exposure from natural background)
Standard abdominal X-ray: 1.2 mSv
CT of the abdomen and pelvis: 10 mSv
So, barium swallow results in only slightly greater radiation exposure than a standard abdominal X-ray. Most experts estimate the risk of the test like this (hps.org):
Fluoroscopic studies such as esophagrams and swallow studies are very
low-dose/low-risk procedures, where the little radiation exposure and
resultant absorbed dose do not result in any risk when compared to the
medical benefit of answering your physician's question concerning your
health.
GASTRIC CANCER RISK FACTORS
According to one systematic review, PubMed, 2018), main risk factors for gastric cancer include:
Male sex, being East Asian, family history of gastric cancer
Age (only 10% of all gastric cancers develops before 45 and most of them between 60-80 years of age)
High consumption of salty or smoked food
Smoking, excessive alcohol drinking, lack of physical activity
Infection with H. pylori of the stomach, or Human papilloma virus
The frequency of tests for gastric cancer can be adjusted to risk factors in a particular person.
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