The experience with breast cancer is relevant to this discussion. For EGC, a proportion of screen detected lesions is likely to be similarly clinically unimportant. It is important that patients and clinicians realize this, but it does not invalidate the concept of EGC as a significant lesion. A paper by Schlemper et al. Thirteen lesions had some elevated component and another six were LMMCs.
Western pathologists are clearly concerned about over-diagnosis leading to unnecessary surgery.
Japanese pathologists, on the other hand, are more concerned about overlooking cancers, probably because of the much higher incidence of true gastric carcinoma. Western surgeons often find that patients with a biopsy of severe dysplasia are subsequently diagnosed with carcinoma. Sometimes these cancers are incurable. Accurate identification of markers that the disease has reached the point of no return is needed. Application of this knowledge by means of immunohistochemical and molecular analysis of biopsy specimen is being pursued in a prospective study in Hiroshima.