[Purpose] We, the Shinkokai Medical Corporation, worked with places of business (telecommunications industry) aiming to improve implementation rates of specific health guidance and began providing group support in FY 2019. We then reported on and examined the results of the first fiscal year of that initiative.

 [Target] 260 individuals (140 received active support, 120 received motivational support; average age of 48.5 years ± 5.0 years) who received group support (total of 27 times) implemented between April 2019 and February 2020. Of these, we examined the results of 203 men who completed evaluation.

 [Methodology] Places of business themselves encouraged the target individuals to participate, and individuals were allowed to participate during work hours. The initial interview was a group interview, while subsequent continued support was provided by phone, email, or other form of communication. The status of progress of continued support was shared with the places of business, and we aimed to prevent participants from dropping out partway through by encouraging use via both the places of business and Shinkokai itself. In order to evaluate the effectiveness of the program, we 1) compared participation rates before and after beginning the program; 2) examined completion rates and drop-out rates; and 3) compared abdominal circumference and weight, at the beginning of the program and after completion, of 203 individuals who completed evaluation. A state of emergency for the COVID-19 pandemic was also declared during the implementation period, before evaluation had been completed. We analyzed the effects of that development as well.

 [Results] Of the 260 participants, 211 completed the program, 18 were deemed to have completed it in effect, 27 dropped out partway through, and 4 were disqualified. Participation rates increased from approximately 20% before the program began to 50%. The completion rate was increased to 80% of the total and the drop-out rate was 11.9% (including disqualified individuals), a low drop-out rate compared to those for all health insurance programs implemented by this institution. Comparing before and after support was provided, a significant decrease was recorded in both abdominal circumference and weight (p < 0.001). After the state of emergency was declared, target achievement for both abdominal circumference and weight slowed down.

 [Investigation] Shortly after a medical examination is completed, it becomes difficult to have working-age individuals receive specific health guidance on an individual basis, and health insurance programs and places of business have struggled with low implementation rates. As a way to address this problem, it is suggested that working with places of business to provide opportunities for group support contributes to improving implementation rates and promoting health management. It is also necessary to consider employing methods of support and encouragement that are suited to the distinctive characteristics of the target group in order to effectively lead them to successful completion of evaluation.

 [Purpose] To examine the usefulness of LA method of serum Helicobacter pylori antibody (Hp antibody) measurement in gastric cancer risk assessment, we compared three methods (ELISA, CLEIA and LA method) with their performance in ABC classification screening.

 [Methods] Fresh serum was collected from 929 persons of the comprehensive medical examination with written consent. The pepsinogen I/II were measured by CLEIA method and LA method, and the Hp-antibody was measured by ELISA method, CLEIA method, LA method, respectively. The results were stratified into A, B, C, D group according to the proposal of Inoue et al. The degree of atrophy by endoscopy examination was based on Kimura -Takemoto classification.

 [Results] There were 929 samples being investigated, including 832 in C0 classification, 32 in C1, 26 in C2, 13 in C3, 16 in O1, 6 in O2, and 4 in O3, respectively. By ELISA method with a cut-off value (CO) of 3U/mL, 849 were stratified in group A, 59 in group B, 17 in group C, and 4 in group D. By CLEIA method (CO:4.0 U/mL), it was 849 (group A), 59 (group B), 16 (group C), and 5 (group D), respectively, consistent with the results of ELISA method. The LA method (Fujifilm Wako Pure Chemical Corporation) (CO:4.0 U/mL) resulted in 823 (group A), 83 (group B), 18 (group C), and 5 (group D), respectively. However, when CO of the LA method was set at 6.0 U/mL, the results were similar to those measured by the other two methods. It was observed that depends on the object population it may obtain a fluctuating CO.

 [Conclusion] For screening test in medical examination, it is necessary to reduce the false negatives and to keep the false positives within acceptable range. It is also necessary to be applicable to automated analyzers for accurately measuring a large number of samples. The results of LA method (CO:6.0 U/mL) were similar to those of the other two methods. Since the LA method can be used in the automated analyzer, it's suitable for the ABC classification screening with a large number of subject persons.

 Objective: We revealed the current status and problems of breast cancer ultrasonography in Sendai City, targeting medical examiners, medical staff, and examinees.

 Subjects and Methods: We conducted a self-administered questionnaire survey on the current status and problems of breast cancer ultrasonography in Sendai City, Miyagi Prefecture, among medical examiners, medical staff, and examinees at facilities that belong to the Association of Surgeons of Sendai City Medical Association and conduct breast cancer screening with ultrasonography.

 Results: We collected 47 questionnaires from medical checkup doctors and medical staff at 19 research institutes and 701 questionnaires from medical checkup recipients. Seventy-four percent of the respondents had undergone annual examinations, and 66% had a history of childbirth. In addition, many of the respondents felt uneasy about self-examination alone, so they went for breast cancer screening with ultrasonography, promoted by Sendai City Health and Welfare Bureau. The overall satisfaction rate for the screening was very high at 95.1%, including "satisfied" and mostly satisfied.

 On the other hand, although the satisfaction of the medical staff and doctors was high, many of them commented that improvements were needed in terms of privacy and administrative procedures.

 Conclusion: In this questionnaire, examinees showed a high degree of satisfaction with the screening. It can be inferred from this that the Sendai City breast cancer ultrasonography is conducted safely and securely, based on the relationship of trust between the screening recipients and the medical staff. In the future, it will be necessary to establish a system for more prompt breast cancer ultrasound examinations.

 Radiographers engaged in gastrointestinal radiographic screening must first learn the standard radiographic method and the new guideline radiographic method for the detection of life-saving gastric cancer. Guideline radiography uses high-concentration, low-viscosity powdered barium powder and mainly employs double contrast radiography, taking images of the posterior wall, anterior wall, and upper part of the stomach in that order. The radiographer occasionally takes additional radiography at his or her discretion during the examination. Additional radiography have the following three meanings. (1) Images that are identified as abnormal but that can be determined to have no deviation from the normal mucosa by subsequent fluoroscopic observation and imaging, (2) Images to compensate for insufficiently delineated areas in screening, and (3) Images to delineate the extent of the mucosa in detail when the findings identified as abnormal are deviated from the normal mucosa. In the present study, we defined an additional as an image that depicts how far away from the normal mucosa is without interfering with the guideline radiographic technique, and evaluated its validity.

 As a result, there was a case in which an abnormal finding was recognized by fluoroscopic observation but interfered with the guideline imaging technique, affecting the subsequent screening imaging. On the other hand, there were cases in which the patient had the fluoroscopic skills and imaging techniques to perform additional imaging, but did not have the morphology to obtain the gross and visual characteristics of gastric cancer, such as the basis for diagnosis and information that takes into account treatment.

 In order to obtain effective additional radiography for gastric radiographic screening, it is necessary to be able to construct radiographic techniques based on guideline radiography, and to apply the knowledge obtained from academic conferences and case review meetings to radiographic imaging. It was thought that this was a shortcut to learning effective additional radiography.

 Cancer screening in the workplace plays a very important role in cancer control in Japan. However, in the workplace, the examination methods and quality control system are often inadequate. Self-collected cytology is widely practiced because of its convenience in the workplace, but the "Guidelines for Cervical Cancer Screening Based on Efficacy Evaluation 2019" indicate that "cytology samples should be collected only by doctors, rather than by self-collection". The self-sampling HPV test has almost the same accuracy as a sample collected by a doctor and has the potential to be used for people who do not attend workplace cervical screening. Here, an approach is described in which good results were obtained for non-attendees based on self-sampling HPV tests. The Wacoal Health Insurance Society sent a self-sampling HPV test kit to persons aged 30 years old or older who had not undergone cervical cancer screening in 2019. About 30% of these persons returned a sample, of whom about 80% who were HPV-positive and about 60% who were HPV-negative subsequently underwent cervical cancer screening. Furthermore, of the approximately 70% of subjects who did not return a sample, about 50% also underwent screening. Thus, it is probable that the sending of the kit itself raised awareness of the examination and led to the subject choosing to undergo screening. These results suggest that the self-sampling HPV test is effective for use in the workplace. However, there is a need to establish guidelines for workplace implementation, such as establishment of a procedure that facilitates HPV-positive persons to undergo cervical cancer screening.

 In Japan, the prevalence of precancerous lesions continues to increase to 2% and the prevalence of cancer continues to increase to 15 due to the sluggish cervical cancer screening rate of 43% and HPV vaccination rate of 1%. We must aim to eliminate cervical cancer only by screening. For that purpose, it is necessary to select a screening method that raises the consultation rate of 25-45 years old, who has the most precancerous lesions, to 80% or more, and does not overlook the precancerous lesions. 1) Cytopathology single examination; Precancerous lesion detection sensitivity in Japan is 85%, specificity 95%. Since the prevalence of precancerous lesions in Japan is 2%, the estimated number of missed cases is 300 out of 100,000. If the consultation rate of 80% can be maintained, the morbidity rate can be reduced to 10. 2) HPV primary testing; detection sensitivity is 95%, specificity is 91%. The number of missed items is estimated to be 100. Morbidity can be reduced to 8. 3) Cytopathology/HPV co-testing; detection sensitivity is 99%, specificity is 90%. The number of missed items is estimated to be 20. Morbidity can be reduced to 5. In Izumo City, which has 12 years of HPV combined examination results, the youth consultation rate was 75% and the morbidity rate decreased to 5. 4) Self-collected HPV test; The concordance rate with the doctor-collected HPV test was 85% for both positive match rate and negative match rate. By mail, 30% of unexamined patients underwent this test, and 10.8% of precancerous lesions could be detected. In Japan, cytopathology/HPV co-testing screening should be selected until the prevalence of precancerous lesions decreases to 0.4 and the morbidity to 7. The mail-type self-collection HPV test is very effective as a measure for young people who have not been examined.

 In Japan, the cervical cancer screening rate is low. To improve the rate, we considered to introduce human papillomavirus (HPV) self-sampling, which can be performed at an individual's convenient time and place. This study aimed to ascertain whether HPV self-sampling is acceptable for Japanese women. The results showed that approximately 10% of the unscreened women were willing to be tested for HPV if self-sampling will be used. Further, a high percentage (13.6%) of the unscreened women were found to be positive for high-risk HPV. Among the participants, approximately 1% were found to have precancerous lesions. This study suggests that the introduction of HPV self-sampling may improve the cervical cancer screening rate.

 In Japan, the rate of cervical cancer screening is about 40% and the HPV vaccination rate is about 1%. The incidence of cervical cancer is still high. We examined the accuracy of self-collected HPV tests from 2012 to 2020. The self-collection devices were Delphi screener^® (wet), Evalyn brush^® (dry), Flocked Swabs^® (dry) and Home Smear Kit plus^® (wet). The HPV tests used HC2 or PCR using Cobas4800^®, DPO-Multiplex PCR^® and HPV13^®. A total of 241 CIN2+ cases were examined at our colposcopy clinic from 2012 to 2020, including 170 using HC2 and 71 using PCR. The HPV-positive rate using HC2 was 77.6% (132/170) for self-collection and 91.8% (156/170) for physician-collection, indicating that the sensitivity of self-collection was lower than that of physician-collection. The HPV-positive rate by PCR was 91.5% (65/71) for self-collection and 90.1% (64/71) for physician-collection, with no differences among self-collection devices and PCR methods. However, about 10% of CIN2+ cases were negative in PCR HPV tests using samples collected by physicians. This suggests the need to explain the risk of a false-negative finding in a single HPV test in advance. Non-HPV related gynecological cancers (endometrial cancer and ovarian cancer) are increasing year by year, and comprehensive gynecological cancer screening is required using a HPV test and by cytology and transvaginal ultrasonography. Self-collection HPV tests may be a solution for patients who have not been examined for cervical cancer.

 The Ministry of Economy, Trade and Industry (METI), in collaboration with the Ministry of Health, Labor and Welfare (MHLW), has been promoting "Health and productivity management" based on the belief that efforts to maintain and promote the health of employees are an investment that will enhance profitability in the future. METI established the Certified Health and Productivity Management Outstanding Organizations Recognition Program, which requires healthy environments, education to improve health literacy, medical examination, health guidance, and other strategic efforts. Therefore, health checkups are a necessary step in this health management.

 The "Health Scoring Report," provided by METI and MHLW, scores the status of lifestyle and health condition of workers, and the implementation of health services of each insurer or corporation, as grasped by the National Database. In addition to providing accurate medical examination data, Health Checkup Institutions are expected to play a role in supporting health management by providing health guidance and an analysis of medical examination data at the request of companies and insurers.

 Nearly eight thousand Small and medium-sized enterprises (SMEs) were certified for Health and Productivity Management in FY2021; yet, it accounted for only 0.26% among a total of three million SMEs. Although there are still regional differences, the Japan Health Insurance Association and local governments have begun to support the health management of local SMEs.

 MHLM revised the "Regional/Occupational Cooperation Promotion Guidelines" in 2019 to promote further cooperation for healthy, long-term living. It refers that the role of Health Checkup Institutions as members of regional cooperation councils is to provide statistical data and information about health issues, and to carry out awareness-raising activities.