Journal "Health Evaluation and Promotion" of the Japan society of health evaluation and promotion faced the issue of volume 50 this year. In the present number, "Past and future of the Health Evaluation and Promotion" is featured as a suitable theme for volume 50 that is a certain kind of turning point. The past history and present challenges were taken up in each area that related to the Health Evaluation and Promotion by the specialist in each area. And, they wrote in the point where it would change in the near future, and where was aimed. In the Health Evaluation and Promotion, there are three roles of the first prevention, the second prevention, and the third prevention. The Health Evaluation and Promotion can extract the high risk group on a specific item from its clients and take individual correspondence of the disease prevention. On the other hand, the approach that urges the behavior modification is conducted to the group, and there is a possibility that the intervention effect can be verified, too.

 The epoch to which the positive stance should be indicated as a field that creates the evidence of a preventive medicine has come of the Health Evaluation and Promotion. The expectation from the client, the employer, and the administration has changed in these 50 years in the method of prevention of three stages and the approach method to two objects. It would be greatly appreciated when this special feature article is useful for the next generation as the record of the development of the Health Evaluation and Promotion, and the view to the future.

 Unification of terminology is an important issue in the standardization of health evaluation and promotion. "Committee for the Creation of Glossary of Terms for Physical and Health Checkups," established by the Japan Society of Ningen Dock in 2018 and joined by the Japan Society of Health Evaluation and Promotion in 2019, has been working to create a thesaurus of standard terms for findings and diagnosis names used in imaging tests and synonymous terms (correspondence table). The results were reflected in the Standard Format for Health Examination Ver. 3.2 in 2021. On the other hand, there are still many issues to be addressed, including the publication of the "Standard Format Text for Health Examination" in the sense of making the thesaurus available to the public, additional consideration of new imaging test terminology, standardization of names of past history, and formulation of terminology explanatory text for medical examiners.

 Cancer screening tests up to now has been conducted on an organ-by-organ basis. Cancer screening in Japan was initially introduced based on the experts' opinions, but with the spread of the concept of cancer screening as a cancer control program, a system has recently been established in which cancer screening is recommended based on scientific evidence based on the contrast between benefits and harms, and recommended by the guidelines of the Ministry of Health, Labor and Welfare along with discussions that take effectiveness into account.

 In recent years, multi-cancer early detection (MCED) tests for systemic cancer screening have been attracting attention, but most of the published reports use a two-gate design. The results should not be compared with those of existing tests using a single-gate design. As far as liquid biopsy is concerned, a large-scale studies in the US and UK are ongoing, the results of which are expected.

 When we think about the future vision and tasks of women's medical checkup, development of healthcare and gender-specific medicine, and prevalence of women's medical inspection especially for breast and cervical cancer are the two key points to discuss. Approaches to the women's healthcare is strongly related to female hormones including estrogen, and it's important to bear in mind the gender difference. Japan Circulation Society published the guidelines for gender-specific cardiovascular disease in 2010 and it brought rapid awareness to the topic of gender difference. Breast and cervical cancer are the main two screening in the field of women's inspection. Japanese National Plan for Promotion of Measures Against Cancer is the foundation for our cancer control but the cancer screening rate is still lower than 50% and this is way below the target, thus the breast and cervical cancer mortality in Japan is increasing.When it comes to breast cancer screening, we always note the accuracy control of screening and prioritize diagnosis based on evidence considering the topic of dense breast. Furthermore, the most important thing we need to do in order to battle this situation is to raise awareness for breast cancer and provide cancer education from elementary school students so that when they grow up they would naturally go to cancer screenings which will enable early diagnosis and even reduced mortality. Cervical cancer is one of the few that can be found at the early stage by screening and is preventable by HPV vaccination and early intervention. It is sad to see the mortality of cervical cancer remain to be so high in Japan knowing that it can be eradicated.I sincerely hope our future to be bright for the sake of all our beautiful children and promise to do my best to raise awareness for women's cancer.

 The results of "statistics A" of health checkup visitors for "health evaluation and promotion" in 2014 were compared with the results of the same statistics in 2020. The rates of persons who are necessary for secondary consultation about liver diseases, diabetes, hyperlipidemia were greatly increased between 2014 and 2020 in many age classes of both sexes. The change was obvious in young ages specially.

 The results of "statistics B" of health checkup visitors for "particular health checkup" in 2014 were compared with the results of the same statistics in 2020. The rates of persons who gave weight gain more than 20kg compared with the weight at 20 age of themselves in all age classes of both sexes. The rates of persons who do not eat breakfast more than three days on a week in all age classes of both sexes.

 Age structure of persons who visits the health checkup for "health evaluation and promotion" have changed highly between 2014 and 2020. The rate of persons who aged under 39 was decreased and the rates of persons who aged from 50 to 59 was increased highly.

 From now on, prevention of life-related diseases of young age, early detection of life-related diseases of all ages and prevention of ill changes of persons who have illness in older ages through health checkups.

 [Purpose] A comprehensive risk management chart for the prevention of cerebrocardiovascular disease was published in April 2015.

 It was epoch-making because it was structured for practicing physicians to easily use in daily medical care, taking into consideration the guidelines and treatment policies of related academic societies.

 However, the risk distribution of the health checkup individual was unknown.

 This study aimed to clarify the disease morbidity and risk category distribution to plan appropriate health guidance after the health checkup program.

 [Targets] From January to December 2015, I visited the one-day health checkup program at St. Luke's International Hospital Preventive Medical Center.

 A total of 38,321 individuals (18,019 men and 20,302 women) were targeted.

 [Methods] According to the algorithm of the comprehensive management chart, 1) (a, basic item; b, additional item; c, judgment of necessity of referral to a specialist) and 2) screening before the start of treatment in all six steps were analyzed. The analysis focused on the diagnosis of each risk factor and additional evaluation items.

 [Results] More individuals who were currently being treated, especially those with diabetes, were more likely to be treated in step 1c (introduction required) than non-treated individuals. Diseases with a high-risk prevalence in step 2 were diabetes (male, 52.7%; female, 41.8%) and dyslipidemia (male, 34.3%, female, 22.5%). The percentage of those who possessed one or more risk factors in step 2 were about 60% for men and 50% for women.

 [Discussions] It was suggested that the individual in charge of healthcare should give health guidance while keeping in mind the status of the possession of risk factors and actively cooperate with the attending physician for the patients who are being treated for each disease.

 We will outline women's health issues and their countermeasures and prevention, which have not been conscious of corporate medical examinations and local government medical examinations. By developing a women's examination and consultation system based on gender and age risks, we will not only increase the ability to respond to menstrual and menopausal disorders, but also treat infertility such as gynecological diseases, thyroid diseases, collagen diseases, anemia, and folic acid deficiency. and reduce risks during childbirth, contributing to safe childbirth and postpartum employment. It also deepens understanding of the human rights of minorities, prevents gender discrimination, sexual violence, child abuse, DV, and sexual harassment, and promotes diversity. I would like you to be aware that any health checkup or examination can be an investment in human resource development and corporate development.

 Current breast cancer screening programs have been established in many countries to reduce breast cancer mortality. The Japan breast cancer screening program has started since 2000 with mammography. However, there is no evidence to reduce breast cancer mortality in Japan even though 22 years have passed since then. Screening mammography might not be suitable for Japanese women because Japanese women with dense breasts are common that results in a lower sensitivity of mammography, due to the masking effect. We must shake things up and look for a new angle. For women with dense breasts, early detection of small invasive cancers needs go beyond mammography. So, risk-stratified breast cancer screening is particularly important for a next-generation breast cancer screening program in Japan. Therefore, we must make Japanese breast cancer risk assessment model and should introduce a risk-stratified breast cancer screening program based on an organized breast cancer screening program with breast cancer awareness campaign so that it may become an optimal program based on scientific evidence with decreasing breast cancer mortality and high participation rate. I'd like propose screening breast ultrasound as a supplemental modality for Japanese women with dense breasts based on the J-START results.