Nihon Nyugan Kenshin Gakkaishi (Journal of Japan Association of Breast Cancer Screening)
Online ISSN : 1882-6873
Print ISSN : 0918-0729
ISSN-L : 0918-0729
Volume 18, Issue 2
Displaying 1-14 of 14 articles from this issue
The 18th Congress/President Lecture
The 18th Congress/Symposium
Verification of mammography breast cancer screening
  • 2009 Volume 18 Issue 2 Pages 115-116
    Published: June 30, 2009
    Released on J-STAGE: November 05, 2009
    JOURNAL FREE ACCESS
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  • Government Effort for Significantly Increasing the Participation Rate of Breast Cancer Screening
    Mitsuya Maeda
    2009 Volume 18 Issue 2 Pages 117-125
    Published: June 30, 2009
    Released on J-STAGE: November 05, 2009
    JOURNAL FREE ACCESS
    In the Cancer Control Promotion Act passed in 2007, the Japanese Government aimed to increase the rate of participation in mass screening for cancers (breast cancer, colon cancer, etc,) to more than 50% within 5 years. The Ministry of Health, Labour and Welfare derived a new estimate in 2009 to increase the participation rate through projects such as (1) raising the screening participation rate for the working population by cooperation with companies, (2) to assist the activity of prefectural health centers, (3) to draw up a model plan to assist several large cities in popularizing the importance of cancer mass screening in busy places such as leisure centers, supermarkets and commercial areas, (4) to encourage family doctors to explain about cancer screening to female patients to promote health, (5) to assist with the dissemination of information that mass screening is useful for reducing the cancer death rate, and (6) to assist the leadership of the National Cancer Center for increasing the quality of activity at municipal health centers.
    Hereafter we intend to coordinate activity with the Japan Association of Breast Cancer to create a society that knows about cancer, is able to face cancer, and is not defeated by the disease by fully utilizing all available activities against cancer. We hope that the entire nation, including patients with advanced cancer and those with recurrent cancer, will be able to obtain more satisfactory treatment.
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  • Tetsuo Kuroishi
    2009 Volume 18 Issue 2 Pages 126-133
    Published: June 30, 2009
    Released on J-STAGE: November 05, 2009
    JOURNAL FREE ACCESS
    On the basis of meta-analysis of eight randomized controlled trials of breast cancer screening with mammography conducted throughout the world, which indicated a significant reduction of breast cancer mortality, breast cancer screening with X-ray mammography was introduced in Japan in 2000. To obtain evidence that breast cancer screening with mammography in Japan can decrease the breast cancer mortality rate among women, efforts should be made to increase the acceptance/coverage rates.
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  • CBE while Reading Mammography and Policy for Reduction of the Recall Rate
    Koji Ohnuki, Noriaki Ohuchi
    2009 Volume 18 Issue 2 Pages 134-141
    Published: June 30, 2009
    Released on J-STAGE: November 05, 2009
    JOURNAL FREE ACCESS
    The first national guideline for breast cancer screening, established in 1987, endorsed the use of clinical breast examination (CBE) without mammography in women aged 30 and over in Japan. However, subsequent studies conducted in Japan indicated that mammographic screening gave better sensitivity and an earlier stage distribution at detection of breast cancer, similar to that in Europe and the United States. An endorsement of mammography for women aged 40 and over was issued by the Ministry of Health, Labour and Welfare in 2004. The most important issue currently is to increase the breast cancer screening participation rate in Japan. If the participation rate were to improve, screening would have a higher risk of harm if the recall rate was high. To reduce the recall rate while maintaining high sensitivity, simultaneous CBE while reading mammograms would be effective. The policy is that the fat density area on the mammogram does not require further examination if it is palpable upon CBE. The recall rate for CBE alone was reduced from 1.0% to 0.7% by using CBE during mammography. In addition, this approach is able to improve the sensitivity when careful palpation was performed for the high-density area on the mammogram. To reduce the recall rate for mammography alone, a third reading for cases where the judgment of the second reader differs from the first is also effective.
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  • Results from the Tochigi Screening Method using Combined Mammography and Ultrasonography
    Miyuki Ichimura, Noboru Itoh, Hideaki Ohkubo, Keiko Kamio, Yoshihiro N ...
    2009 Volume 18 Issue 2 Pages 142-149
    Published: June 30, 2009
    Released on J-STAGE: November 05, 2009
    JOURNAL FREE ACCESS
    Tochigi Public Health Service Association has provided breast cancer screening using a combination of mammography (MMG) and ultrasonography (US) since 2000. Among the 115,444 women examined in the 7 years since then, 285 (0.25%) were found to have breast cancer. The proportion of cases requiring more thorough examination has increased year by year, and reached 11.6% in 2006. Although from the beginning reference was made to previous images for mammographic interpretation, a system for reference to echographic interpretation was started in 2007. Introduction of this US reference system reduced the re-examination rate in 2008 to 8.0% (MMG 4.2%, US 4.7%). The proportion of identified cases requiring complete examination and consultation with medical institutions was as low as 75%, which is an issue related to quality control. Cancer was confirmed by both MMG and US in 155 cases (55%), by MMG in 81 cases (28%), and by US in 49 cases (17%). Cases that were stage 0 and I by the TNM classification comprised 78%, while lymph node metastases were present in 18%. Diagnostic benefit among test parameters was investigated by reference to age and mammographic density. The detection rate in patients in their 60s or older was higher with MMG than with US, whereas no such difference was evident in patients in their 50s or younger. With regard to mammographic breast density, cases showing an entirely fatty density or scattered fibroglandular density-2 were found more frequently with MMG. Taken together, in cases in their 50s or younger and those classified as having patterns of heterogeneous density or scattered fibroglandular density-1, MMG and US work in a mutually complementary manner, and their combined use in examinations is recommended. Nine years have passed since the introduction of MMG for breast cancer screening. Further effort is necessary to formulate and validate an effective and efficient structure for cancer screening.
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  • Hiroko Kawashima, Mari Tawara, Ayako Katagiri, Hiroshi Yoshino, Hiroyu ...
    2009 Volume 18 Issue 2 Pages 150-155
    Published: June 30, 2009
    Released on J-STAGE: November 05, 2009
    JOURNAL FREE ACCESS
    In Ishikawa Prefecture, mammography breast cancer screening was started tentatively in three pilot towns in 1999, and since 2004 it has been performed in all cities, towns and villages. The results of screenings in the prefecture carried out up to 2007 were analyzed.
    During the 9-year period from 1999 through 2007, a total of 131,115 women underwent screening, the rate of closed examination was 13.8%, the rate of responders for closed examination 89.3%, the cancer detection rate was 0.30%, and the proportion of early cancers was 67.9%.
    We have endeavored to improve the quality of breast cancer screening by careful selection of the reading doctors, maintaining good teamwork between screening institutions and reading doctors and that of individual screening institutions, and extensive introduction of mammography technicians at sites where film reading is conducted.
    Along with further promotion of these efforts, we anticipate that we will be able to accommodate any increase in the number of responders.
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  • Takako Morita, Tae Niwa, Ruriko Suzuki, Namiko Suda, Tokiko Endo
    2009 Volume 18 Issue 2 Pages 156
    Published: June 30, 2009
    Released on J-STAGE: November 05, 2009
    JOURNAL FREE ACCESS
  • Hiroshi Terada, Masatoshi Okazaki, Tokiko Endo, Katsuhei Horita, Norik ...
    2009 Volume 18 Issue 2 Pages 157-162
    Published: June 30, 2009
    Released on J-STAGE: November 05, 2009
    JOURNAL FREE ACCESS
    Mammographic screening calls for high-precision reading of high-quality mammograms. Therefore, from September 2004, the Mammography Facility Image Evaluation Committee of the Central Committee of the Quality Control for the Mammographic Screening, a nonprofit organization, has been performing evaluation of analog and digital images using a common evaluation basis. However, only a small number of facilities have undergone image evaluation, and the number that will be authorized in response to image evaluation as of August 2008, and listed on the Internet, is 1,259, which accounts for only 35% of institutions that perform mammography.
    All mammography institutions, not limited to screening institutions but also those that carry out detailed examinations, should recognize that it is a social obligation to receive facility image evaluation as part of the quality assurance program.
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  • 2009 Volume 18 Issue 2 Pages 163-168
    Published: June 30, 2009
    Released on J-STAGE: November 05, 2009
    JOURNAL FREE ACCESS
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Original Articles
  • Tae Niwa, Namiko Suda, Takako Morita, Tokiko Endo
    2009 Volume 18 Issue 2 Pages 169-175
    Published: June 30, 2009
    Released on J-STAGE: November 05, 2009
    JOURNAL FREE ACCESS
    In the present study, we compared the image depiction capacity of hard copies (HC) and soft copies (SC) of CR digital mammograms from 969 cases. Two of 12 Grade A board-certified radiologists recognized by the Central Committee for Quality Control of Mammography Screening in Japan, independently diagnosed each individual case. Then, at least one of the two radiologists who examined either the HC or SC image diagnosed as “Category 2”, however, a different category was also given. We picked up 65 suspicious cases (69 findings including 13 tumors, 39 cases of focal asymmetric density (FAD), 15 calcifications, and 2 architectural distortions). Three senior members among the 12 radiologists re-examined these images paying special attention to differences in depiction capacity between HC and SC. We used the 5M LCD and changed the window level, window width and employing zoom. Thirteen (1 tumor, 6 FAD, 6 calcifications) of the 69 findings showed differences between HC and SC, but 54 findings showed no difference. In 2 cases there were interpretation differences between the radiologists. Calcification was clearly depicted by SC when zoom was used, compared with HC. There was a tendency for FAD in the mammary gland to be enhanced by changing the brightness and contrast, resulting in overdiagnosis. Furthermore, it was difficult to evaluate low-density areas in the extra-mammary gland.
    In conclusion, state-of-the-art technology in digital mammography is not yet mature enough to evaluate all suspected lesions, and further improvement of soft copies is required.
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  • Hiroko Okazaki, Fumio Tsujimoto, Tomoyuki Ohta, Kyoko Okamoto, Yoshihi ...
    2009 Volume 18 Issue 2 Pages 176-181
    Published: June 30, 2009
    Released on J-STAGE: November 05, 2009
    JOURNAL FREE ACCESS
    From January 2005 to October 2007, 53 women were diagnosed as ductal carcinoma in situ (DCIS) from our program. We examined the sensitivity of mammography (MMG) and ultrasonography (US) using individual initial report written independently on the same day. Category 3 or higher judgement was considered as a true positive.
    The sensitivities of MMG and US were 71.7% (38/53) and 81.1% (43/53), respectively, and the difference was not statistically significant. When the results were analyzed in terms of patient age, women who were 49 or younger had a MMG sensitivity of 75.0% (21/28) and a US sensitivity of 82.1% (23/28), whereas women who were 50 or older had a MMG sensitivity of 68.0% (17/25) and a US sensitivity of 80% (20/25), none of these differences being statistically significant. Thus US was proved to have a DCIS detection rate similar to that of MMG.
    Among the 53 patients with proven DCIS, 29 (54.7%) presented positive findings on both MMG and US, 9 (17.0%) only on MMG, and 14 (26.4%) only on US. Five of the 14 US-positive patients showed punctate high echoes, suggesting the usefulness of US for detection of calcification. In 52 (98%) of the patients, either MMG, US, or both gave positive results for detection of DCIS. Therefore we conclude that MMG and US compensate each other for breast cancer screening.
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  • Kanako Ban, Tomoko Takanashi, Kyoko Minamisa, Shigeki Takeshita, Masao ...
    2009 Volume 18 Issue 2 Pages 182-188
    Published: June 30, 2009
    Released on J-STAGE: November 05, 2009
    JOURNAL FREE ACCESS
    We conducted a comparative study of breast cancer mass screening by the Tokyo Health Service Association for the regional and working population. The mammographic screening rate has been over 90% for all examinees since 2004, and the rate of inspection and palpation has been almost 0% in the regional population, although the rate was still 24% of all screenings among the working population even in 2006. In the working population the average age at which breast cancer screening was done was younger than in the regional population. The proportion of the population under 40 was 38.4% in 2003 and 35.7% in 2006, and in this population the rates of mammography, ultrasonography, and inspection and palpation were almost the same. This suggests a degree of confusion about breast cancer screening among younger women. The breast cancer detection rate was significantly better in the regional than in the working population. However, there was no significant difference in the rate between the two populations in the 40- to 59- year age range.
    In conclusion, the breast cancer screening system for the regional population has been improved as a result of the official notices of the Ministry of Health, Labour and Welfare. On the other hand, the data for the working population have not been favorable because of age-related factors and the methods used for screening. It will be necessary to refine the screening system for the working population to improve not only screening efficacy but also the breast cancer mortality rate.
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Case Report
  • Tomoyuki Monma, Takeshi Sakuma, Masami Matsuzaki, Naoto Katagata, Fumi ...
    2009 Volume 18 Issue 2 Pages 189-195
    Published: June 30, 2009
    Released on J-STAGE: November 05, 2009
    JOURNAL FREE ACCESS
    Coexistence of a phyllodes tumor and a breast cancer in the same breast is very rare. Nineteen such cases have been reported previously in Japan, and the presenting symptom was a palpable tumor in almost all cases. Here we present a case in which a tumor was palpable at breast cancer screening.
    A female patient in her 6th decade presented with a history of fine calcific deposits that had been found at breast cancer screening 7 years before, when a stereo-guided mammotome biopsy at a closed examination yielded a diagnosis of mastopathy. No abnormal findings had been detected at two other breast cancer screenings conducted 3 years and 1 year previously. On this occasion, a lump was palpable. When the patient visited our institution, a tumor measuring 5×4.5 cm was palpated in the upper lateral quadrant of the right breast, and lymph nodes were palpable in the right axilla. Mammography showed only a Category 2 finding of a popcorn-like calcific deposit, suggesting the presence of a fibroadenoma in the right breast. Ultrasonography demonstrated a low-echoic mass shadow with an irregular margin and calcific deposits. Needle biopsy cytology gave a diagnosis of invasive ductal carcinoma, and chest computed tomography showed multiple lung metastases. Thus the preoperative diagnosis was a breast cancer, T2 N3 M1, Stage IV.
    The patient underwent a right mastectomy with preservation of the pectoral muscles and right axillary node dissection (Bt+Ax). The final histopathologic diagnosis was an invasive ductal carcinoma (papillary ductal carcinoma) combined with a phyllodes tumor. Metastatic lesions were found in 22 of 24 resected lymph nodes. Chemotherapy and irradiation were carried out after surgery.
    This case was a rare combination of a phyllodes tumor and a breast cancer, the latter having been missed at three previous biennial screenings and having presented at an advanced stage when detected at the fourth screening.
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