[in Japanese]

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Kamakura City has conducted a breast awareness campaign named “breast health guidance” for 5 years, as part of the municipal health screening program. The campaign targets women in their 20s and 30s, and is aimed at improving the proportion of women undergoing mammography screening. The guidance is conducted at health screening sites by nurses, public health nurses and midwives, who provide face-to-face guidance by appointment. These instructors attend a workshop every year and are trained to use unified tools in the guidance process. A list of frequently asked questions and answers is also provided at the workshop. Seventy percent of the participants in the guidance were in their 30s. The main reason for their participation was the increasing frequency of breast cancer in their friends, etc. Although the screening program had been going on smoothly, the COVID-19 pandemic led to an interruption of both the screening and the guidance. During the pandemic, the breast awareness campaign was considered as non-essential and non-urgent, and most people also wanted to avoid face-to-face interactions. Therefore, after the program was resumed, the number of participants decreased. Under these circumstances, we have developed an application, taking into account living with the coronavirus for years to come. This application has enabled us to establish a method that enables participants to learn about breast cancer, without face-to-face interactions. On the other hand, the impression we obtained from the participants suggested that the enthusiasm of the instructors also perhaps encouraged women to participate in the screening program. Therefore, face-to-face guidance combined with the application appears to be the best practice for the future. Since use of the application is not restricted to the local residents of Kamakura City, we hope that our application will be actively used. We would like use of the application to contribute to the paperless movement in health screening. Whether the proportion of women undergoing mammography screening has increased with the introduction of the breast health guidance has not yet been determined, and we propose to continue the program in the future.

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[in Japanese]

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The Basic Plan for Promoting Cancer Countermeasures was formulated by Japanese government in 2018 and stresses the importance of conveying accurate information about cancer to children by utilizing doctors, external lecturers such as cancer patients and experienced people. In response to this, “Cancer Education” was added to the “New Course of Study”, and would be fully implemented junior high schools from fiscal year 2021. Since fiscal year 2014, the Niigata Health Foundation has been holding lectures on “basic knowledge about cancer”, “the importance of early detection and early treatment”, and “the importance of medical examinations” as part of cancer education for junior high school students. Since fiscal year 2014, 39 schools and about 5,700 students have attended the course, and in fiscal year 2020, it was held at 10 more schools. The lectures were given by doctors from cancer medical center hospitals, etc., and questionnaires were collected from students before and after the lectures. According to the results of the 2020 survey (994 valid responses), the number of students who responded “yes” to the question “Do you think cancer has a high probability of healing when detected early?” increased from 77.8% before to 92.1% (1.18 times) after the lecture. From the number of respondents who answered “yes” to “Do you think you will get a cancer checkup?” increasing from 54.8% to 88.8% (1.62 times), it was found that junior high school students’ awareness of “cancer” and “medical examination” changed before and after the lecture. In order to spread “Breast awareness” that should be practiced in daily life, it is important and effective to raise awareness not only for the age group affected by cancer but also for the younger generation that is in the stage before that.

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[in Japanese]

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BACKGROUND: Breast awareness is an efficient and effective behavioral pattern against breast cancer, however, its popularity is not yet sufficient. Thus, an effort to raise breast awareness is required. We have established a system for providing breast cancer information through videos on YouTube, and have posted videos on breast awareness. In this study, we compared our videos for breast awareness information in order to clarify the effective way of providing breast awareness information to public. METHODS: Multiple breast clinicians collaborated to create the videos. We ensured scientific validity by using a peer-review system by independent group of breast clinicians. Patients and public are involved in confirming to ensure explicitness and expression appropriateness. The videos were posted on the YouTube channel “Breast Cancer Encyclopedia”. Among 6 videos for breast awareness information, we compared the number of views and retention rates of these videos from July 2020 to June 2021. RESULTS: The most frequently viewed video was “A Short Summary of Breast Cancer Symptoms” with 29,000 views and a higher retention rate than the other videos at 47.2%. The video explaining breast awareness itself had 5,000 views and a retention rate of 37.2%. CONCLUSIONS: The more concise video about the symptoms was viewed more than the video explaining breast awareness. As breast awareness refers to “the process of raising awareness of one's own breasts,” it is essential to establish a concise and accessible platform for viewers to “Think of it as a personal matter” and “Being familiar with the normal consistency of your breasts” so that they understand what's normal and promptly report changes. In addition, it is necessary to continue to improve the contents and methods of providing information in accordance with the times

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[in Japanese]

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Recognition of the data on cancer screening in the workplaces in Japan is complicated because the structure of cancer screening in the workplaces relies on insurers or business owners, regarded as employee benefits, due to absence of any Acts, which has led to a large variety of issues on the screening program. In addition, lack of systems to regularly compile the numbers of objectives and participation rates has made it complicated to compute the participation rates and conduct the quality control, resulting in many issues on the types and examinations of cancer screening, quality controls, and how to handle personal health information. To proceed the evidence-based cancer screening programs in the workplaces as well as the population-based cancer screening in municipalities, the Ministry of Health, Labour and Welfare published “the Manual for cancer screening in the workplaces” in March, 2018. The manual demonstrates the types and examinations of cancer screening, quality controls, and how to handle personal health information. We require uniform systems for collecting and assessing the data on cancer screening in order to continuously provide the effective cancer screening in the workplaces. Additionally, the Ministry has been tackling the investigation of the condition around cancer screening in the workplaces and novel proposition of the indicator for quality control through the Health Labour Sciences Research. The manual needs to be widely spread into the insurers and business owners, and the uniform structure for data management needs to be prepared.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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In cancer screening in workplace, improvement of process index is required so that early detection of cancer will lead to a reduction in mortality. It was also shown that the process index can be evaluated by creating an aggregation format in accordance with the cancer screening manual for workplace, and that the status of cancer screening uptake and accuracy index can be rapidly evaluated by using the aggregation format in the COVID-19 pandemic infectious disease as well

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Since 2017, we have been conducting breast cancer screening combined with tomosynthesis imaging as part of opportunistic screening. The addition of digital breast tomosynthesis (DBT) improved the close recall rate, cancer detection rate, and positive predictive value of breast cancer screening, but it posed the problems of increased exposure dose and imaging time. Therefore, we examined whether it is possible to interpret mammography using only synthesized 2D images (S2D) from DBT imaging (3D) data, and whether it is possible to omit 2D mammography imaging (2D). We used the images of 2,611 women who had undergone mammography screening with the addition of DBT, and the images of 5,211 breasts, including the breasts of only one side in some cases. These images were set to the monitor so that S2D + 3D (Group A), 2D + 3D (Group B), and 2D only (Group C) images were displayed, and six doctors with screening mammography interpretation certification A or AS interpreted the images, with staggered timings. Image groups A, B, and C were interpreted separately, and it was assessed whether there were some differences in the process indication among the three groups. The results revealed no differences in the categorical judgment among the three groups. In regard to the process indicators, in groups A, B, and C, the recall rates were 7.1%, 7.8%, 9.1%, the cancer detection rates were 0.27%, 0.23%, 0.19%, and the positive predictive values were 3.8%, 2.9%, 2.1%, respectively. In conclusion, process indication using synthesized 2D imaging was better than the interpretation of 2D images alone. For the future, it is suggested that omission of 2D imaging may be useful in opportunistic breast cancer screening conducted with the addition of DBT.

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It is difficult to determine the presence/absence (P/A) of axillary lymph node (Ax-LN) metastasis on breast sonography, and it has been reported to be useful to clarify the shape characteristics of the LNs for determining the P/A of Ax-LN metastasis. The number of cases analyzed in this study were 333 cases with confirmed P/A of metastasis by preoperative fine-needle aspiration cytology (FNAC) for suspected Ax-LN metastasis. The LN status, characteristics of the breast lesions, and patient background data were evaluated. The LN parameters that showed significant differences in the P/A of LN metastasis were as follows, irregularity, loss of LN hilum, short diameter > 5mm, long diameter/short diameter ratio < 2, cortical blood flow (+), and presence of multiple LNs. In regard to the breast lesions, there was a significant difference in the number of tumors with (T)2 or larger tumors and category (C)5 between the groups with P/A of Ax-LN metastasis. A shape classification-table (SCT: 6 classifications, I to VI) was created based on the shape of the LNs and loss of LN hilum. Then, the findings were compared with the results of FNAC. The six shape classifications and the results of comparison were as follows. I: no malignancy; II: 3.5% malignant; III: 34.1% malignant; IV: 50.0% malignant; V and VI: all malignant. It was often difficult to discriminate between malignant and benign lesions in shape III lesions. In order to resolve this problem, the T and C categories of the breast lesions were added to the SCT. With this inclusion, the results revealed that the percentage of malignant lesions among shape III lesions that were T2 or larger tumors and C5 lesions was 53.7%; thus, a significant difference was observed when T and C factors were added to shape III. Therefore, it is possible to estimate the probability of LN metastasis by adding T and C to the SCT, which makes the SCT more useful.

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In Fukushima Prefecture, breast cancer screening has been performed by sending doctors in clinical breast examination (CBE) and mammography (MG)-equipped bus to areas where it is difficult to perform the screening independently. The results of population-based mass screening conducted by the Fukushima Preservative Service Association of Health from April 2005 to March 2018 were examined in Fukushima Medical University School of Medicine. In total, 220,007 people underwent screening. The closer-examination-required rates, the medical examination rate, the discovery rate, and the positive predictive value were 3.3%, 90.7%, 0.240%, and 7.4%, respectively. Among those in whom the detection was based on the MG findings, the percentages of C-1/2, C-3, C-4, and C-5 lesions were 6.4%, 33.2%, 35.8%, and 24.2%, respectively. The percentages of clinical early-stage cancer (stage 0, I) and late-stage cancer (stage III, IV) were 69.6% and 4.1%, respectively. The closer-examination-required rates derived from CBE plus MG, MG alone, and CBE alone were 3.7%, 2.0% and 3.3%, respectively. The positive predictive values derived of CBE and MG, MG alone, and CBE alone were 6.9%, 11.0%, and 0.7%, respectively. In 2016, after CBE for breast cancer screening was virtually abolished, municipalities that have omitted CBE from screening have been increasing. Furthermore, full field digital MG and monitor diagnostics for MG have been adopted from 2015, and comparative reading MG was started in 2016. These transitions and quality control of screening improved the diagnostic accuracy. While high-quality screenings should be continued, a mechanism linking medical facilities or administrations needs to be built.

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Ever since our institution was inaugurated in 2005, we have been conducting types of prone mammography-guided vacuum-assisted breast biopsy (MMG-VAB) for non-palpable lesions found by calcification. Initially, MultiCare platinum (device A) was used to identify the Target coordinates in stereo photography, In January 2019, the Affirm Prone Biopsy System (device B) equipped with digital breast tomosynthesis began to be used. Was introduced. I gained experience using two types of MMG-VAB. For devices A and B, the EUREF's Average Glandular Dose (AGD) measurement method was modified to estimate the comparative AGD. From the comparative AGD, device B could be tested at low doses. The malignant lesion detection rate was the same for both devices A and B, with no significant difference. In device B, the number of alignment options increased and the tomosynthesis image made it easier to identify the target, and the collection success rate was high (p=0.04). In some cases, the hemostasis time was longer with device B (p<0.001), but the examination time was shorter than with device A (p<0.001). In some cases, it took a long time for the bleeding to stop when device B was used (p<0.001), but the examination time was shorter than that with device A (p<0.001), and the comparative AGD was also kept low, so that the burden on the patients could be reduced. Whether the examination can be performed accurately, safely, and quickly or not even if the equipment performance is improved depends on the alignment of the radiological technologist, and the role of the radiological technologist is considered to be important.

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This study compared the mean glandular dose (MGD) displayed by three types of mammography devices, namely, AMULET F with a Mo target, MAMMOMAT Fusion with a W target, and Senographe DS with Mo and Rh targets, and the MGD measured according to the method proposed by Dance. The dose calculation methods of Dance and Wu are used to calculate the displayed MGDs in the three types of mammography devices. The results showed that when the compressed breast thickness was low, the displayed MGD was less than the measured MGD, and when the breast thickness was higher, the displayed MGD tended to be greater than the measured MGD. The relationship between the measured and displayed MGDs differed depending on the mammography device used. Of the three devices, the Senographe DS, with Mo and Rh targets exhibited a different relationship between the displayed and measured MGDs depending on the target/filter combinations. In summary, the relationship between the displayed and measured MGDs differed depending on both the compressed breast thickness and the mammography device used. However, verification of the relationship between the displayed and measured MGDs may be useful as an index for monitoring patient exposure during mammographies.

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Breast density in mammography is known to be highly associated with the risk of breast cancer and with false negative results of breast cancer screening. With the spread of digital mammography and availability of software for measuring the breast density, it has become possible to objectively and 3-dimensionally interpret the breast composition; however, there are still very few reports of detailed evaluation in Japanese women. In this study, a total of 5,177 consecutive digital mammography images were analyzed using a volumetric breast composition assessment software. Parameters, such as the Dense Volume (DV), Non Dense Volume (NDV), and Volumetric Breast Density (VBD), which were automatically calculated by the software, were compared by age group. When BMI, breast thickness and breast volume were matched, the median annual rates of change of NDV in the groups of women who were under 50 years of age and over 50 years of age (<50 and ≥50 years age groups, respectively) were 13.3% and 11.4%, respectively, with no significant difference between the two groups. The median annual rates of change of the DV and median annual rates of change of the VBD in the <50 years and ≥50 years age group were -6.6% and -9.8%, and -9.3% and -12.7%, respectively; the rates of decrease of these parameters were significantly higher in the ≥50 years age group (p<0.01). With further investigation, these results are expected to help in individualizing breast cancer screening in the future.

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