BACKGROUND: Breast awareness is an important lifestyle habit when considering the early detection of breast cancer but awareness of the term in Japan is low at 5%. In this study, we believe that improving the breast cancer screening uptake rate is the first step toward dissemination of breast awareness and we aimed to obtain clues for improving the breast cancer screening uptake rate by examining efforts to improve the breast cancer screening uptake rate in other countries. METHODS: Thirty−six OECD member countries as of 2019 were included in the study, which was based on official documents, websites, and review literature of national governments. We focused on three items that were common to countries with high screening uptake rates of 75% or more and that had rising screening uptake rates : digitization of medical public services, development of methods to encourage screening and making screening free of cost. RESULTS: A positive correlation was found between the digitalization of medical public services and the breast cancer screening uptake rate(correlation coefficient 0.579, p value 0.0037). Regarding the method of recommending breast cancer screening, in some countries the date and time were already specified in the invitation letter. Other countries, notification was given by methods other than letters. Lastly in some countries, family physicians directly recommended breast cancer screening. In addition, more than 26 out of 36 countries offered free medical checkups. CONCLUSIONS: The survey on efforts to improve the breast cancer screening uptake rate in each country revealed that digitalization of medical public services, devising methods to recommend screening and making screening free of charge were important factors. It is hoped that the incorporation of these elements in Japan will enhance the screening uptake rate and lead to the spread of breast awareness.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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Mammography is a diagnostic examination with unique characteristics distinct from other methods. Notably, the breast is highly radiosensitive, necessitating extra care when employing localized X-rays. Furthermore, given that breast cancer screening often entails periodic imaging every one or two years, these factors must be kept in mind. The number of breast cancer cases in Japan was estimated to exceed 94,000, with death toll surpassing 15,000 in 2022. Breast cancer screening aims to reduce mortality rates through early detection of the disease, yet one of the risks associated with mammography is the health hazard posed by radiation exposure. Health risks from radiation have traditionally been assessed using protective measures such as equivalent dose and effective dose. However, the application of the effective dose has its limitations in terms of risk assessment subjects, uncertainty, and handling. In light of this, the new ICRP recommendation suggests that the absorbed dose is the most suitable dose value for preventing tissue reactions. It also issues a caution regarding the use of effective dose, stating that it should not be applied to localized, unequal exposures like those in mammography. This article presents a summary of the concepts of dose and risk assessment that should be taken into account for screening mammography, which irradiates the breast exclusively.

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[in Japanese]

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[in Japanese]

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In Japanese breast cancer care, BRCA1/2 genetic testing, risk-reducing surgery, and surveillance for hereditary breast and ovarian cancer (HBOC) will be covered by health insurance starting in 2020. The use of genetic information for surveillance requires essential support tailored to individual lifestyles and social circumstances. The role of certified genetic counselors is to provide care and support that meets the unique psychological, economic, and social needs of clients undergoing hereditary tumor surveillance, and to serve as an important link between specialized screening clinics and treatment facilities. By addressing the potential psychological challenges of living with the ongoing risk of cancer detection, regular consultations and telephone support are expected to reduce attrition from surveillance. This article highlights the importance of creating a collaborative system among different medical departments and institutions and emphasizes the importance of psychological support from the perspective of certified genetic counselors to sustain surveillance programs.

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[in Japanese]

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The circumstances surrounding BRCA mutation-positive breast cancer have changed dramatically over the past several years, with surgery and drug treatment based on genetic testing incorporated into routine medical care. Also, in relation to cancer screening, knowledge about hereditary tumors among screening recipients may lead to improved screening behavior and breast awareness. It is desirable to provide appropriate information to subjects, without misleading them. To examine what might represent appropriate information to guide the screening recipients, we considered it necessary to first determine how much information screening recipients might actually desire to receive on hereditary tumors. Therefore, we conducted a questionnaire survey of breast cancer screening recipients at the health screening center of our hospital between January 28 and March 8, 2019. Responses were obtained from 717 screening recipients. Of the respondents, 82.0% knew of the term “hereditary cancer, ” and 8.8% had received an explanation previously about the nature of hereditary cancers. Of the respondents, 74.5% indicated that they would like to know more about “hereditary cancer, ” and 86.6% indicated that they would like to know if they were at a risk of developing “hereditary cancer. ” Thus, our survey revealed that a definite proportion of cancer screening recipients desires information on hereditary tumors. Based on the results of our questionnaire survey, we examined how information on hereditary tumors should be provided at the time of cancer screening.

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At our institution, breast cancer screening with digital breast tomosynthesis (DBT) has been implemented since 2017. The addition of DBT was found to improve the process index. However, the increase in exposure dose and imaging time, as well as the increase in reading time and data volume were also identified as major problems. In this study, we compared the reading results of the 6-mm-thick images yielded by Hologic's new technology (3DQuarumm^TM) with those of conventional 1-mm-thick images. [Subjects and Methods] We used imaging data obtained from 443 outpatients who underwent digital mammography (2D) plus DBT (3D), and the lesions in 474 breasts were classified as category 3or higher. Two sets of images were prepared for each case, “2D + 1-mm-thick images 3 D” and “2D + 6-mm-thick images 3D,” and three doctors interpreted the findings in both sets at intervals of at least one month. [Result] The category agreement rate for all cases was 77.5%, and the judgment agreement rate (for differentiating between category 2 or lower and category 3 or higher) was 85.9%, with no significant differences between the 1-mm-thick and 6-mm-thick images. The category agreement rate for cancer cases was 75.0%, and the judgment agreement rate was 90.5%. Category discrepancies in cancer cases tended were represented by the classification of mass lesions into higher categories in the 6-mm-thick images and into lower categories in the 1-mm-thick images, while the distortion rate was higher in the 1-mm-thick images than in the 6-mm-thick images. In regard to the reading time evaluated in 20 cases, the reading time was 2.7 minutes lower for the 6-mm-thick images than for the 1-mm-thick images. [Conclusion] A comparison between 6-mm-thick and 1-mm-thick images revealed a favorable agreement rate for discriminating between category 2 or less and category 3 or more lesions. A reduced time for the 6-mm-thick images was evident. Therefore, we consider that obtaining 6-mm-thick images is acceptable for the purpose of screening.

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Regarding city examinations for breast cancer screening performed in our area, two kinds of “primary breast cancer examination: palpation only” and “breast cancer examination: combination of visual examination and mammography (hereinafter referred to as MMG)” are alternated every year for women aged 40 years or over. Recently, there have been diverse opinions about the importance and significance of palpation in breast cancer examination from the viewpoints of medical economics and ease of securing personnel, and some municipalities have abolished palpation. All of the breast cancer examinations at our hospital were individual examinations, with 1,723 performed in 2016, 1,616 in 2017, and 1,539 in 2018. We examined the results of city examinations of a total of 4,878 people over a 3-year period. In the current situation, where palpation is being omitted from the examination, we believe that there might be cases that are overlooked by MMG alone. In order not to overlook breast cancers that could be detected by palpation, we believe that the practice of breast awareness at home by the examinees is important. Therefore, proactive measures to improve the awareness of the examinees about self-examination of the breast are necessary. We also provide some relevant bibliographical considerations.

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Purpose: It is generally known that the judgment of breast composition on mammographic images shows inter-reader or inter-device variations. Therefore, a specific method to minimize such variations has been published. We trained a breast composition judgment software based on artificial intelligence (AI) technology created by a manufacturer with the results of breast composition judgments made by doctors using this method. The purpose of this study was to validate this software. Subjects and Methods: Images were collected from 6 facilities, and 1353 eligible images were classified into 2 groups, one for training and the other for evaluation. Data based on visual evaluation of the breast composition, breast density, and fibroglandular area on the images of the learning set by 11 doctors were used as the correct answers. The AI software was trained with the correct answers, and subsequently, the correlation between the results of judgement by the software and the results of visual evaluation by the doctors was examined. Results: For images with no findings, the correlation coefficient between the estimated breast density by the software and the correct density was 0.930, as compared to that of 0.923 between the subjectively estimated breast density by the 11 physicians and the correct density. The percentage of correct answers on the overall breast composition was 81.8% for physician evaluation and 81.6% for software evaluation, although the software was more accurate for judging “scattered dense” and “heterogeneously dense” (84.6% and 74.5%, respectively, for the doctor evaluation, and 88.3% and 79.4%, respectively, for the software evaluation). The kappa coefficient for classification into dense breast and non-dense breast were 0.7595 for the physician evaluation and 0.7799 for the software evaluation, indicating that the software performed better. Discussion: The use of this software as an adjunct for breast composition evaluation is expected to reduce the blurring and hesitation of judges in human evaluation, resulting in more accurate and efficient reading.

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[Introduction] There are some cases of breast cancer cases in which the mammographic (MMG) findings do not match any of the diagnostic criteria. We reported a case of breast cancer in which the detection of gross calcification on the MMG initially led to the suspicion of a benign tumor. [Case] A 65-year-old woman who presented with a history of having been aware of the presence of a right breast mass from her 40’s. MMG performed for breast cancer screening revealed a gross calcified lesion in the right breast which was classified as category 2, and she was referred to our department for further examination. Clinical examination at our department by palpation revealed a hard, mobile mass measuring 2 cm in diameter in the C region of the right breast. Breast ultrasonography revealed a 1-cm and 1.6-cm hypoechoic mass with an internal calcified lesion. Core needle biopsy revealed the diagnosis of invasive ductal carcinoma. We performed video-assisted right partial mastectomy with dissection of the right axillary lymph nodes. [Discussion] Large calcified lesions detected on breast MMG are generally considered as being benign. From the MMG image findings in this case, with the calcified lesion categorized as Category 2, which is generally managed by follow-up observation, it was difficult to suspect malignancy. [Conclusion] We encountered a case of breast cancer that was initially difficult to diagnose because of the presence of gross calcification on the MMG.

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The patient was a 38-year-old woman. Breast cancer screening at 5 weeks of pregnancy by breast ultrasound revealed a mass measuring 8 mm in diameter in the left breast at the 1 o'clock position, and the patient was referred to our department. She visited our department first when she was 10 weeks pregnant. Breast ultrasound showed a well-defined, rough, irregular mass measuring 86x8 mm in size at the 1 o'clock position in the left P area. A core needle biopsy revealed the diagnosis of invasive ductal carcinoma of the breast. The patient wished to continue her pregnancy, so that we planned to wait until the second trimester for the surgery. A left mastectomy with sentinel node biopsy was performed at 20 weeks of gestation, and the postoperative histopathological diagnosis was invasive ductal carcinoma of the breast, pT1b (10mm), pN 0, histological grade II, Ly0, V0, ER positive (100%), PR positive (90%), HER2 negative (1+), ki 67 22.4%. The patient delivered by normal vaginal delivery at 36 weeks of gestation and was started on tamoxifen. The child showed good growth milestones after delivery, and until date, has shown no evidence of growth retardation. Breast ultrasonography is a useful modality for early diagnosis of breast cancer even in the presence of physiological changes associated with pregnancy, but the drawbacks of this screening tool under these circumstances (decreased sensitivity of cancer screening, increased false positives, lack of evidence) should be fully communicated in advance to the examinee. In the treatment of gestational breast cancer, it is important to decide on a treatment plan considering the number of weeks of pregnancy at the time of diagnosis, the breast cancer subtype, the clinical cancer stage, and the patient’s wishes.

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Less than 1% of all breast cancers occur in men. A 71-year-old man presented with bloody discharge from the right nipple of a 6-month duration in 2014. Mammography revealed a nodular shadow in the right retroareolar region (diameter = 6 mm). Most of the tissues of the nipple and areola, including the nodules, were excised. Histopathological examination initially indicated the presence of a ductal hyperplasia. However, further immunostaining resulted in the diagnosis of low-grade intraductal breast cancer (DCIS). Tamoxifen was administered for 2 years. Seven years after the initial presentation, the right nipple discharge recurred. Mammography and ultrasonography revealed a nodular shadow again in the left retroareolar region. Recurrence of breast cancer was suspected, and a right mastectomy was performed. Intraoperative axillary lymph node biopsy was negative. The postoperative pathological diagnosis was DCIS. The lesion had the following histopathological and immunohistochemical features: Size: 25mm× 8mm, Grade 1, ER: (+)(80%), PgR: (+)(10%), HER2: 0, and MIB-1: 1%. The possibility of recurrence was suggested. In the same year, the patient was diagnosed with low grade, submucosal early gastric cancer, and endoscopic resection was performed. The patient is currently under observation without medication. He has no family history of breast cancer and no BRCA1/2 germline mutations. Attention to early signs, such as nipple discharge, and early diagnosis are important in men who have not been screened for breast cancer.

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