We examined sustainable breast cancer screening from the perspective of cancer education, the standpoint of the general public who undergo medical examinations, and the standpoint of being a patient. Since Heisei 29, cancer education has been implemented in health and physical education in junior and senior high schools to deal with cancer. NPO Cancer Support Kagoshima conducts classes with school teachers at about 190 schools a year to convey cancer knowledge and the importance of life. There has been a change in the willingness to actively undergo cancer screening when students are old enough to be screened. Although it is important to maintain a large system for breast cancer screening, it is important to consider the diverse backgrounds and health risks faced by the examinees. It is natural that there are people with various backgrounds and personalities, and it takes much effort to change them. It is necessary to create a system that allows people of all backgrounds to easily receive medical examinations without burden. In addition, in awareness-raising activities for breast cancer screening, efforts that hurt patients are not allowed. We believe that eliminating prejudice will lead to an increase in the screening rate and its continuation.

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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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[in Japanese]

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[in Japanese]

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[in Japanese]

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Breast awareness is crucial for reducing the mortality rate of breast cancer. Since 2015, breast surgeons in Kamakura have been promoting breast awareness through methods such as lectures and event participation at universities. The initiative took off in 2021 when students from two universities, inspired by their exposure to the medical field, actively began advocating for mammography screening. Students specialized in nutrition worked on designing a menu that may reduce the risk of breast cancer, while students from a digital art university created monorail headmarks, hanging banners, and posters for light-up events, and distributed recommendations for screening through social media. The unexpectedly creative menus and visually appealing headmarks received positive feedback. Instead of a passive approach with only temporary effects, students’ voluntary involvement in research and action deepened interest in and understanding of breast cancer. This engagement expanded to other students in subsequent years and across different faculties, contributing to the practical implementation of breast awareness. There is a desire to connect similar activities nationwide, fostering collaboration for a more comprehensive approach.

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[in Japanese]

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Mammography-guided aspiration mammary tissue biopsy (MG-VAB) is performed to diagnose category (C) 3 or higher calcified lesions that cannot be detected by ultrasound. However, it is important to decide whether biopsy is indicated or not. We have developed a scoring system to classify C3-1 and C3-2 lesions, especially in the recent softcopy diagnosis, which can be difficult to evaluate because of its detailed morphological observation. The J-RADS 4th edition states that “a large number and high density is considered C3-2,” but there was no significant difference in the number and density between benign and malignant cases. The items with significantly higher malignancy rate were: (1) heterogeneity of density, small and large difference in density, shading, and background density, and (2) heterogeneity of density, small and large difference in density, and angle. Using this system, the malignancy rate of C3-1/C3-2 was (1) 11.6%/32.3% and (2) 6.5%/45.8%, making it possible to create a system that is easy to evaluate even for those inexperienced in MG and may help in determining the indication for biopsy.

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One of the causes of false positive results in mammography screening is focal asymmetric density (FAD). False FADs occur when the mammary glands are not fully spread due to poor positioning. Furthermore, mammary gland spread is visually evaluated by physicians and radiological technologists and depends on their personal experience. In this study, an ROC experiment was conducted on 14 radiological technologists. Fifty-one MLO images were used in the experiment, and the sequential rating method was used to compare the agreement and accuracy of the evaluation between the single evaluation and the evaluation with a reference image. The Kappa coefficient and mean AUC value were 0.63 and 0.74, respectively, for the single evaluation, and 0.66 and 0.82, respectively, for the evaluation with reference images. The use of a reference image of the same patient improved the agreement and accuracy of mammary gland spread evaluation. However, there was variation in the interobserver evaluation of mammary gland spread.

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Improving the accuracy of breast cancer screening is important in order to reduce disadvantages for subjects. We evaluated the recall rate (RR), the discovery rate (DR) and the positive predictive value (PPV) in Kashiwazaki City based on municipality results that have been publishing by Niigata Prefecture since 2003. Inspection and palpation were abolished in Kashiwazaki City in 2012. The medical association that is responsible for most of the populationbased screening in Kashiwazaki City began conducting comparative interpretations after introducing digital mammography. Comparing the three years before and after 2012, the RR decreased significantly (8.60% vs. 4.47%, p < 0.05). Regarding the screening accuracy of Kashiwazaki City, which is summarized every three years from 2009 to 2020, the RR was lower than that of the prefecture as a whole in all periods, and the PPV was high. The difference in the PPV gradually increased even after 2015. The DR temporarily fell below the prefecture’s overall rate. The difference in the PPV was small until 2014, and increased to more than 5.9% after 2015. In Kashiwazaki City, a good accuracy was achieved in the prefecture by cooperating with local examination facilities and sharing the results at the screening committee. The quality control results in Niigata Prefecture were useful materials for sharing information.

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To identify patients at high risk of hereditary cancer, opportunistic screening based on germline pathogenic variant is important because it can lead to early detection of cancer. We conducted the SEIREI-CARE (comprehensive assessment, risk and education) program, which is a genetic evaluation for hereditary cancer aimed at women undergoing gynecological cancer screening, by using an artificial intelligence (AI) chatbot based on the National Comprehensive Cancer Network Guidelines from April 2021 to May 2023. Patients who met the NCCN criteria were referred to genetic counseling and germline multigene panel testing (MGPT). Among the 37,493 patients invited, 2,863 (7.6%) registered through and completed the chatbot survey, and 757 (26.4%) of them met the NCCN criteria. Fifty-two patients (6.9%) received genetic counseling, and 9 patients (1.2%) underwent germline MGPT. Thus, we determined the rate of at-risk women for hereditary cancer for the first time in Japan, and found that a low percentage of patients received genetic counseling and germline MGPT. This low percentage is considered to be due to a lack of genetic awareness among patients as well as health care professionals. Therefore, we need to provide education for patients along with improving our medical genetic knowledge.

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A 51-year-old woman was admitted to our department with the complaint of right nipple bleeding. She had bilateral inverted nipples. An easily-bleeding tumor about 1 cm in size was found in the right nipple. A breast ultrasonography (US) revealed a well-defined low-echo tumor measuring 12.7 mm in the concave part of the right nipple. On color Doppler echo imaging (CDI), extremely rich blood flow was observed, and about 10 arterial blood flows running almost parallel from the deep to the shallow part were observed. The blood flow in this case was like the flow of a “broom”. Since the tumor in the right nipple was easily bleeding, Paget’s disease should be ruled out. An incisional biopsy was performed using a trephine needle. Nipple adenoma was diagnosed as a proliferation of ductal epithelium with myoepithelium in a tubular or papillary shape. One month after the initial visit, the right nipple tumor was resected under local anesthesia by our plastic surgeon. The pathological diagnosis of the resected specimen was the same as the biopsy. Abundant vessels were observed in the resected specimen. Nipple adenoma is a rare benign tumor that grows in the nipple. Differential diagnosis from malignant diseases such as Paget’s disease is necessary. Most cases are reported by dermatologists and there are few descriptions of US, but some reports have also noted abundant blood flow by CDI. It is considered that such abundant blood flow findings may be useful for differential diagnosis of nipple adenoma in the future by accumulating case reports.

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