The diffusion rate of screening for prostate cancer using PSA in Japan is still very low and many clinically significant cancer cases may be undetected and missed until they develop into clinically advanced disease. The number of deaths due to prostate cancer had increased to 11,600 in 2010 and is estimated to increase to 15,700 by 2025. Therefore, there is an urgent need to determine the best available countermeasures to decrease the rate of prostate cancer death.
Recently, the positive impact of PSA-based screening on mortality due to prostate cancer has been confirmed by large and reliable prospective randomized controlled trials. The Japanese Urological Association (JUA) recommends PSA screening to men who are at risk for prostate cancer. The recommendation should be based on fact sheets indicating merits and demerits of screening for prostate cancer and the JUA provides the best available screening system for men who want to be screened.
The JUA guidelines on PSA-based screening for prostate cancer could be of value in establishing an optimal screening system, which would decrease the mortality of prostate cancer, in the two major screening systems in Japan; population-based screening and health check-up (Ningen dock).

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Objective: To compare the evaluation results and diagnostic performance of liquid based cytology (LBC) with those of conventional smears in cervical cancer screening.
Subjects and Methods: Smears were taken from women who visited our clinic for an examination by SurePath LBC or the conventional method according to the timing of the appointment. The number of samples taken was 1,796 for LBC and 1.835 for the conventional method. Evaluations were made according to Bethesda System 2001 and additional tests were conducted using the Hybrid Capture 2 assay for high risk types of human papillomavirus (HPV) when the evaluation was atypical squamous cells of undetermined significance (ASC-US) for both types of smear. Those who were positive in the HPV test were referred for colposcopy and histopathologic diagnoses.
Results: The percentage of unsatisfactory slides was significantly lower with LBC (2.07% vs. 0%, p<0.0001). The percentage of normal slides (NILM) did not differ between the 2 types of sample. The detection rate of ASC-US was significantly higher for LBC (0.72 % vs. 2.45%, p<0.0001), though the rates for other categories (ASC-H, LSIL, HSIL, AGC) did not differ. HPV testing was conducted for 8 (61.5%) conventional smears and 19 (43.2%) LBC smears. One (12.5%) conventional smear and 4 (21.1 %) LBC smears were positive. Upon referral for colposcopy, 3 smears were diagnosed as moderate dysplasia and 1 as mild dysplasia.
Conclusions: LBC reduced the proportion of unsatisfactory slides and had a higher detection rate for the ASC-US category, in which dysplastic lesions are included, when compared with conventional smears. Combined with additional testing for high-risk HPV types, LBC could improve diagnostic performance in cervical cancer screening.

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Background: Carcinoma of the prostate continues to be a major health problem in Japan. The incidence of prostate cancer is increasing.
Subjects and Methods: Serum prostate-specific antigen (PSA)-based prostate cancer screening was conducted on healthy Japanese seamen between 2005 and 2007.
Results: Among 8,453 subjects aged over 40 years in whom serum PSA was measured for the first time during this period, 191 were positive for PSA measurement (PSA level>4.00 ng/mL). The PSA positive rate was 2.3%, which is considered to be about correct for healthy adult males in an ordinary distribution of PSA levels in Japan. The PSA positive rate increased steadily with increasing age in the seamen. It was less than 1% for those under 50 years old, 5.8% for 65 to 69 years, and 12.7% for 70 years or older. A total of 16 seamen were diagnosed with prostate cancer through further evaluation during this study. The detection rate of prostate cancer was assumed to be at least 0.19% (16 seamen out of 8,453), and PSA levels ranged from 4.85 to 134.5ng/mL.
Conclusion: Our findings indicate that screening through PSA measurement is useful for detection of prostate cancer at an early stage in a population of healthy men.

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Objective: Ningen Dock is carried out for the purpose of prevention and early treatment of lifestyle-related diseases and cancer. However, few studies have been conducted to compare the medical costs of Ningen Dock and general health check-ups. Therefore, we carried out a comparison of medical costs between a group of subjects who underwent a general health check-up each year and a group who underwent Ningen Dock to determine if the latter was more effective in reducing medical costs.
Methods: Our subjects were NTT group employees on the island of Shikoku in their 40s and 50s. The annual medical costs for a group of subjects who underwent a general health check-up continuously from 2003 to 2005 and those for a group which underwent Ningen Dock continuously in the same period were studied over the 5-year period from 2006 to 2010.
Results: Annual medical costs increased gradually in the general health check-up group for males. Cumulative medical costs over the 5 years for those in their 40s were about 143,000 yen for males and -69,000 yen for females. However, for those in their 50s,cumulative costs were about 330,000 yen for males and 40,000 yen for females. The spread between males and females increased every year for both age ranges.
Conclusion: For males in their 50s, even taking the variance in costs between Ningen Dock and general health check-ups into consideration, undergoing Ningen Dock every year was shown to be effective in cutting medical costs.

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Objective: The prevalence of glaucoma in those over 40 years of age in Japan is 5.0%. Of this, 78% is primary open-angle glaucoma in the broad sense and 92% is normal tension glaucoma (NTG). We examined the usefulness of frequency doubling technology (FDT) perimetry in detecting NTG.
Subjects and Methods: Among 4,014 people who underwent FDT between May 17 2010 and January 31 2011, 235 (5.9%) were FDT positive and among them, 108 were examined in ophthalmology. The diagnosis results were analyzed.
Results: Fifty-six subjects had NTG, 5 primary open-angle glaucoma, 1 primary angle-closure glaucoma and 1 secondary glaucoma. Through detailed examination of FDT negative subjects by funduscopy and tonometry, including 5 subjects who had been diagnosed with NTG and primary open-angle glaucoma, 68 subjects were found to have glaucoma. Of 172 people with FDT abnormalities only, 68 underwent further examination and glaucoma was detected in 49. Of 88 with abnormalities only in funduscopy and tonometry, 48 underwent further examination and glaucoma was detected in 19. Of the total of 68 in whom glaucoma was detected, only 3 had been positive in tonometry. Thus without FDT perimetry, glaucoma would not have been detected in 49 of 68 subjects and funduscopy and tonometry only would have discovered 19 cases of glaucoma. So the introduction of FDT increased the detection rate 3.6-fold. In 2007, by means of funduscopy and tonometry alone, only 10 of 4, 313 people were found to have glaucoma, giving a detection rate of 0.23%. However, following the introduction of FDT, the detection rate rose to 1.68%, a significant increase, in a total of 4,051 persons who were examined by funduscopy, tonometry or FDT.
Conclusion: FDT perimetry is very useful for the detection of NTG in Ningen Dock.

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Objective: We evaluated the clinical backgrounds of examinees diagnosed with gastric cancer by gastroendoscopy in our Ningen Dock.
Methods: A total of 20,051 persons examined by gastroendoscopy in Ningen Dock were enrolled in this study. They were classified into groups based on the interval between the previous gastroendoscopic examination and the current one, into an annual group, a non-annual group, and a first-time group. In addition, they were classified by atrophy of gastric mucosa into 5 categories; none, slight, moderate, severe, and unknown.
Results: Incidence of gastric cancer: A total of 52 cases (0.26%), 48 (0.34%) in males and 4 (0.07%) in females, were diagnosed by gastroendoscopy, with 30 (0.21%) in the annual and non-annual groups and 22 (0.38%) in the first-time group. Relationship between history of gastroendoscopy and size and depth of cancer: The incidence of a size of less than 20 mm was 73.7% (14/19) in the annual group and 36.4% (8/22) in the first-time group. Regarding incidence of musosal cancer, such cancer was present in all of 16 subject in the annual the group and 59.1% (13/22) in the first-time group. Relationship between atrophy of gastric mucosa and histological type: Well-differentiated carcinomas were detected more frequently in stomachs with atrophic mucosa. Three cases without atrophy of gastric mucosa had signet-ring cell carcinomas and were negative for anti-Helicobacter pylori antibodies.
Conclusions: Annual examination by gastroendoscopy is useful for the early detection of gastric cancer.

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Objective: To assess effectiveness of active dietary education program including flaxseed oil intake in improving MetS.
Methods: Subjects were 18 specific health examination patients, (males 4, females 5)of whom 9 were assigned to an intervention group, IG (Active Program), and the remaining 9 (all males) to a control group, CG (e-mail Program). We conducted the intervention from November 2009 - March 2010 with a clinical examination and dietary survey of the groups at baseline and 2 and 4 months after intervention. Dietary intake was 1,800±150 kcal/day with flaxseed oil (ALA, 2.14g/day) until 2 months after intervention and without until 4 months, and exercise. The IG received 8 sessions of lectures/cooking instruction. The CG received information 4 times by e-mail.
Results: After 2 months, in the IG, there were significant decreases in CW and SBP (p<0.05 each) and DBP and numbers of MetS risk factors (p<0.01 each) compared with the CG. The IG had significant decrease in lauric acid (p<0.05) and there were significant decreases in total energy, protein and carbohydrate intake (p<0.05 each) and an increase in soybean energy intake (p<0.05). After 4 months, the IG had significant decreases in SBP (p<0.05) and DBP (p<0.01) compared with CG; In the IG, there were significant decreases in lauric acid (p<0.01) and palmitic acid (p<0.05), and increases in oleic acid, DHA and DTA (p<0.05 each). There were also significant decreases in total energy and carbohydrate intake (p<0.05 each).
Conclusion: Our dietary education program including flaxseed oil intake was effective in improving MetS.

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Objective: Recently, the incidence of prostate cancer in younger males has been increasing in Japan. As prostate cancer is a clinically significant cancer in younger patients, it is important to understand its status and an age-specific reference range of PSA (ASRR PSA) is useful for this purpose. We have been using an ASRR PSA in prostate cancer screening at the Ningen Dock of Kurosawa Health Park Clinic in Takasaki since April, 2009. In this paper, we report the results of PSA screening using the ASRR PSA from April 2009 to March 2010.
Subjects and Methods: The subjects of this study were 4,532 males who were screened using the ASRR PSA from April 2009 to March 2010, giving written consent to participate in the study.
Results: Out of the 4,532 subjects, prostate cancer was detected in 12. Prostate cancer was discovered in 2 of them using the ASRR PSA. They both had clinically significant prostate cancer, which was NCCN with an intermediate risk level.
Conclusion: In this preliminary study, ASRR PSA was found to be a promising screening method for prostate cancer in Ningen Dock.

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Objective: Recently the prevalence of hypertension (HT) and diabetes mellitus (DM) has been increasing in Japanese middle-aged men. In view of this, we examined the trends in prevalence of retinal arteriolosclerosis (RA) and risk factors for it.
Subjects and Methods: The subjects were male employees and citizens aged 40 to 69 years in Osaka who underwent a cardiovascular health check-up that included retinal photography during the periods 2001-2003 (4,079 subjects), 2004-2006 (3,253 subjects) and 2007-2009 (3,003 subjects). RA was defined according to Scheie’s classification regarding hypertensive and atherosclerotic changes. We assessed the prevalence of RA and risk factor rates in the 3 periods and examined an association between RA and its risk factors using multivariate analysis.
Results: The prevalence of RA in those 40-49 years of age significantly increased with respect to the 1st period; 5 % in 2001-2003, 9% in 2004-2006 and 9% in 2007-2009, (p<0.001). In those 50-59 years of age, there was also a significant increase from period to period; 12% in 2001-2003, 18% in 2004-2006 and 20% in 2007-2009, respectively (p<0.001). According to multiple logistic analysis, age, blood pressure, and anti-hypertensive medication were significantly associated with RA in all 3 periods, and DM was a significant risk factor for RA in 2007-2009.
Conclusion: Our results showed that the prevalence of RA has been increasing significantly among middle-aged men in Osaka. The Increasing trend in RA prevalence in this population was associated with the increasing use of anti-hypertensive medication and prevalence of DM.

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Objective: To assess the positive predictive value (PPV) for polyps ≥ 5mm detected in CT colonography (CTC) in routine clinical practice and evaluate patient acceptance of it.
Subjects and Methods: Nine hundred ninety four average-risk patients were enrolled in the study. All patients in whom a ≥ 5 mm polyp had been diagnosed in CTC or who had been positive in a fecal immunochemical test (FIT) and then underwent post-CTC colonoscopy for diagnosis were evaluated by PPV. Patient acceptance was assessed with questionnaires.
Results: Per-polyp PPVs for detected polyps of ≥ 5mm and ≥ 10mm were 89.6% (43/48) and 94.4% (17/18), respectively. Regarding rates of discomfort for CTC and colonoscopy, the rate for more discomfort in colonoscopy than in CTC was 40.8% (248/608), 27.1% (165/608) were indifferent about this, and the rate for more discomfort in CTC than in colonoscopy was 32.1% (195/608). As for future colonic examination preference, 31.5% (191/607) preferred CTC, 28.2% (171/607) were indifferent and 40.4% (245/607) preferred colonoscopy.
Conclusions: Although CTC has a high PPV for the detection of polyps ≥ 5mm in average-risk patients, further study is required to improve patient acceptance.

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Objective: We examined breast cancer screening rates and screening systems for the cities of Sayama, Kawagoe, Tokorozawa, Iruma, Hanno, and Hidaka in Saitama Prefecture, and determined the problems.
Method: We examined breast cancer screening rates during the period 2006-2008, and breast cancer screening systems in 2011 for the above cities using National Cancer Center data and public information provided by the cities.
Results: The 2008 annual breast cancer screening rates were Iruma 31.0%, Sayama 21.9%, Tokorozawa 16.0%, Hanno 8.9%, Kawagoe 8.0%, and Hidaka 7.1%. The number of mammography screening image certified facilities in each city was 1-10 and the number of certified mammography interpreting doctors was 0-24. Four cities targeted those over 40 years old and 2 cities those over 30 years old in breast cancer screening. The screening frequency of 5 cities was every 2 years and that of 1 city was every year. In 5 cities, screening was done in 2 directions for those 40-49 in age and 1 direction for those over 50 years old. One city screened in 2 directions for anyone over 40 years old. The screening charge ranged from free to a maximum of 1,600 yen. Various types of examination findings sheet were used.
Conclusion: Measures proposed for increasing breast cancer screening rates: Expand breast cancer screening to a wider area, Set screening periods all year round so that examinees are not concentrated at any particular time, Increase number of doctors who can read mammograms, Continue free vouchers, Consider combined mammography and ultrasound diagnosis without clinical breast examination, Standardize examinations, create a common examination findings sheet and aim at improving statistical accuracy of screening.

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Objective: Waist circumference and BMI are fundamental criteria for diagnosis of metabolic syndrome and as well as for determining specific health guidance levels. This study was carried out to clarify their influence on specific health examination items and presence of Liver-Kidney contrast.
Methods: The subjects were 6,705 men (30s to 60s) who underwent our Ningen Dock and course of health check-up examinations from April 2010 to March 2011.
Results: Increasing age tended to be associated with blood pressure, plasma fasting glucose levels, and HbA1c levels in a Liver-Kidney contrast (+) and Liver-Kidney contrast (–) group. In more than half of the subjects in a group having waist circumference (–) and BMI (–), but Liver-Kidney contrast (+), plasma fasting glucose levels and HbA1c levels exceeded standard levels. Comparing findings over 4 years, in a group in which both waist circumference and Liver-Kidney contrast improved to (–), there were significant improvements in many items of laboratory data.
Conclusions: Our findings suggest that we should not focus exclusively on whether waist circumference and BMI criteria are met; there is also a need to continuously follow up persons with Liver-Kidney contrast (+) from an early date.

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Objective: We aimed to improve our new simple, low-cost method for detecting overt thyroid dysfunction using a set of routine tests during the general health check-up called "Ningen Dock", with no TSH measurement.
Methods: In this study, screening was conducted on a total of 9,816 Japanese (4,355 with no overlaps) undergoing a health check-up at JR Sendai Hospital from July 2008 to December 2011. The existing procedure comprised 5 routine tests (alkaline phosphatase (ALP), serum creatinine (S-Cr), total cholesterol (TC), lactate dehydrogenase (LDH) and red cell count (RBC)) and we investigated further refinements to it such as (1) including heart rate in hyperthyroid screening, (2) correcting for the effect of dosing in examinees taking cholesterol-lowering agents, (3) considering characteristics of time series variation in routine tests.
Results: 89 examinees were suspected of having thyroid dysfunction by our screening and 11 of them were actually confirmed to do so by blood thyroid hormone measurements. None of them had complained of any illness. The implementation of (1) - (3) above was successful in decreasing both false negatives and false positives.
Conclusions: The usefulness of our new method for screening patients with overt thyroid dysfunction through a set of routine tests conducted during Ningen Dock without thyroid hormone measurement was further confirmed. We also verified that refinements to our screening method, such as adding heart rate, including the influence of dosing and considering characteristics of time series variation of routine tests, were very effective.

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Objective: To change lifestyle behavior in the treatment of hypertension, diabetes, dyslipidemia and obesity, we tested a telemonitoring system (i-TECHO) consisting of an automated sphygmomanometer, a body weighing scale and a pedometer. These devices were connected via USB to a specific home gateway device, which transmitted self-monitoring data to a central server via the cellular-phone network.
Methods: One hundred and two patients with lifestyle diseases (average age 51.5, 84 males and 18 females) were asked to measure their blood pressure every morning and before going to bed at night, and body weight every morning, and to wear a pedometer all the time except when they were in bed for 3 to 4 months. Charts made from the telemonitoring data were sent to each patient by mail each month.
Results: The averages of blood pressure, body weight and daily steps and all other measurements, significantly improved, especially in the subjects with an initially poor lifestyle status. The actual measurements as a proportion of the total number due were 55-76% for each sensor and the rates decreased significantly in the third month. Only 5-12% of the subjects complained that they could not conduct the self-measurement well but a considerable proportion of them (32.5%) found difficulty in the data transmission procedure. Elderly people showed greater willingness to pay for a potential commercial health promotion service using i-TECHO.
Conclusions: Although the usefulness of the i-TECHO system in achieving lifestyle changes was validated, it should be made easier to use by revisions such as adopting automatic wireless data transmission, and encouragement through the provision of individualized advice should also be given.

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Objective: To improve customer service, we surveyed people who underwent annual Ningen Dock health check-ups.
Methods: A total of 129 subjects who visited the Department of General Medicine, National Center for Global Health and Medicine from February through March 2011 for annual Ningen Dock health check-ups were surveyed. Data were collected using a questionnaire that included the following items: satisfaction with hospitality, examination quality, waiting time, distance between examination rooms, facilities, meals, protection of privacy, fees, overall satisfaction, intention to revisit, and referring others. The responses were scored on a five-point Likert scale.
Results: In total, 119 subjects responded. Average scores for examination quality and satisfaction with hospitality were highest, while the score for fees was lowest. Multiple regression analysis showed that protection of privacy, satisfaction with hospitality, and examination quality were statistically associated with overall satisfaction. The correlation coefficient between the overall satisfaction score and intention to revisit was 0.470, which demonstrated that correlation was only present to a certain degree.
Conclusion: Protection of privacy, satisfaction with hospitality, and examination quality are factors important to customer satisfaction. Further improvements in these areas will be necessary to attract more customers. The significant correlation between the overall satisfaction score and intention to revisit suggests that improvements in customer satisfaction could increase the number of repeat customers.

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Objective: Although the same high-density lipoprotein cholesterol (HDL-C) reference value is used for both genders in Japan, there are distinct HDL-C criteria for men and women in Western countries. In this study, we compared the 95% reference intervals of healthy subjects for men and women and tried to clarify a gender difference in HDL-C after adjusting for factors which may affect the HDL-C level.
Methods: Study subjects were selected from health check-up examinees. People were excluded if they were taking medication for hypertension, dyslipidemia, diabetes and/or hyperuricemia, had a history of coronary artery disease, cerebrovascular disease and/or chronic renal failure, had a body mass index ≥25 kg/m², were smokers, or drank ≥25 g/day alcohol. HDL-C values were log transformed, with values beyond the mean ±3 SD truncated. The means ±2 SD of the log HDL-C values were defined as the upper and lower reference limits for HDL-C. A total of 1,582 subjects (365 men, 1,217 women) were analyzed.
Results: The reference interval for HDL-C was 42 - 92 mg/dL in men and 50 - 109 mg/dL in women. Mean HDL-C was 63.3 ± 12.8 mg/dL for men and 74.7 ± 15.2 mg/dL for women.
The results of multiple regression analysis suggested that HDL-C was increased by female sex (9.922 mg/dL gain), exercise habit (more than 30 min a time, twice a week: 2.512 mg/dL gain), losing 1 kg/m² in BMI (1.575 mg/dL gain) and aging one year (0.206 mg/dL gain).
Conclusion: Having a distinct HDL-C reference interval for each gender might be desirable for Japanese.

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