Cancer Screening In Japan Research Articles

History and perspective of population-based breast cancer screening in Japan

History and perspective of population-based breast cancer screening in Japan

Breast cancer screening using digital breast tomosynthesis compared to digital mammography alone for Japanese women.

The purpose of this study is to confirm the position of DBT in breast cancer screening in Japan, to assess cancer detection rates, recall rates, positive predictive value (PPV), and to evaluate the type of mammographic findings of cancer with the use of digital mammography alone (2DDM) and combined with digital breast tomosynthesis (DBT). 11,894 examinations of the opportunistic breast cancer screening using only 2DDM and 2DDM plus DBT were performed from May 1, 2017 to March 31, 2019. The 11,894 women [3535 women who received DBT in addition to 2DDM (3D group) and 8359 who received 2DDM only (2D group)] participated in this study. The study was approved by the Institute's Ethics Committee and all participants provided written informed consent. The recall rate was 2.6% for the 3D group and 3.6% for the 2D group (p < 0.01). The cancer detection rate was 0.17% in both 3D and 2D groups (p = 0.978). The positive predictive value (PPV) was 6.5% for the 3D group and 4.7% for the 2D group (p = 0.484). The cause of the decrease in recall rate was due to a decrease in the finding of focal asymmetric density (FAD). The recall rate was improved by using DBT for breast cancer screening in Japanese women. Cancer detection rates were exactly the same in DBT and 2DDM groups, so only DBT non-inferiority could be verified. We have verified that breast cancer screening combined with DBT is useful even for Japanese women to reduce unnecessary further examination.

Associations of multimorbidity with breast, cervical, and colorectal cancer screening delivery: a cross-sectional study of a nationally representative Japanese sample

BackgroundMultimorbidity is associated with a high mortality rate and low health-related quality of life. Previous studies have indicated that multimorbidity tends to be associated with not receiving cancer screening, although this association remains unclear. This study aimed to investigate the associations between multimorbidity and the delivery of breast, cervical, and colorectal cancer screening in Japan, and to identify subgroups that did not receive cancer screening. MethodsThis study used cross-sectional data from the 2016 Comprehensive Survey of Living Conditions, which used a stratified random sample of the general Japanese population. Multivariable logistic regression models were used to evaluate the associations between the number of chronic conditions and each cancer’s screening proportion. The relevant covariates included age, marital status, education level, occupation, and household income. ResultsRelative to subjects with no chronic conditions, subjects with two chronic conditions received more screening for breast, cervical, and colorectal cancers (breast cancer, adjusted odds ratio [aOR]: 5.42, 95% confidence interval [CI]: 2.80–10.5; cervical cancer, aOR: 4.59, 95% CI: 2.03–10.4; male colorectal cancer, aOR: 3.26, 95% CI: 1.29–8.24; female colorectal cancer, aOR: 1.05, 95% CI: 0.39–2.81). Low socioeconomic status was associated with not receiving any type of cancer screening consistently. ConclusionMultimorbidity and high socioeconomic status were associated with higher proportions of screening for breast, cervical, and colorectal cancers in the Japanese population. More aggressive strategies may be needed to promote screening among Japanese individuals with no chronic conditions and individuals with low socioeconomic status.

Effect and cost-effectiveness of national gastric cancer screening in Japan: a microsimulation modeling study

BackgroundA national endoscopic screening program for gastric cancer was rolled out in Japan in 2015. We used a microsimulation model to estimate the cost-effectiveness of current screening guidelines and alternative screening strategies in Japan.MethodsWe developed a microsimulation model that simulated a virtual population corresponding to the Japanese population in risk factor profile and life expectancy. We evaluated 15 endoscopic screening scenarios with various starting ages, stopping ages, and screening intervals. The primary outcomes were quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratio. Cost-effective screening strategies were determined using a willingness-to-pay threshold of $50,000 per QALY gained. One-way sensitivity and probabilistic sensitivity analyses were done to explore model uncertainty.ResultsUsing the threshold of $50,000 per QALY, a triennial screening program for individuals aged 50 to 75 years was the cost-effective strategy, with an incremental cost-effectiveness ratio of $45,665. Compared with no endoscopic screening, this strategy is predicted to prevent 63% of gastric cancer mortality and confer 27.2 QALYs gained per 1000 individuals over a lifetime period. Current screening guidelines were not on the cost-effectiveness efficient frontier. The results were robust on one-way sensitivity analyses and probabilistic sensitivity analysis.ConclusionsThis modeling study suggests that the endoscopic screening program in Japan would be cost-effective when implemented between age 50 and 75 years, with the screening repeated every 3 years. These findings underscore the need for further evaluation of the current gastric cancer screening recommendations.

Analysis of population-based and worksite cancer screening in Japan

Abstract Background In some European countries, cancer screening is conducted and evaluated by the nation. In Japan, about half of cancer screenings are conducted by the government or local governments, while the other half is in a worksite, conducted by business owners and insurers as part of a welfare program. The Ministry of Health, Labor and Welfare (MHLW) have prepared guidelines for cancer screening in worksite and provided specific recommendation methods to practitioners. For an understanding of its use does not progress, it is necessary to identify problems. Methods A research group, organized by the MHLW grant, surveyed 20 major insurers in Japan about the guidelines for cancer screening in worksite. The contents of the questionnaire are related to the establishment of a system with a view to organizing screening, and consist of a total of 45 items. Answers to these questions were obtained in the following format. (1. Yes, 2. No, 3. Can't answer, 4. Can't understand the meaning of the question) Results Around 30% of insurers were able to answer all items, but 70% were not able to answer any items. Approximately 10% of the respondents answered that they had implemented the items in the guidelines, while 70% did not, and 20% can't answer or can't understand the meaning of the question. The reasons for not being able to answer were that the terms were difficult to understand, there was no need to grasp the data of cancer screening, and there was a legal problem and personal information could not be obtained. Conclusions This suggests that employers and insurers differ in their understanding of cancer screening, resulting in various implementations and evaluations. In order to establish organized screening in the whole country, it is necessary to develop a system that can also evaluate data, such as cancer screenings and health check conducted in worksite. It is also important to improve the literacy of cancer screening practitioners. Key messages Integrating cancer screening across the country. Improving the literacy of cancer screening practitioners.

Impact of reduced smoking rates on lung cancer screening programs in Japan.

In Japan, lung cancer screening by annual chest radiography has been performed for the past 30years. However, changes in risk factor status may have influenced the efficiency of current organized lung cancer screening program. The purpose of this study was to clarify whether the reduced smoking rate in younger Japanese affects the efficiency and effectiveness of lung cancer screening. We investigated chronological changes in epidemiological indicators, which support lung cancer screening programs offered by the Japan Cancer Society, such as gender- and age-specific numbers of participants and lung cancers detected by the screening by clinical stage, in relation to smoking rates from 1991 to 2016. Participant age at the time of screening and age at the time of cancer detection have both increased over time. The lung cancer detection rate (LCDR) in younger age cohorts tended to decrease from 1991 to 2016 in both genders, particularly men aged <55years. Age-adjusted LCDR significantly decreased from 1991 to 2016 in both genders. After 2001, ~45% of overall detected cases in men and 70% in women were found in stage I. Although trends differed between men and women, smoking rate decreased from 1991 to 2016 in most age cohorts in both genders. These results suggest that organized lung cancer screening in Japan should be limited to higher-risk populations.

Low-dose CT lung cancer screening in never-smokers and smokers: results of an eight-year observational study.

BackgroundThis was an observational study of Japanese participants who underwent low-dose computed tomographic (LDCT) lung cancer screening between February 2004 and March 2012, to evaluate the lung cancers in never-smokers and smokers.MethodsThe study population consisted of a total of 12,114 subjects [never-smokers, 6,021 (49.70%); smokers with <30 pack-years of smoking, 3,785 (31.24%); smokers with ≥30 pack-years of smoking, 2,305 (19.03%); unknown smoking status, 3 (0.02%)]. The odds ratio (OR) of lung cancer detection according to the smoking status adjusted for age and gender was evaluated.ResultsA total of 152 lung cancers were diagnosed in 133 patients [never-smokers, 66 (49.6%); smokers with <30 pack-years of smoking, 31 (23.3%); smokers with ≥30 pack-years of smoking, 36 (27.1%)]; therefore, 72.9% of lung cancer patients did not meet the National Lung Screening Trial (NLST) criterion of smokers with ≥30 pack-years of smoking. The OR of lung cancer detection in smokers with ≥30 pack-years of smoking was higher than that in the never-smokers (OR =1.71, 95% CI: 1.04–2.82, P=0.03) and that in smokers with <30 pack-years of smoking (OR =1.71, 95% CI: 1.04–2.80, P=0.03), while the OR of lung cancer detection in smokers with <30 pack-years of smoking was the same as that in the never-smokers (OR =1.00, 95% CI: 0.62–1.61, P=0.99).ConclusionsAlthough the OR of lung cancer detection in smokers with ≥30 pack-years of smoking was higher than that in the never-smokers and smokers with <30 pack-years of smoking, approximately 70% of lung cancer patients might be missed if we only adopted the NLST criterion of smokers with ≥30 pack-years of smoking. Therefore, never-smokers and smokers with <30 pack-years of smoking should be included in the target population for LDCT lung cancer screening in Japan.

Current status and future prospects of gastric cancer screening in Japan

Current status and future prospects of gastric cancer screening in Japan

Current situation of colorectal cancer deaths and challenges in colorectal cancer screening in Japan and comparison with the UK and the US

Current situation of colorectal cancer deaths and challenges in colorectal cancer screening in Japan and comparison with the UK and the US

Effect of message framing on colorectal cancer screening in Japan:

Effect of message framing on colorectal cancer screening in Japan:

Aiming at more efficient utilization of colonoscopy for colorectal cancer screening in Japan

Aiming at more efficient utilization of colonoscopy for colorectal cancer screening in Japan

The status of compliance with guidelines of cancer screening in Japan

Abstract Background The Ministry of Health, Labour and Welfare (MHLW) establishes screening recommendations specifying screening methods, age, and interval for gastric, colon, lung, breast, and cervical cancers. Screening programs are provided via local healthcare departments (LHD), who are responsible for managing programs and reporting the screening status through a survey annually. Methods We analyzed screening status provided by LHDs in fiscal 2017 in regards to appropriate screening age and interval. Briefly, current recommended screening age by MHLW is followed: colon, lung, breast cancer screening are age 40 years and older, and cervical cancer for aged 20 and older, and gastric cancer for aged 50 and older. Screening intervals are gastric, breast, and cervical cancer screening are two years, and colon and lung cancer screening are one year. Results The survey was completed by 1736 LHD (response rate: 99.9%). Regarding age-appropriate compliance, in cervical cancer, 96.4% of LHDs reported following recommended target age, while compliance was lower for lung, colon, breast, and gastric cancers at 79.4%, 75.7%, 60.2% and 4.2%, respectively. High compliance with recommendations for screening interval was identified for colon (99.7%) and lung (98.7%) cancers; this was substantially less for breast, cervical, and gastric cancer screening at 39.8%, 34.1%, and 4.6%, respectively. Conclusions In 2016, MLHW changed the starting screening age for gastric cancer from 40 to 50 years old, likely resulting in the lowest compliance in our analysis. Though it may take time for screening facilities to come into compliance with newer recommendations. Many LHDs provide screening without adhering to recommended starting ages, with a general tendency to provide screening at younger than recommended ages. This is a barrier to maximizing effectiveness and minimize harms of screening and warrants closer monitoring to promote efficiency in cancer screening programs. Key messages There is relatively low compliance with cancer screening guidelines in Japan. Establishing an environment of appropriate monitoring and support to achieve the goal of cancer screening is warranted.

Characteristics of ultrasonographic images of ductal carcinoma in situ with abnormalities of the ducts

PurposeAlthough the number of ductal carcinoma in situ (DCIS) cases has increased with the spread of breast cancer screening in Japan, there are very few reports that summarize ultrasound image features of DCIS. The Japan Association of Breast and Thyroid Sonology (JABTS) investigated the incidence of DCIS with masses and non-mass abnormalities and the characteristics of US images in a retrospective, multicenter, observational study (JABTS BC-02 study). The purpose of this report is to clarify the proportion of DCIS with abnormalities of the ducts with each ultrasound finding and the characteristics of US images.MethodsThe JABTS BC-02 study population was comprised of patients who were examined by ultrasonography, underwent surgery, and were histopathologically diagnosed with DCIS at each study site between January 2008 and December 2012. The US images of DCIS and pathology and clinical information were retrospectively collected from 16 institutions in Japan. The US images were evaluated by 22 experts on the Central Image Interpretation Committee of JABTS.ResultsAbnormalities of the ducts were noted in 78 (10.5%) of 705 US images of DCIS. Of the 78 cases, the distribution of abnormalities of the ducts was focal or segmental. The second characteristic was the presence of internal echoes in dilated ducts. All cases were accompanied by intraductal solid echoes, and 40 cases (51.3%) were accompanied by echogenic foci. In addition, intraductal solid echoes were continuous or multiple in 72 cases (92.4%), and the shape of the solid echoes was broad-based and/or irregular in 62 cases (79.5%).ConclusionDCIS cases with duct abnormalities on ultrasound were investigated in this study. The important characteristics were as follows: (1) the distribution of ductal dilatation was focal or segmental, (2) solid parts were present in the dilated ducts, (3) the distribution of internal echoes was continuous or multiple, (4) the shape of solid echoes was broad-based and/or irregular, and (5) internal echoes were sometimes accompanied by echogenic foci. Accurate evaluation of these findings may be useful for diagnosing DCIS. Although the duct abnormalities are included in “ASSOCIATED FEATURES” in ACR BI-RADS ATLAS (USA), we emphasize that this concept is very important for understanding US characteristics of DCIS.

Trends in Uterine Cervical Cancer Screening at Physical Health Checkups for Company Employees in Japan.

The consultation rate for uterine cervical cancer screening in Japan is markedly low in comparison with other developed countries. The purpose of this study is to investigate the trends in uterine cervical cancer screening during regular company checkups and to identify potential problems. Questionnaires were sent to occupational health physicians through Sansuiken (Alumni Association of the University of Occupational and Environmental Health, Japan). Overall, 127 valid responses showed that Papanicolaou (Pap) tests are conducted in 100 companies (79%). The detailed information from 50 of the 100 responses was analyzed. Mandatory cervical cancer screenings are performed at just 6 companies (12%). Pap test are started at 30 years of age at 9 of 49 companies, and only 18 of 49 companies (37%) start Pap tests for employees at 20 years old. Of the 86,695 women, 31,294 (36%) received cervical cancer screening. Abnormal Pap test results were detected in 3.0%. Although cervical cancer screening rates have slightly increased compared to our previous studies (17% in 2004, 23% in 2008), it remains at a low level. Complete examinations with colposcopy and punch biopsy were carried out in 70% (61 of 87 women) of those with an abnormal Pap test. Twelve of 26 companies had no information about detailed examination results. It is important to note that cervical cancer incidence and mortality are increasing among young women in Japan. Occupational physicians and health nurses should manage female health education and care at the workplace, by including uterine cervical cancer screening in the growing female working population.

The Impact of Triage for Atypical Squamous Cells of Undetermined Significance with Human Papillomavirus Testing in Cervical Cancer Screening in Japan

Background:One of the features of cervical cancer screening using the combination of cytology and human papillomavirus (HPV) testing is the triage for atypical squamous cells of undetermined significance (ASC-US). The effectiveness of the triage has been recognized widely. However, there are few reports evaluating this triage process in Japan.Material and Methods:We retrospectively examined the results of cytology and HPV co-testing for cervical cancer screening in the Oyama area of Tochigi Prefecture between 2012 and 2014. Women who were ASC-US/HPV positive and had cytologic abnormalities [low-grade squamous intraepithelial lesions (LSIL) or worse] were examined by colposcopy. The results of the colposcopy testing were evaluated. In addition, we also examined the results of those who underwent co-testing a year after a ASC-US/HPV-negative result.Results:A total of 21,342 women received their first screening test during the study period, with 542 (2.5%) found to have ASC-US. Of the ASC-US-positive women, 289 (53.3%) were also HPV positive. The prevalence of CIN+ (cervical intraepithelial neoplasia or higher) in the ASC-US/HPV-positive group was 63.2%, with 81.8%, 16.4% and 4.8%. showing CIN 1, CIN 2 and CIN 3+, respectively. The prevalence of CIN+ in the LSIL group was 66.8%, with the majority having a low risk CIN 1 (76.6%) compared to CIN 2 (18.6%), and CIN 3+ (4.8%). No significant difference was observed between the LSIL and ASC-US/HPV-positive groups. The prevalence of women diagnosed with CIN in the ASC-US/HPV-negative group, following co-testing a year after colposcopy was low (3%).Conclusions:The ASC-US/HPV-positive group was comparable to the LSIL group in terms of prevalence of CIN+ lesions. Furthermore, low CIN prevalence after one year in the ASC-US/HPV-negative group provides confirmation that the screening interval could be extended. The application of HPV triage (which is routine in other countries) to identify these groups would be of benefit in Japan.

Annual Report 2015 on Breast Cancer Screening in Japan

Annual Report 2015 on Breast Cancer Screening in Japan

PCN209 - ASSOCIATION BETWEEN AGE FACTORS AND STRATEGIES FOR PROMOTING PARTICIPATION IN GASTRIC AND COLORECTAL CANCER SCREENINGS

Despite the long history of cancer screening in Japan, the participation rates in gastric and colorectal cancer screenings have not increased. Although strategies for improving the participation rates have been proposed, the differences of these effects among age groups are unclear. The Japanese government conducted a national survey for all municipalities to investigate with or without the implementation of promotion strategies for increasing participation in cancer screening in 2010. We investigated the association between age factors and strategies for promoting participation in cancer screening based on this national survey. Multiple regression analysis with generalized linear model was performed using the participation rates in gastric and colorectal cancer screenings as dependent variables, and the following strategies for promoting participation as independent variables: 1) personal invitation letters, 2) household invitation letters, 3) home visits by community nurses, 4) screenings in medical offices, and 5) free cancer screening programs. 1,639 municipalities for gastric cancer screening and 1,666 municipalities for colorectal cancer screening were selected for the analysis. In gastric and colorectal cancer screenings, the participation rates of individuals aged 60-69 years was higher than those of other age groups. Personal and household invitation letters were effective promotion strategies for all age groups, which encouraged even older people to participate in gastric and colorectal cancer screenings. Screening in medical offices and free screenings were not effective in all age groups. Home visit were effective, but its adoption was limited to small municipalities. Although personal and household invitation letters are effective strategies for promoting participation in cancer screening for all age groups, these strategies equally encourage older people to participate in gastric and colorectal cancer screenings. If resource is limited to send invitation letters, priority should be considered as individuals aged their 50s and 60s for gastric and colorectal cancer screening.

Cost-effectiveness of Helicobacter pylori screening followed by eradication treatment for employees in Japan.

Gastric cancer is the third leading cause of cancer death worldwide. Gastric cancer screening using upper gastrointestinal series, endoscopy and serological testing has been performed in population-based (employee-based and community-based) and opportunistic cancer screening in Japan. There were 45 531 gastric cancer deaths in 2016, with the low screening and detection rates. Helicobacter pylori (H. pylori) screening followed by eradication treatment is recommended in high-risk population settings to reduce gastric cancer incidence. The aim of this study was to evaluate the cost-effectiveness of H. pylori screening followed by eradication treatment for a high-risk population in the occupational health setting. Decision trees and Markov models were developed for two strategies; H. pylori antibody test (HPA) screening and no screening. Targeted populations were hypothetical cohorts of employees aged 20, 30, 40, 50 and 60 years using a company health payer perspective on a lifetime horizon. Per-person costs and effectiveness (quality-adjusted life-years) were calculated and compared. HPA screening yielded greater benefits at the lower cost than no screening. One-way and probabilistic sensitivity analyses using Monte-Carlo simulation showed strong robustness of the results. H. pylori screening followed by eradication treatment is recommended to prevent gastric cancer for employees in Japan, on the basis of cost-effectiveness.

Association between dietary inflammatory index and high-sensitive C-reactive protein levels in cancer screening in Japanese

Introduction Inflammation is related to the development of many cancers. Diet plays an important role in the regulation of inflammation. The dietary inflammatory index (DII®) is a literature-derived dietary index designed to assess the impact of diet on individual inflammation status. However, most validation studies of DII conducted to date have been done in Western countries, indicating the need for evaluation in Asian populations. The aim of this study was to validate DII scores derived from a food frequency questionnaire (FFQ) with high-sensitive C-reactive protein (hs-CRP) levels in participants undergoing cancer screening in Japan. Methods In cancer screenings conducted from 2009 to 2013 in the National Cancer Center in Japan, 7919 participants aged 40–70 years answered the FFQ and received blood analysis for hs-CRP. Of these, we excluded participants with a body mass index (BMI) of 40 kg/m2 (n = 13); missing data on smoking status (n = 1) or metabolic equivalents (Mets, n = 1); history of cancer, stroke, or myocardial infarction (n = 877); extreme energy intake (upper and lower 2.5 percentiles, n = 349); missing data on alcohol consumption (n = 120); and missing data of hs-CRP, or hs-CRP > 1.0 mg/dL (n = 84). Finally, 6474 participants (3825 for men and 2649 for women) were included in this analysis. DII was calculated from crude intake from the FFQ and adjusted for energy using the density method. Adjusted geometric mean levels of hs-CRP were calculated using a multivariable linear regression model by quartiles of DII score. P for trend across quartiles of DII score were calculated using DII quartiles as continuous variables. Further, logistic regression analysis was also applied to estimate odds ratio (OR) [95% confidence interval (95% CI)] of hs-CRP > 0.3 mg/dL across quartiles of DII score. These statistical models were adjusted by age, body mass index (BMI), smoking status, and metabolic equivalents. Results Mean (standard deviation, SD) energy-adjusted DII for men and women was 0.62 (1.93) and −1.01 (2.25), respectively. Mean (SD) hs-CRP levels for men and women was 0.09 (0.11) mg/dL and 0.07 (0.10) mg/dL, respectively. We found a significant positive association between DII scores and geometric means of hs-CRP levels in men (P 0.3 mg/dL was 1.17 (1.02–1.35) in men and 0.99 (0.79–1.24) in women. On stratified analysis by age and BMI in women, a marginal positive association was observed in women with 25 ≤ BMI Conclusions DII assessed by FFQ was correlated with hs-CRP level in Japanese men, but not in Japanese women.

Association between age factors and strategies for promoting participation in gastric and colorectal cancer screenings

BackgroundDespite the long history of cancer screening in Japan, the participation rates in gastric and colorectal cancer screenings have not increased. Strategies for improving the participation rates have been proposed, but differences in their effects among different age groups remain unclear.MethodsThe Japanese government conducted a national survey in all municipalities in Japan in 2010 to investigate whether the implementation of promotion strategies increased participation in cancer screening. We investigated the association between age factors and strategies for promoting participation in cancer screening based on this national survey. Multiple regression analysis with generalized linear model was performed using the participation rates in gastric and colorectal cancer screenings as dependent variables, and the following strategies for promoting participation as independent variables: 1) personal invitation letters, 2) household invitation letters, 3) home visits by community nurses, 4) screenings in medical offices, and 5) free cancer screening programs.ResultsOne thousand six hundred thirty nine municipalities for gastric cancer screening and 1666 municipalities for colorectal cancer screening were selected for the analysis. In gastric and colorectal cancer screenings, the participation rates of individuals aged 60–69 years was higher than those of other age groups. Personal and household invitation letters were effective promotion strategies for all age groups, which encouraged even older people to participate in gastric and colorectal cancer screenings. Screening in medical offices and free screenings were not effective in all age groups. Home visits were effective, but their adoption was limited to small municipalities.ConclusionsTo clarify whether promotion strategies can increase the participation rate in cancer screening among different age groups, 5 strategies were assessed on the basis of a national survey. Although personal and household invitation letters were effective strategies for promoting participation in cancer screening for all age groups, these strategies equally encouraged older people to participate in gastric and colorectal cancer screenings. If resource for sending invitation letters are limited, priority should be given to individuals who are in their 50s and 60s for gastric and colorectal cancer screening.