Breast Cancer—Screening for Your Life
Malignant tumors of the breast are cancer’s greatest threat to women in Japan, accounting for 19.2 percent of case rates for the disease. While the survival rate remains around 90 percent, Japan’s mortality rate per 100,000 persons from breast cancer between 1960 and 2010 has consistently risen, and the rate for menopausal women spiked from around 10 to 38 per 100,000. Much of the rise can be chalked up to changes in lifestyle, including worsening dietary habits. Early detection of the disease is a key factor in both prevention and survival.
Physical breast exams—either self-exams or those administered by a physician—have long been recommended, and have been used successfully to spot both benign masses and cancerous tumors. However, these exams seldom detect masses of less than 5 mm in size. Since smaller cysts or tumors escape notice, the cancerous ones may have been growing for a year or more and already be well developed before they are discovered.
On a global level, governments are fighting breast cancer by supporting programs based on the pink ribbon initiative started in North America by the Susan G. Komen Foundation to encourage women to get screened. Regular screening using imaging methods such as x-ray mammography, ultrasound and magnetic resonance imaging (MRI) is the most efficient way to detect breast cancer.
In Scandinavian countries such as Sweden and Norway, screening rates are around 70 percent, and around 50 percent in North America. The only Asian country that has been successful in achieving a relatively high rate is Korea, between 40 to 50 percent.
By contrast, the screening rate in Japan is shockingly low—just 20 percent. The Japanese government’s target for women over the age of forty—who are most at risk—is 50 percent. Municipalities across the country issue coupons for free mammograms to women over a certain age, and some of them even advertise these screenings in the mass media.
Despite all that official persuasion, the vast majority of Japanese women still avoid screening. The reasons for this reluctance are complex: shyness, rationalization that there is no family history of the disease, and the notion that hospitals are where you go after something wrong is discovered, not for screening and prevention.
It Runs in the Family
Recent genetic research into breast cancer has reinforced the evidence that breast cancer tends to run in families. In North America, about 5 to 10 percent of breast cancer cases are classified as hereditary breast cancer, and Japan has started to produce similar results. BRCA 1 and 2 gene mutations, for example, are associated with higher rates of breast cancer in both women and men. Actress Angelina Jolie, whose mother passed away after a long fight with breast cancer, recently underwent an elective double mastectomy because she faced an 80 percent probability of developing the disease herself.
Although Jolie’s radical move apparently hasn’t helped to increase the number of Japanese women seeking screening, it has pushed some to submit their DNA for testing to find genetic markers for disease such as BRCA 1 and 2. That costs about 200,000 to 300,000 yen, however, and obviously isn’t for everyone. There is no reimbursement from the government for it, either.
Breast cancer affects a very small portion of women in their twenties and thirties, but increases in the forties to fifties age bracket, with the late forties to fifties being the peak. Generally speaking, the Japanese government and hospitals recommend that women be screened once every two years after the age of forty. Those with a family history of the disease or the BRCA 1 and 2 gene mutations, however, should start regular screening earlier, and do it every six months to one year.
How early can screenings find cancerous tissue? In general, X-ray mammography can spot groups of microcalcification measuring less than 100 microns by assessing a combination of shape and size.
There are merits and demerits to the various screening procedures. X-ray mammography is the starting line—very good for spotting calcified tissue, it represents the most widespread and simplest option. In Japan, mammography is also overwhelmingly used for screening and biopsies. However, it is not effective enough for scanning high-density breast tissue.
Ultrasound is useful for identifying masses and cysts, and is better for examining breasts with high-density tissue, which is more common in younger women, and costs about five to six thousand yen. MRI testing is the best detection option, but is also very expensive—from about 40,000 to 50,000 yen. Medical facilities frequently offer screening packages that combine mammography and ultrasound as an option in the popular ningen dokku physical exams that millions of Japanese go through every year.
Not many medical facilities can supply a system and workstation that can cross-reference the data from the spectrum of x-ray mammography, ultrasound and MRI screening options, which provide varying perspectives on the potentially cancerous mass. In the near future, however, it may be possible to diagnose certain types of cancerous tissue by using different types of x-rays or dedicated workstations in what is known as multimodality breast image management.
A more relevant point is whether the hospital a patient wishes to use not only has such a setup but also has specialists knowledgeable enough to interpret the data accurately. Hospitals and clinics may not have all of the screening options available. Breast radiologists need to be trained to provide comprehensive breast diagnoses involving multimodality.
Boosting screening is essential to preventing a further rise in breast cancer rates, and Japan is slowly gaining dedicated medical facilities that focus on breast imaging. HealthyIM is ready to introduce women from Japan and abroad to these facilities so that they can get the dedicated screening needed to avoid breast cancer and the pain and anguish it brings.