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Abstract: Background: In Japan, the bivalent HPV vaccine was approved in October, 2009 and became available as a non-routine vaccine from December, 2009. While routine vaccinations are free, the cost and responsibility for non-routine vaccinations are left to the individual. In exceptional circumstances regional governments fund non-routine vaccinations. This was the case in Shiki City, Saitama Prefecture, where a high uptake rate for individual (non-school based) HPV vaccination was obtained. Materials: On January 20, 2010, the mayor of Shiki City announced to the media his decision to vaccinate adolescent girls in Shiki City against HPV. A project team for HPV vaccination was set up in the city''s Health Promotion Center. To gain mutual consent for HPV vaccination, senior health professionals, city officials, the head of the board of education, school principals and health-care teachers met several times. The cohort to be vaccinated was 1254 girls aged 12–15 years. Individual notifications were mailed to each girl on April 23, 2010, along with information about the HPV vaccine. Conclusions: As of April 10th, 2011, the uptake rate for girls aged 15 years old was 90.7% for the 1st dose. The vaccine registry is managed by the health care system of the city. The success of the HPV vaccination program and high uptake rates in Shiki City is a good model for the nationwide HPV vaccination program that started in February, 2011. [Copyright &y& Elsevier]

Background: Little is known about clinical or sociodemographic factors that influence health-related quality of life (HRQoL) in patients with adult congenital heart disease (ACHD).Methods and Results: We conducted a nationwide prospective cross-sectional multicenter study at 4 large ACHD centers in Japan. From November 2016 to June 2018, we enrolled 1,223 ACHD patients; 1,025 patients had an HRQoL score. Patients completed a questionnaire survey, including sociodemographic characteristics, and the 36-Item Short-Form Health Survey (SF-36). To determine factors associated with HRQoL, correlations between 2 SF-36 summary scores (i.e., physical component score [PCS] and mental component score [MCS]) and other clinical or sociodemographic variables were examined using linear regression analysis. In multivariable analysis, poorer PCS was significantly associated with 11 variables, including older age, higher New York Heart Association class, previous cerebral infarction, being unemployed, and limited participation in physical education classes and sports clubs. Poorer MCS was associated with congenital heart disease of great complexity, being part of a non-sports club, current smoking, and social drinking. Student status and a higher number of family members were positively correlated with MCS., Conclusions: This study demonstrates that HRQoL in ACHD patients is associated with various clinical and sociodemographic factors. Further studies are needed to clarify whether some of these factors could be targets for future intervention programs to improve HRQoL outcomes.

Background: The coronavirus disease 2019 (COVID-19) pandemic has rapidly and dramatically influenced healthcare across Japan. However, the influence of the COVID-19 pandemic on the number of newly diagnosed cancer, surgical treatment, and diagnostic examination for cancer types have not been completely investigated all over Japan. This study aimed to analyze the number of cases before and during the COVID-19 pandemic., Methods: This retrospective study was a survey that asked to provide the number of cases diagnosed with gastric, colorectal, lung, breast, and cervical cancer between January 2019 and December 2020. The survey was sent to tertiary healthcare hospitals, including national cancer institutions, university hospitals, and general hospitals, all over Japan. Data obtained from 105 of 486 surveyed hospitals were evaluated, and the number of cases in each quarter in 2020 was compared with that in the equivalent quarter in 2019., Results: In the second quarter (Q2), significant reductions were observed in the median number of newly diagnosed cases from 2019 to 2020: gastric cancer, 26.7% (43 vs. 32, p <  0.001); colorectal cancer, 17.9% (52 vs. 40, p <  0.001); lung cancer, 12.3% (53.5 vs. 47, p <  0.001); and breast cancer, 13.1% (43 vs. 35.5, p <  0.001). A significant reduction of 11.4% (9 vs. 8, p = 0.03) was observed in the third quarter (Q3) for cervical cancer. In Q2, the number of cases decreased by 30.9% (25 vs. 15, p <  0.001) for stage I gastric cancer, by 27.3% (12 vs. 9, p <  0.001) for stage I colorectal cancer, and by 17.6% (13 vs. 10, p <  0.001) for stage II breast cancer. The magnitude of reduction was significant for the localized stages of gastric, colorectal, and breast cancer according to diagnostic examinations in Q2 and surgical and endoscopic treatment in Q3 rather than that for lung or cervical cancer., Conclusions: COVID-19 has prolonged collateral effects on cancer care, including examination, diagnosis, and surgery, with significant effects on gastric cancer, followed by colorectal, lung, breast, and cervical cancer in Japan., (© 2022. The Author(s).)

Competing Interests: Declaration of competing interest Kenro Chikazawa received lecture honoraria from ETHICON (Tokyo, Japan), Terumo (Tokyo, Japan), and Chugai Pharmaceutical Co. (Tokyo, Japan). Ryo Konno received research funding from Yakult Pharmaceutical Industry Co (Tokyo, Japan) and Chugai Pharmaceutical Co (Tokyo, Japan), as well as lecture honoraria from Japan Vaccine Co (Tokyo, Japan), MSD Japan (Tokyo, Japan), Chugai Pharmaceutical Co (Tokyo, Japan), and Kaken Pharmaceutical Co (Tokyo, Japan). Ken Imai, Takaaki Ito, and Tomoyuki Kuwata have no conflicts of interest to declare.

Background: Family caregivers of people with dementia (PWDs) experience significant physical, psychological, and social burdens. Empowerment, which refers to the process of gaining power in society through behavioral change, is important to coping successfully with care-related burdens. The high burden of care faced by family caregivers in Japan often makes accepting social support difficult for caregivers of PWDs, resulting in feelings of isolation. Clarifying what components constitute empowering experiences for family caregivers of PWDs is necessary to gain a better understanding of their empowerment experiences and to develop relevant support schemes., Purpose: This study was developed to describe the components of empowerment experienced by family caregivers of community-dwelling PWDs in Japan., Methods: This qualitative descriptive study used semistructured in-depth interviews to explore components of empowerment experienced by family caregivers of adults/older adults with dementia. Purposive sampling was used to recruit 20 family caregivers (age range: 50-87 years) from four self-help groups. A qualitative content analysis method was used to analyze the data. The components derived from the interviews were reviewed by three nursing researchers not directly involved in this study who are specialists in qualitative research and geriatric nursing., Results: Four categories and 12 subcategories were derived to illuminate the components of empowerment among family caregivers of PWDs. Specifically, these categories were as follows: (a) proactive aspects of dementia care that were acquired through the caregiving experience, (b) creating a relationship that respects PWDs, (c) Building relationships based on mutual understanding of one's surroundings, and (d) understanding the social aspects of dementia care., Conclusions/implications for Practice: The findings of this study provide additional understanding of the components of the empowerment experiences of family caregivers of PWDs in Japan and in other East Asian countries experiencing increasing dementia diagnoses and population aging. In addition, the structural components of empowerment offer a useful perspective for health professionals on assessment and intervention that is framed on the cultural characteristics of East Asia. Ultimately, the results suggest that healthcare professionals should develop intervention programs that are tailored to the needs of caregivers at different levels of empowerment., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc.)

Background: Although more than 10 years have passed since HPV vaccination was implemented, first as an interim programme (Emergent vaccine promotion programme) in November 2010, followed by incorporating into the National Immunization Programme in April, 2013 and suspended in June 2013, limited studies have investigated the HPV vaccine effectiveness against high-grade cervical lesions in Japan., Methods: We collected the matched data of the results of cervical biopsy and history of vaccination from the Japan Cancer Society database. The subjects were women aged 20 to 29 years screened for cervical cancer between April, 2015 and March, 2017, and with information on HPV vaccination status. We estimated the relative risk of developing high-grade cervical lesions in vaccinated subjects using Poisson regression as compared to unvaccinated subjects., Results: Among the 34,281 women screened, 3770 (11.0%) were vaccinated. The prevalence of CIN2+ was statistically significantly lower in the vaccinated women as compared to the unvaccinated women (Vaccine Effectiveness (VE) =76%; RR = 0.24, 95% CI:0.10-0.60). High VE against CIN3+ was also observed (91%; RR = 0.09, 95% CI:0.00-0.42)., Conclusion: Women aged 20-29 years who received at least one dose of HPV vaccine had a significantly lower risk of high-grade cervical lesions than those not vaccinated. In Japan, HPV vaccination should be resumed in order to reduce the incidence of cervical cancer.

Purpose: The aim of the study was to investigate if ultrasound probes are reusable medical devices that risk becoming contaminated after a patient examination in Japan., Methods: The level of bacterial contamination on transvaginal ultrasound (TVU) probes following current routine probe cleaning at a university hospital (site A) and a clinic (site B) in Japan was investigated., Results: A total of 98.1% of probes were found to be contaminated at site A (median CFU 40, IQR 10, 132.5) and 94.1% were found to be contaminated at site B (median CFU 50, IQR 20, 85). Of the contaminated probes, 52.9% at site A and 64.6% at site B harbored potentially pathogenic bacteria including methicillin-resistant Staphylococcus aureus (MRSA)., Conclusion: These findings suggest that there is a high rate of ultrasound probe residual bacterial contamination in Japan.

The effectiveness of HPV vaccine against HSIL+ (pathologically diagnosed CIN2+) in the first cohort in Japan was investigated in 22,743 women aged 20 to 29 years (parts of national cervical cancer screening program of FY [fiscal year] 2015, the Japan Cancer Society). Vaccinated women had a statistically significant 69% lower risk of HSIL+ as compared to the unvaccinated women; the crude relative risk estimate was 0.31 (95% CI: 0.11-0.83; p-value = 0.013) by normal approximation and 0.31 (95% CI: 0.08-0.80; p-value = 0.009) by the exact Poisson regression. The effect of age was not significant (chisq = 7.7 (df = 9), p-value = 0.569) and the estimate of relative risk remained essentially intact after adjustment for age. This study brings scientific evidence on the effectiveness of HPV vaccine on development of cervical high grade lesions., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: When evaluating health-economics for cervical cancer prevention policies in Japan, it is important to use Japanese value settings. This study aimed to obtain preference-based measures (preference measures) for hypothesized health states among healthy Japanese women, and to examine differences between the EuroQol-5D (EQ-5D) and standard gamble (SG) instruments., Materials and Methods: The investigation was performed among female students at a nursing university. We used written hypothetical scenarios describing three grades of cervical intraepithelial neoplasia (CIN) and eight stages of cervical cancer, both at diagnosis and after medical intervention. Preference measures were evaluated using both EQ-5D and SG., Results: We received responses from 136 women. The mean number of respondents per stage was 24.6 (SD: 2.7). At diagnosis, average EQ-5D scores for CIN1, CIN2, CIN3, IA1, IA2, IB1, IB2, IIA, IIB, III, and IV stages were 0.84 (0.14), 0.78 (0.12), 0.73 (0.10), 0.78 (0.12), 0.72 (0.12), 0.63 (0.13), 0.64 (0.12), 0.68 (0.08), 0.62 (0.13), 0.55 (0.21), and 0.18 (0.24), respectively. Using one-way analysis of variance with the Tukey-Kramer method for multiple comparisons (each stage vs. CIN1), we found significant differences for IB1 and more advanced stages (p<0.05). After medical intervention, corresponding EQ-5D scores were 0.84 (0.12), 0.81 (0.12), 0.84 (0.12), 0.80 (0.15), 0.78 (0.11), 0.64 (0.15), 0.63 (0.15), 0.71 (0.15), 0.50 (0.17), 0.52 (0.17), 0.21 (0.28). The multiple comparisons identified significant differences for IB1 and more advanced stages, excepting IIA (p<0.05). SG evaluations were more variable and relatively higher than EQ-5D evaluations., Conclusions: We obtained preference measures for three grades of CIN1-3 and eight stages of cervical cancer. In combination with appropriate sensitivity analyses, these preference measures will provide a basis for an economic evaluation of cervical cancer prevention in Japan. We suggest that EQ-5D is appropriate for cost-utility analysis of this topic.

Background: No studies on male attitudes towards HPV and HPV vaccination have been conducted in Japan, and little is known globally whether attitudes of single fathers differ to those living with a female partner. This exploratory study assessed whether Japanese fathers were likely to have their daughter vaccinated against HPV in a publically funded program and whether any differences existed regarding attitudes and knowledge about HPV according to marital status., Materials and Methods: Subjects were 27 fathers (16 single; 11 married) who took part in a study on HPV vaccine acceptability aimed at primary caregivers of girls aged 11-14 yrs in three Japanese cities between July and December 2010., Results: Knowledge about HPV was extremely poor (mean score out of 13 being 2.74 ± 3.22) with only one (3.7%) participant believing he had been infected with HPV and most (81.4%) believing they had no or low future risk. No difference existed regarding knowledge or awareness of HPV according to marital status. Concerning perceived risk for daughters, single fathers were significantly more likely to believe their daughter was at risk for both HPV (87.5% versus 36.4%; p=0.01) and cervical cancer (75.0% versus 27.3%; p=0.02). Acceptability of free HPV vaccination was high at 92% with no difference according to marital status, however single fathers were significantly more likely (p=0.01) to pay when vaccination came at a cost. Concerns specific to single fathers included explaining the sexual nature of HPV and taking a daughter to a gynecologist to be vaccinated., Conclusions: Knowledge about HPV among Japanese fathers is poor, but HPV vaccine acceptability is high and does not differ by marital status. Providing sexual health education in schools that addresses lack of knowledge about HPV as well as information preferences expressed by single fathers, may not only increase HPV vaccine acceptance, but also actively involve men in cervical cancer prevention strategies. However, further large-scale quantitative studies are needed.

In this open, extended follow-up study (NCT00929526, Clinicaltrials.gov), we evaluated the human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine efficacy, immunogenicity and safety up to 4 years after first vaccination in Japanese women aged 20-25 years. In the initial randomized, double-blind study (NCT00316693), 1040 women received the study vaccine or hepatitis A control vaccine; 752 women were included in the follow-up study. In women from the according-to-protocol efficacy cohort (ATP-E), who were initially seronegative for the HPV type analyzed, no cervical intraepithelial neoplasia (CIN) grade 1 or greater (CIN1+) cases associated with HPV-16/18 were reported in the HPV group, while in the control group, 5 cases were identified in extended follow-up analyses (vaccine efficacy [VE] 100% [95% CI: -3.7-100]) and 8 cases in combined initial and follow-up studies analyses (VE 100% [42.2-100]). In the ATP-E, VE against CIN1+ and CIN2+ associated with high-risk HPV types reached 66.4% (21.6-87.1) and 83.0% (22.1-98.2) in extended follow-up analyses, and 63.4% (28.8-82.3) and 77.3% (30.4-94.4) in analyses of combined studies, respectively. During the 4-year period, protection against CIN1+ and CIN2+, irrespective of the HPV type, was 56.7% (32.8-72.6) and 54.9% (20.5-75.3) in women receiving ≥1 vaccine dose, regardless of baseline serostatus (total vaccinated cohort [TVC]) and 61.0% (11.8-84.2) and 73.9% (1.1-95.3) in women naïve to HPV infection at baseline (TVC-naïve), respectively. The high VE observed in Japanese women, accompanied by a sustained immune response and a clinically acceptable safety profile, support findings of large, international trials.

To better understand how to achieve high uptake rates of human papillomavirus (HPV) vaccination in Japan, we investigated acceptance of and attitudes towards HPV vaccination in 2192 mothers of girls aged 11-14 yrs. A school-based survey was conducted in five elementary and fourteen junior high schools in Sapporo, Japan. Responses from 862 participants were analyzed. Ninety-three percent of mothers would accept the vaccine for their daughter if free, but only 1.5% was willing to pay the minimum recommended price of ¥ 40,000. Vaccine acceptance was higher in mothers who had heard of HPV vaccine (adjusted odds ratio, aOR=2.58, confidence interval, CI=1.47-4.53), and who believed susceptibility to (aOR=2.30, CI=1.34-3.92) and severity of (aOR=3.73, CI=1.41-9.88) HPV to be high. Recommendations from a doctor (aOR=12.60, CI=7.06-21.48) and local health board (aOR=27.80, CI=13.88-55.86) were also positively associated with increased HPV vaccine acceptance. Concerns about side effects of both the HPV vaccine (aOR=0.03, CI=0.01-0.08) and routine childhood vaccines in general (aOR=0.11, CI=0.02-0.78) emerged as barriers to vaccination. Not participating in routine cervical screening also emerged as a deterrent (aOR=0.49, CI=0.27-0.91). While most mothers (66.8%) agreed that 10-14 yr was an appropriate age for vaccination, a further 30.6% believed >15 yr to be more appropriate. In conclusion, attitudes of Japanese mothers toward HPV vaccination are encouraging. While lower vaccine acceptance in mothers who do not undergo regular cervical screening needs further investigation, this study indicates that high uptake may be possible in a publically funded HPV vaccination program if physicians actively address safety concerns and justify why the vaccine is needed at a particular age., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: Human papillomavirus (HPV) type 16/18 AS04-adjuvanted vaccine was shown to be highly immunogenic and generally well tolerated in the interim analysis of a phase 2 double-blind, randomized controlled multicenter study in Japanese healthy women aged 20 to 25 years. Vaccine efficacy, immunogenicity, and safety are assessed in this study through 24 months after the first vaccination., Methods: Japanese women aged 20 to 25 years were randomly assigned to receive either HPV-16/18 AS04-adjuvanted vaccine (n = 519) or hepatitis A vaccine (n = 521) at 0, 1, and 6 months. Women were assessed for virological, cytological, and histological end points associated with HPV-16/18 and 12 other oncogenic HPV types (types 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, and 68) in cervical specimens and for the vaccine safety and immunogenicity. Antibody concentrations were measured by an enzyme-linked immunosorbent assay. Primary efficacy analysis was performed in the according-to-protocol cohort for efficacy, primary immunogenicity analysis was performed in the according-to-protocol cohort for immunogenicity, and primary safety analysis was done in the total vaccinated cohort., Results: Vaccine efficacy against persistent infections (6 month definition) associated with HPV-16/18 was 100% (95.5% confidence interval, 71.3-100; P < 0.0001). Vaccine efficacy against cervical intraepithelial neoplasia 1+ associated with 14 oncogenic HPV types was 64.9% (95.5% confidence interval, 4.9-89.0; P = 0.02). At 24 months after the first dose of the vaccine, geometric mean antibody titers against HPV-16 and HPV-18 were 1521.5 enzyme-linked immunosorbent assay U/mL and 627.4 enzyme-linked immunosorbent assay U/mL, respectively. The HPV-16/18 AS04-adjuvanted vaccine had a clinically acceptable safety profile., Conclusions: The HPV-16/18 AS04-adjuvanted vaccine showed excellent prophylactic efficacy against 6-month persistent infection with HPV-16/18. The HPV-16/18 AS04-adjuvanted vaccine was generally well tolerated and immunogenic in the study population of healthy Japanese women aged 20 to 25 years.

A phase II, double-blind, controlled randomized multicenter study with human papillomavirus (HPV) 16/18 AS04 (3-O-desacyl-4'-monophosphoryl lipid A and aluminum hydroxide)-adjuvanted vaccine is ongoing in Japanese women aged 20 to 25 years. An interim analysis was performed at month 7 (1 month after the third dose of vaccine) to determine reactogenicity, safety, and immunogenicity of the vaccine and to evaluate the baseline HPV-16/18 seropositivity and DNA status of women. In the HPV-16/18 group (according-to-protocol cohort for immunogenicity analysis), 100% seroconversion was observed against HPV-16 and HPV-18 at month 6 (5 months after the second dose) and at month 7. At month 7, anti-HPV-16 geometric mean titer (GMT) was 7441.0 enzyme-linked immunosorbent assay units/mL and anti-HPV-18 GMT was 3805.4 enzyme-linked immunosorbent assay units/mL, which is, respectively, 250- and 168-fold higher than GMTs observed after natural infection with HPV-16 or HPV-18. In the total vaccinated cohort, the seropositivity rates against HPV-16 and HPV-18 at study entry were 17.3% and 15.8%, respectively. At the same time point, HPV-16 and HPV-18 DNA was detected in 6.5% and 4.0% of the women, respectively. The immunogenicity of the HPV-16/18 vaccine and the HPV prevalence before vaccination in Japanese women are in line with what was observed in other populations. Injection site symptoms and some general symptoms were reported more frequently in the HPV-16/18 group than in the hepatitis A vaccine group but had no impact on compliance with completion of the vaccination course. Overall, the HPV-16/18 vaccine had a good safety profile, was well tolerated, and is highly immunogenic in the study population of Japanese women.

Cervical cancer is a common cancer among women in Japan and Korea. Implementation of national cervical cancer screening programs has led to a reduction in the incidence of cervical cancer in both countries. However, over the past decade, there has been a recent marked increase in cervical cancer incidence among young women in Japan. Human papillomavirus (HPV) is found in the majority of cervical cancers, and HPV-16 and 18 are the two most common types. The next most frequent HPV types in cervical cancer are 52, 58 and 33 for Japan and 52, 58, and 33 for Korea, varying slightly when compared to the worldwide distribution. Screening coverage for both countries remains a challenge. Current coverage is reported at 24% in Japan, with the lowest coverage in young Japanese women, and 41% in Korea. Cytology remains the predominant screening method. HPV DNA testing is widely used to triage women with abnormal cytology in Korea. HPV vaccines have been licensed in Korea, but not yet in Japan. In both countries cost is a substantial impediment to implementation and no national programs are currently planned or in place. Therefore, increased disease awareness and utilization of screening is the first priority for controlling cervical cancer.

Background: Interleukin-18 (IL-18), a cytokine produced by macrophages, is capable of inducing T-lymphocyte synthesis of interferon-gamma (IFN-gamma). In this study, for the first time, the serum concentration of IL-18 and its significance as a prognostic indicator was evaluated in patients with epithelial ovarian cancer., Methods: The serum IL-18 level was measured by an enzyme-linked immunosorbent assay (ELISA) in 69 patients with epithelial ovarian cancer and 8 healthy controls. Relationships between the IL-18 level and clinicopathological features were examined by univariate and multivariate analyses., Results: The median serum IL-18 level in the ovarian cancer patients was 229.6 pg/ml, and the level was significantly elevated compared with that in the normal controls (151.3 pg/ml; P < 0.01). No significant correlations were detected between the IL-18 level and stage or histology (P = 0.08 and P = 0.12, respectively). On univariate analysis, overall survival was shown to be affected by IL-18 serum levels. However, multivariate analysis failed to demonstrate an independent prognostic significance for IL-18 serum levels, while confirming the role of previously established prognostic variables, such as performance status, stage, and residual tumor., Conclusion: This study showed that IL-18 serum levels were elevated in ovarian cancer patients and were correlated with overall survival, although they were shown not to be an independent prognostic factor.

A questionnaire survey was administered by Tohoku University hospital to investigate the current status of gynecological laparoscopic operations in teaching hospitals in which residents were trained as obstetricians and gynecologists. Thirty-eight senior doctors in 18 hospitals were sent a postal questionnaire. The response rates of facilities and doctors were 94.4% and 76.3% respectively. Diagnostic and operative laparoscopy was performed in all of the hospitals surveyed, however only a few hospitals performed more than 100 laparoscopies per year, and many surgeons did not perform advanced laparoscopic operations including hysterectomy, myomectomy and lymphadenectomy. Half of the doctors performed minilaparotomy, which is a so-called "open" technique. The standard surgical style involved the use of a carbon dioxide (CO2) pneumoperitoneum and an endoscope 10 mm in diameter. Unipolar endocoagulating instruments were generally used for hemostasis and incision. Most of the doctors surveyed thought that operative laparoscopy would become a necessary procedure in gynecological field, and half of them hoped to receive training in the technique. Instruction of expert endoscopic surgeons is necessary, especially in teaching hospitals, for the spread of safe and advanced laparoscopic surgery. An educational and training system for established surgeons as well as for young residents is urgently needed in Japan.

The current standards for surgical procedures and lymph node dissection of endometrial cancer in Japan were investigated using a questionnaire survey. The estimated clinical stages used in the questionnaire were predicted from preoperative diagnostic imaging, histopathology of endometrial biopsies and intraoperative findings using a new classification, Federation Internationale de Gynecologie et d'Obstetrique (FIGO) in 1988. Questionnaires were mailed to 235 institutions, and 212 institutions (90.2%) responded. As a standard surgery for endometrial cancer, institutions performed simple total hysterectomy or semiradical hysterectomy and bilateral adnexectomy, which accounted for 86% of all respondents. For stage I carcinoma, simple (44%) or semi-radical (47%) hysterectomy was carried out in 91% of institutions, while radical hysterectomy was selected in 84% of institutions when stage II carcinoma was diagnosed clinically. The consensus of this survey was that dissection of both the para-aortic and pelvic lymph nodes can be omitted in G1 cases showing lesions confined to the endometrium, and that pelvic lymph nodes should be dissected, but para-aortic lymph node dissection could be omitted in G1 or G2 cases demonstrating myometrial invasion of 1/2 or less. Moreover, findings from this survey suggest that biopsy or dissection of the para-aortic lymph nodes was required in G3 cases, or in those patients diagnosed with myometrial invasion more than 1/2.

In Miyagi Prefecture, mass screening for cervical cancer was initiated in 1961. We organized the project in cooperation with the Miyagi Cancer Society. Because cases detected in mass screening were treated earlier, their prognoses were better than cases diagnosed in outpatient clinics. A high proportion of patients detected in stage 0 and I showed improved prognoses. In 1983, the central government established the first Health and Medical Services Law for the Aged to support the project. The standardized death rate of cervical cancer in Miyagi Prefecture fell from 12.1 per 100,000 in 1961 to 4.0 per 100,000 in 1994. A case-control study revealed that women who were screened, compared with women who had no prior screening, had an odds ratio for invasive cervical cancer of 0.14. The time interval of following the last negative smear was assessed, and we found that an odds ratio for a one-year interval was 0.09. However, there still remain problems, such as the lack of a further increase in the screening rate, fixation of examinees, and increase in the incidence of young women. Uterine body cancer is one of the increasing malignancies in Japan, as well as worldwide. Its epidemiological characteristics are as follows; 1) over 50 years old, 2) infertile and irregular menstruation, 3) post-menopause, and 4) atypical genital bleeding. Screening for uterine body cancer was started in 1987 under the second Health and Medical Services Law for the Aged. The target of the screening is limited to cases with the high-risk factors above described. We reported the results of mass screening in Miyagi Prefecture, elucidated the characteristics of uterine cancer detected by mass screening, and indicated the problems.

Objective: To survey the results of mass screening for cancer of the endometrium performed over a six-year period in Miyagi Prefecture, Japan., Study Design: Materials were cytodiagnostic samples of the endometrium examined by the Miyagi Cancer Society. The samples were classified into two groups: The mass screening group, from whom samples were collected according to the Health and Medical Service Law for the Aged, and the outpatient group, consisting of samples from other patients. The rates of subjects judged to require close examination and the detection rate of cancer of the endometrium in the two groups were compared., Results: In the mass screening group, the rate of subjects judged to require close examination and the detection rate of cancer of the endometrium were 2.3% and 0.11%, respectively, while they were 5.9% and 0.39%, respectively, in the outpatient group; the differences between the two groups were significant., Conclusion: To improve the detection rate in mass screening for endometrial cancer according to the Health and Medical Service Law for the Aged, it is necessary to establish a new criterion for selecting subjects.

Cervical cancer is about 6 times more frequent in Ecuador than in Japan. We investigated the association between infection by the human papillomavirus (HPV) and the genesis of cervical cancer in specimens of lesions of the cervical epithelium obtained from patients in Ecuador and Japan. We also examined the results of HPV DNA detection and typing by the polymerase chain reaction (PCR) performed under the same technical conditions in areas with differing rates of cervical cancer. Purified tissue DNA from paraffin-embedded samples was amplified by PCR with universal and type-specific primers. HPV DNA was detected in 8 (20%) of 40 normal cervical epithelial samples from Ecuadorian patients, 19 (45%) of 42 low-grade squamous intraepithelial lesions (LSIL), 16 (50%) of 32 high-grade squamous intraepithelial lesions (HSIL), and 38 (81%) of 47 invasive squamous cell carcinomas (SCC) compared with 3 (10%) of 30 normal cervical specimens from Japanese patients, 107 (51%) of 210 HSILs, and 45 (71%) of 63 SCCs. The prevalence of HPV types 16 and 18 rose significantly with increasing histological grade (p < 0.05). The prevalence of HPV DNA decreased with increasing age in both Ecuadorian and Japanese patients. The detection rate and type-specific distribution of HPV DNA were not correlated with geographic location. Findings suggest that risk factors associated with poverty and underdevelopment may influence the prevalence of HPV infection and the sequence of events after HPV infection culminating in cervical cancer. These factors may help to explain the differing geographic distribution of this disease.

HPV infection was examined with Cytobrush in exfoliated cervical cells sampled from 347 women. HPV DNA analysis was conducted in two steps. The presence of HPV DNA was demonstrated by dot blotting and typing of HPV DNA was made by Southern blotting using biotinylated probes. Of 167 cases with cervical intra-epithelial neoplasia (CIN) and cervical carcinoma, HPV DNA was detected and typed in 25 cases (15.0%). HPV 16, 18, and 33 were found mainly, and no HPV 6 or 11 was detected. The frequency of HPV DNA was 7.1% of CIN I, 28.6% of CIN II, 54.5% of CIN III, and 50.0% of invasive carcinoma. HPV occurred in patients newly diagnosed as CIN at 25.8% and in those of diagnosed as CIN in the past and followed up, 7.6%. Of 180 healthy women, the screening test of FO8830 was positive for HPV DNA in four women (2.2%). The present system proved to be useful for facilitating large-scale clinical research.