Objective: Routine, population-based mammographic screening for breast cancer has been implemented nationally in Japan for the past decade. The objective of this study was to evaluate the knowledge of the general public and of nurses concerning breast screening practices in Japan, especially with regards to the benefits and risks of breast cancer screening.

Methods: In 2014, a questionnaire regarding the benefits and risks of breast cancer screening was administered to women who underwent breast cancer screening and to registered nurses. The questionnaire was distributed to 1,649 women and 1,905 registered nurses.

Results: Completed questionnaires were returned by 1,552 (94.1%) of the screened participants and 1,710 (89.8%) nurses. The majority of the screened participants and registered nurses believed that screening prevented or reduced the risk of developing breast cancer (86% and 62%, respectively); that screening reduced the mortality risk of breast cancer by more than 50% (69% and 60%, respectively); and that 10 years of regular screening for 50-year-old women could prevent ≥ 10 breast cancer deaths per 1,000 women (62% and 61%, respectively).

Conclusions: Women in the target population and registered nurses were aware that earlier diagnosis led to better prognosis, but demonstrated misconceptions regarding other aspects of the benefits and risks of breast cancer screening. In Japan, all women should be educated on both the benefits and risks of breast cancer screening to enable them to make an informed decision on whether to participate in the mammographic breast cancer screening program.

A total of 146 patients with breast cancer were operated on at our hospital between April 1991 and January 1997. The number of those patients who had undergone mass screening was 37. Those 37 patients were divided into three groups: 18 patients with interval breast cancer (the interval group), 12 patients having breast cancer detected by mass screeing (the mass screening group) and 7 patients diagnosed with breast cancer in outpatients clinics during the course of periodic routine examinations (the outpatient clinic group). To investingate the limitations and beneficial effects of mass screening programs consisting of observation and palpation, seven clinicopathological factors were analyzed, with special attention paid to tumor doubling times. These factors were % body fat, tumor size at the time of mass screening calculated from the age-dependent tumor doubling times, interval between mass screening and surgery, actual tumor size at the time of surgery, histological type, extent of nodal involvement and pathological staging. The percentage of early breast cancer was higher for these groups than for the other 109 patients, who had never undergone mass screening (59.4% versus 32.1%, p<0.01). However, the following limitations were found. In mass screening, it was difficult to detect masses smaller than 2 cm in diameter. Analysis of th data for the interval group showed that it was possible for women to find a breast mass measuring around 2cm through self-examination and that mass screening had no difinite advantage over the self-examination. In addition, it was found that earlier detection was called for in outpatient clinics in terms of the nodal status. We concluded that the benefits of the currently organized mass screening programs were doubtful. Women should be educated about the importance of self-examining their breasts and taught how to practice the self-examination. Goals should include finding women who considered at high risk and detecting breast cancer 1 cm or smaller in diameter during the course of periodic examinations at medical institutions.

We report here 2 cases of traumatic diaphragmatic hernia. Case 1 was a 76-year-old man who was injured in a road traffic accident (RTA). Chest X-ray and computed tomography (CT) revealed prolapse of the stomach into the left thoracic cavity. We performed laparotomy with a diagnosis of traumatic left diaphragmatic hernia. A 12-cm hole was seen in the central tendon of the left diaphragm and this was repaired by suturing. Case 2 was a 75-year-old man who was also injured in an RTA. Chest X-ray and CT revealed prolapse of the stomach and transverse colon into the left thoracic cavity. We performed laparotomy with a diagnosis of traumatic left diaphragmatic hernia. A 15-cm hole was seen in the central tendon of the left diaphragm and this was repaired by suturing. Traumatic diaphragmatic hernia is a relatively rare condition and one that requires surgical repair. It is important to make prompt diagnosis with appropriate radiological investigations. Additionally, patients with diaphragm hernia caused by blunt trauma often have injuries to other organs. Care should be taken so as not to miss associated injuries.