We reviewed the cases of breast cancer that had not been detected by physical examination (PE), ultrasound (US) and mammography (MMG). Of 90 cases that were diagnosed as breast cancer definitely on pathological assay, 13 cases had gone unnoticed by PE, seven by US, and 15 by MMG. Thus, the detection rate worked out at 85.6%, 92.2% and 83.3%, respectively. When the diagnoses wee made by any combination of one with another, the detection rate for joint PE/US, PE/MMG and US/MMG came to95.6%, 97.8% and 98.9%, indicating that the combined use of US and MMG was most efficient.Tumors that had been undetected by PE and MMG were significantly smaller in size than those that had been detected, but this was not the case for tumors that had gone unnoticed by US. Therefore, we considered that oversight during US examination is more likely due to difficulty making diagnostic differentiation between cancer and fatty tissue or cyst, etc. than tumor size. We found that those cases which had gotten pass PE had a significantly lower histological grade malignancy and a lower grade of invasiveness than the other cases of breast cancer, even though the former tended to show lymphatic metastasis frequently. Furthermore, all of these metastatic breast cancers had a smaller diameter ranging from 0.8cm to 0.9cm. This suggested hat we cannot afford to let them pass because they are non-palpable. At present, the Japanese Ministry of Health, Labor and Welfare are recommending the breast cancer mass-screening by use of PE in combinationwith MMG. However, because MMG is not always omnipotent and lets many breast cancer cases pass, we should conduct the mass screening with US and MMG but without PE.
cisplatin/etoposide protocol ; Malignant neoplasm of breast ; Clinical examination ; Mammography ; Cases

A total of 82 cases of breast cancer detected by hand-scanning ultrasound massscreenig (hereafter referred to as US screening) over the past 15 years were divided into two groups--one aged under 50 and the other aged 50 or over at the time of examinaton. The accuracy and capacity of US screening and the rate of patients with subjective symptoms were studied for each group. As a result, we discovered that the groupaged under 50 was significantly higher in the rate of “further examination needed”, and the rate of “having subjective symptoms”, and was significantly lower in “positive predictivevalue” than the older age group. In the detection rate, sensitivity and specificity, there was no difference between the two groups. Thus, we concluded that US screening were beneficial to both groups.
Dividing the 15 years of US screening into three periods (each 5 years), we investigated the caliber of detected breast cancers, and found the tumor size became smaller year after year. As a result, the cases of non-palpable breast cancer came to form 26.6%, of which 72.3% was accounted for by invasive breast cancer. Further more, we found that in the group aged under 50, because of stiffness of their breast gland, the ratio of non-palpable breast cancer came to 30.2%, which was larger than in the older age group, and 69.2% cases out of them were invasive breast cancer. We are afraid that mass-screening by physical examination alone will overlook many cases of breast cancer, and we recommend that in view of the increasing mortality rate of breast cancer in women in their50s the safe and useful US screening program should be implemented without delay on the younger age group.

Ibi Welfare Hospital covers a local town that has an aging population, and the development of a community-based integrated care system is an important issue. We have established and are operating a regional integrated NST system to maintain oral nutrition intake essential for daily life and prevention of pneumonia in this area, and here we report on outcomes and future issues. In this study, we investigated the regional integrated NST system (NST outpatient · NST hospitalization · NST visit) and examined dissemination of its service. Data was collected from February 2016 to March 2017. The investigation involved the following: (1) extraction of survey results of latent NST subjects and retrospective investigation of medical records; (2) expansion of NST outpatient services (examinations by surgeons, endoscopic evaluation of swallowing function, blood tests, dental examination, and evaluation by a dietician speech-language-hearing therapist, and return of a joint report created by the individual professionals to the introducing professional); and (3) introduction of NST hospitalization (2-week hospital stay for local inclusion sickbed care, introduction of swallowing passport, initiation of rehabilitation, oral care roundtrip, NST roundtrip, personnel care meetings with home staff, and introduction of visiting speechlanguage-hearing therapist rehabilitation to support home care after discharge). To increase awareness of this system, we visited the local nursing care insurance agency and welfare hospitals and tried to obtain cooperation through transparency. Introducing and initiating this regional integrated NST system “Ibi Model” revealed that the system is greatly needed in our region. We think that it has the potential to become a key supporting tool for the home-based medical care system within the regional comprehensive care system. Further verification is needed to assess real outcome changes such as a decrease in the incidence of pneumonia and improvement in quality of life.