Breast cancer is the most commonly diagnosed cancer among Japanese women, with a rapidly increasing incidence. This disease, often seen in middle-aged women, is the fifth leading cause of cancer-related death in Japanese females and a cause of psychosocial burden. Cancer stage and other clinical factors at diagnosis predict prognosis in breast cancer patients.
Breast cancer diagnosed at an early stage, when it is not too large and has not spread, is more likely to be treated successfully than breast cancer diagnosed at an advanced stage. Advanced breast cancer not only creates an urgent health challenge but also impedes the quality of life, and brings significant economic costs for patients, their families and public health systems.
There are significant opportunities to improve early breast cancer care in Japan by understanding the patient-centred care pathway for early breast cancer diagnosis and treatment and investigating the unmet needs in managing breast cancer.
Using an evidence-based approach that incorporates a review of existing data and an expert panel meeting, we designed a force field analysis to assess existing policies and system performance across four domains of the patient journey: population awareness, screening and diagnosis, treatment, and survivorship.
Indicators within each domain were selected based on evidence of their impact on promoting or deterring optimisation of patient-centred care for early breast cancer. We then conducted a workshop to discuss our findings and gain the perspective of key experts in Japan to flesh out key opportunities for improvement. We drafted scores for indicators within these four domains based on our research and insights from the workshop. This report combines in-depth research and force field analysis of early breast cancer care in Japan.
Key findings:
• Awareness: Improving health literacy and breast awareness are fundamental to optimising early breast cancer care however, in Japan, there is low knowledge about the signs and symptoms of breast cancer. To improve this, the government and non-governmental organisations (NGOs) are working together to spread awareness of the disease and the importance of early detection. The Ministry of Education targets young individuals by educating them on cancers to improve understanding and remove the social stigma associated with the condition.
• Screening and Diagnosis: The actual screening participation rate is not known. The low participation rates reflected in Japan’s national survey suggest a significant barrier to early breast cancer diagnosis. The lack of a system to monitor voluntary breast cancer screening participation in workplace screenings and the lack of clear recommendations and a centralised strategy for all municipalities could lead to low screening rates. Early diagnosis using genetic tests to detect hereditary cancer in at-risk populations would also help enhance patient-centred care and improve outcomes.
• Treatment: Japan focuses on innovative treatment options and personalised medicine to enhance patient-centred care. However, despite the treatment coverage, patients have reported financial burdens. Japan has free access to hospitals and financing mechanisms to support patients, but sometimes patients do not fully understand the system and cannot leverage the full benefits leading to a cost burden. Improving the availability of integrated mental health services is another way to enhance patient-centred care.
• Survivorship: Follow-up care and continuity of support for cancer survivors are both important elements of patient-centred care, but these receive a different amount of focus in Japan. In particular, although acknowledged, psychological support is identified as an unmet need that must be addressed.
We conclude with the following opportunities to optimise early breast cancer care and improve outcomes for people living with breast cancer in Japan:
1. To encourage greater screening participation, knowledge is key: In Japan, expanding the educational opportunities for people to acquire knowledge about the importance and benefits of breast cancer screening and early detection is key to improving screening participation and promoting earlier diagnosis.
2. For accurate management, data should be integrated: to better understand and monitor the status of screening in Japan, there is a need to develop an integrated platform to combine the various systems of breast cancer screening (populationbased and voluntary), which would improve accuracy and enable better recommendations.
3. Move from diversified to centralised: To achieve more uniform outcomes for all municipalities, some broader cancer control measures, policies and guidelines should be operated under a prefectural basis rather than under local governments, and reporting requirements should be clearer.
4. Simplify and digitise: There is a need to simplify and digitise procedures and systems to increase efficiency and reduce the load that is felt by patients and healthcare professionals. Encouraging follow-up care via teleconsultations and providing follow-ups at smaller, local clinics rather than large hospitals, would not only help in cost containment but also save time for patients and doctors, improving follow-up care.
5. Invest for the future: For young early breast cancer patients and survivors, there should be a more tailored approach to addressing their medical, psychosocial, and financial needs to enable them to have the best chance at living long, productive, and healthy lives.
