Professional Documents
Culture Documents
in Japan
men
300000
Cancer 200
250000
150
200000 Stroke
CVD women
150000
100
100000
50
50000
Liver disease
0 DM 0
60
65
70
75
80
85
90
95
00
05
60
65
70
75
80
85
90
95
00
05
19
19
19
19
19
19
19
19
20
20
19
19
19
19
19
19
19
19
20
20
47 Prefectures
Population 128 million (2008) Max 12.6 million (Tokyo)
Min 0.6 million (Tottori)
Trends in age-standardized rates by major sites
(world pop, male)
mortality incidence
Trends in age-standardized rates by major sites
(world pop, female)
mortality incidence
History of cancer control in Japan
1983 Cancer screening started under the Health Law for the Aged
(for stomach and cervical cancer, later extended to lung,
breast, endometrium, colorectum and liver)
Men Women
(%100 (% 40
) )
80 20s
30s 20s
60 40s
50s 30s
20
60+ 40s
40
50s
20
60+
All ages All ages
0 0
2005
1995
2000
1965
1970
1975
1980
2005
1990
2000
1995
1965
1970
1975
1980
1985
1985
1990
Year Year
Prevalence of current smokers for all ages in 2005: Data source: Japan Tobacco Inc.
Men: 45.8%, Women: 13.8%
Current issues for tobacco control in Japan
Low price and tax
Low price and tax compared to other developed countries
Increase of price is effective especially for preventing initiation
among young people
Insufficient regulation of second hand smoke
In 2003, Health Promotion Law promoted restriction of smoking
in public places
Need to expand smoke-free policies in hospitals, worksites and
other public places
Inexplicit warning labels
In 2003, Finance System Council strengthened restrictions
Need to make message about health dangers more explicit
Easy access to cigarette among youth
Banning vending machine or restricting placement of machines
Few occasions of intervention, prevention and cessation
Cessation treatment covered by health insurance
Increase opportunities for short interventions at health check-
ups
Cancer screening methods according to the Health Law for
the Aged (modified in 2004)
Site Method of screening Interval Age (y.o.)
Stomach X-ray screening (barium 1 yr 40 or more
photofluorography)
Cervix Cytology (Pap smear) 2 yrs 20 or more
8,000,000
7,000,000
6,000,000 stomach
cervix
5,000,000
endometrium
4,000,000 lung
colorectal
3,000,000
breast(PE only)
2,000,000 breast(MMG+PE)
1,000,000
0
1983 1988 1993 1998 2003
Source: Division of Health for the Elderly , Health and Welfare Bureau for the Elderly ,
Ministry of Health and Welfare
Current issues for cancer screening in Japan
2007 Jan: Designated Cancer Care Hospitals expanded 135 -> 286
2007 Apr: Cancer Control Act implemented
2007 Jun: Basic Plan to Promote Cancer Control Programs
2008 Feb: Designated Cancer Care Hospitals expanded 286 -> 351
2008 Mar: Cancer Control Promotion Plans by Local Governments
3rd-term Comprehensive Ten-Year Strategy for Cancer Control
1.Introduction of interdisciplinary study
and advanced scientific technology
2.Translational research: from the most
up-to-date basic research to
Promotion of prevention, diagnosis and therapy
3.Establishment of an effective method of
cancer cancer prevention
4.Innovation of cancer diagnosis and therapy
research 5.Nationwide investigation of the actual disease
rate, and dissemination of cancer information and
medical technology
Headquarters
for promoting cancer control program
Minister
Vice-ministers
Councillors
Directors of relevant Bureaus
President of NCC
Administrative director of NCC
Hospital
Hospital East
MHLW NCC
Prefecture
Prefecture Cancer
Care Hospital
Cancer Care Support Center
Designated Cancer
Care hospitals
Cancer Care Support Center
Local
hospitals
Designated Cancer Care Hospitals - Standards -
Clinical Services Providing System 2001, (2002), 2006, 2008
Clinical Practice
Providing multi-disciplinary and standard treatment
clinical guidelines, critical path, cancer board
System for providing chemotherapy
System for providing palliative care
Collaborating referral system between hospitals and clinics
System for providing second opinion
Medical staff
Physician (at least 1 specialist for chemotherapy, pathology and radiotherapy)
Co-medicals (cancer specialist for radiotherapy, pharmacy, palliative nursing,
cytopathology)
Worksite environments (common room…), Evaluation of clinical activities
Facilities
More than 1,200 admitted patients
Radiotherapy, Outpatients clinic for chemotherapy, ICU, Bio-clean room,
communication room
Smoke-free
Education system for family physicians
Information Services
Cancer Care Support Center
Hospital-based Cancer Registry
Clinical Research
岩手医科大学附属病院※〔盛岡
がん診療連携拠点病院 351施設 群馬大学医学部附属病院※[前橋市]
群馬県立がんセンター[太田市]
青森県立中央病院※ [青森市]
八戸市立市民病院 [八戸市]
北海道がんセンター[札幌市]
砂川市立病院 [砂川市]
市立札幌病院 [札幌市]
王子総合病院 [苫小牧市]
市〕
岩手県立中央病院[盛岡市]
(3-15 / Prefecture)
兵庫県立がんセンター※[明石市] 高山赤十字病院 [高山市]
神戸市立医療センター中央市民病院 桐生厚生総合病院 [桐生市] 秋田大学医学部附属病院※[秋田市] 宮城県立がんセンター※[名取市]
木沢記念病院 [美濃加茂市] 由利組合総合病院 [由利本荘市] 10 東北大学病院※[仙台市]
[神戸 公立藤岡総合病院 [藤岡市]
市] 公立富岡総合病院 [富岡市] 仙北組合総合病院 [大仙市] 東北労災病院 [仙台市]
岡山大学病院※[岡山市] 金沢大学医学部附属病院※[金沢市] 前橋赤十字病院〔前橋市〕 平鹿総合病院 [横手市] 仙台医療センター [仙台市]
岡山済生会総合病院 [岡山市] 神戸大学医学部附属病院[神戸市]
岡山赤十字病院 [岡山市] 関西労災病院 [尼崎市] 金沢医療センター [金沢市] 山本組合総合病院〔能代市〕
秋田赤十字病院〔秋田市〕
北海道 大崎市民病院 [大崎市]
石巻赤十字病院 [石巻市]
近畿中央病院 [伊丹市] 石川県立中央病院 [金沢市]
倉敷中央病院 [倉敷市] 小松市民病院 [小松市] 雄勝中央病院〔湯沢市〕 東北厚生年金病院〔仙台市〕
津山中央病院 [津山市] 姫路医療センター [姫路市]
姫路赤十字病院 [姫路市] 金沢医科大学病院 [河北郡] 信州大学医学部附属病院※[松本市]
岡山医療センター〔岡山市〕 長野赤十字病院 [長野市] 山形県立中央病院※ [山形市]
川崎医科大学附属病院〔倉敷市〕 赤穂市民病院 [赤穂市]
豊岡病院 [豊岡市] 長野市民病院 [長野市] 山形市立病院済生館 [山形市] 福島県立医科大学附属病院※[福島市]
兵庫県立淡路病院 [洲本市] 福井県立病院※ [福井市] 佐久総合病院 [佐久市] 山形大学医学部附属病院 [山形市] 大原綜合病院 [福島市]
兵庫県立医科大学病院〔西宮市〕 福井県済生会病院 [福井市] 諏訪赤十字病院 [諏訪市] 山形県立日本海病院 [酒田市] 坪井病院 [郡山市]
広島大学病院※[広島市] 飯田市立病院 [飯田市]
県立広島病院 [広島市] 西脇市立西脇病院〔西脇市〕 福井赤十字病院 [福井市] 公立置賜総合病院 [東置賜郡] 太田西ノ内病院 [郡山市]
広島市立広島市民病院 [広島市] 兵庫県立柏原病院〔丹波市〕 福井病院 [敦賀市] 相澤病院〔松本市〕 山形県立新庄病院 [新庄市]
5
青森 福島労災病院 [いわき市]
広島赤十字・原爆病院 [広島市] 福井大学医学部附属病院 [吉田郡] 竹田綜合病院 [会津若松市]
鳥取大学医学部附属病院※〔米子市〕 南東北病院〔郡山市〕
廣島総合病院 [廿日市市] 鳥取県立中央病院 [鳥取市] 新潟県立がんセンター新潟病院※ [新潟市] 7 6
呉医療センター [呉市] 鳥取市立病院 [鳥取市] 会津中央病院 〔会津若松市〕
滋賀県立成人病センター[守山市] 新潟市民病院 [新潟市]
東広島医療センター [東広島市] 鳥取県立厚生病院 [倉吉市] 富山県立中央病院※ [富山市]
尾道総合病院 [尾道市] 米子医療センター [米子市]
大津赤十字病院 [大津市]
富山市民病院 [富山市]
新潟大学医歯学総合病院 [新潟市] 秋田 岩手 栃木県立がんセンター※[宇都宮市]
Chapter 1. General
Fundamental principles
Promotion of research
Proper medical treatment for all cancer patients
Patient-centered medical system
Chapter 2. Basic Plan to Promote the Cancer Control Program
National and Prefectural level
Review the Plan at least every 5 years
Chapter 3. Basic measures
Section 1. Promotion of prevention and early detection of cancer
Section 2. Promotion to standardize cancer medical treatment service
Section 3. Promotion of research
Chapter 4. Cancer Control Promotion Council
including patients with cancer and their families
Supplementary Provision
Basic Plan to Promote Cancer Control Programs
Projection of age-adjusted cancer deaths rates for all sites
図1
based対数線形回帰による年齢調整死亡率の予測
on log-linear regression (use data from 1990 to 2005)
(1990年から2005年のデータを使用) 男女計 75歳未満
Males and females, age 0-74
140
(1985 Japanese model population)
120
100 96.2
death rate 1985年モデル人口)
91.7
87.5 10%
83.5
93.0
80 10%
年齢調整死亡率(
74.4
60
Age-adjusted
40
20
0
1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020 2025 2030
年
Goals
Decrease age-adjusted rate (0-74 y.o.) for all sites of
cancer 20% from 2005 to 2015
1% annual decrease (1990-2005) x 10 years = 10%
10% additional decrease by implementation of
cancer control program
Mortality
Methods Strategic Objectives Scenario reduction
in 2015 (%)
Tobacco (1) 50% reduction 1.6
Smoking rate
Control (2) 75% reduction 2.9
(3) increase to 50% 3.9
Screening Participating rate
(4) increase to 70% 6.0
Equalize 5-year survivial (5) 5 major sites 3.2
Quality in rate: improve to (6) all sites (10 years) 4.9
Cancer Care current ideal level (7) all sites (7 years) 6.8
(1)+(3)+(5) 8.7
Total (1)+(3)+(6) 10.4
(2)+(4)+(7) 15.7
Terima Kasih