五島奈留町において昭和46年から毎年継続して集団検診を行ってきて，平成10年で27年になる．総合検診が確立した昭和60年から平成7年までの11年間の集団検診のデータを基に調査を行い，昭和60年から平成2年の6年間を前期，平成3年から平成7年の5年間を後期とした．癌死亡率の推移を見ると，前期平均31.1％，後期平均27.3％と有意（P. We thus concluded this long term general mass screening program to be an effective community measure for reducing the mortality rate of cancers. However, various issues remain regarding non-participants in the mass screening program among inhabitants who live in such a medically depopulated area. We carried out a questionnaire survey and an interview both by telephone and home visits, on a total of 882 individuals (males:427, females:455) who had not participted in the mass screening program for at least 5 years and were all over 40 years of age and residents of Naru town. The objective of this story was to evaluate the non-participants in this mass screening program

Imanaka Etsuko

Ishihara Kazuko

Kanematsu Takashi

Katahono Kuniko

Matsumoto Mari

Okuma Keiko

Oshikawa Yoko

Shimizu Yuka

Sumida Sumiko

Tomioka Tsutomu

Nagasaki University's Academic Output SITE: NAOSITE

Issues involving long term non-participants in a program from one town. mass screening Kazuko ISHIHARA * , Tsutornu TOMIOKA * , Etsuko IMANAKA * , Keiko OKUMA*, Mari MATSUMOTO*, Yuka SHIMIZU * , Kuniko KATAHONO*, Yoko OSHIKAWA * , Takashi KANEMATSU ' , Sumiko SUMIDA* Abstract A mass screening program for cancer has been carried out in the town of Naru in Nagasaki Prefecture since 1971. According to the data obtained from the general mass screening between 1985 and 1995, the mortality rate of all cancers in the late period (1991-1995, 27.30/0 ) in Naru town was significantly Japan in the late period (28.50/0) . We thus concluded this long term general mass screening program to be an effective community measure for reducing the mortality rate of cancers. However, various issues remain regarding non-participants in the mass screening program among inhabitants who live in such a medically depopulated area. We carried out a questionnaire survey and an interview both by telephone and home visits, on a total of 882 individuals (males:427, females:455) who had not participted in the mass screening program for at least 5 years and were all over 40 years of age and residents of Naru town. The objective of this story was to evaluate the non-participants in this mass screening program. Table I The mortality rate of all cancers, the population, the area m the model area Naru and four neighboring towns Bull. Sch. Allied Med. Sci., Nagasaki Univ. 12: 13-18, 1998 Key Words : Mass screening, Non-participants, I . Introduction Numerous mass screening programs are now being conducted in Japan since they are thought to be an effective cornmunity measure for detecting cancers in the early stage, in order to reduce the mortality rate of cancers and also decrease medical costs. Needless to say, the purpose of mass screening is to detect cancers from many subjects, especially in the early stage. Nagasaki Prefecture has many isolated Mortality rate small islands and thus tends to be a medically depopulated area. Mass screening is therefore an especially appropriate system for inhabitants who live in such a medically depopulated area. The members of The Second Department of Surgery, Nagasaki University School of Medicine have continually conducted a mass screening annually since 1971 in Naru town*") We found this long term general mass screening 1 School of Allied Medical 2 Department of Surgery II 3 The Public Health Center Sciences, Nagasaki University , Nagasaki University School of Naru - 13 -of Medicine Kazuko ISHIHARA et al. program to be an effective community measure for reducing the mortality rate of cancers. However, the number of non-participants remains large . Between 1985 and 1995, the rate of the screenees gradually decreased and numbered only 37.70/0 of the inhabitants, while non-participants numbered approximately 62.30/0 . We carried out a questionnaire survey and an interview by both telephone and with home visits, on a total of 882 individuals (males:427, females:455) who had not participated for at least 5 years and were all over 40 years of age and residents of Naru town. % 250o 80 60 40 10 1985 86 87 88 89 90 91 92 93 94 '95 year included along with screening for in 1988, and ophthalmic diseases col orectal in 19952). diseases 2 . The subjects participating in a questionnaire surve y Since the non-participants numbered 62.30/0, we carried out a questionnaire survey and an interview by telephone or home visits including a total of 882 individuals (males : 427, females : 455 ) who were all over 40 years of age and residents of Naru town and had not participated in the mass screening program for at least 5 years. The age distribution of the subjects was 27.90/0 in their 60's, 25.90/0 in their 40's, 21.80/0 in their 50's, 18.70/0 in their 70's for males and 29.50/0 in their 60's, 21.80/0 in their 70's, 19.30/0 in their 40's, 15.40/0 in their 50's for females . Table 2 The aged distribution males and females of the subjects f or =E subiects ~! non-participants - percentage F ig. I The changes of the non-participants in the mass screening program II . Subjects and Methods 1 . The area of mass screening A mass screening program has been performed since 1971 in Naru town, which had a population of 4,517 and covers an area of 25.2 square kilometers 2 > . An ultrasonographic examination was included since 1982, especially for identifying liver, biliary and pancreas diseases. In 1985, for heart diseases, gastric, breast, uterus, kidney diseases was also added. Screening for other organs has also been gradually 3 . The survey and a questionnaire methodology 1 ) The first survey was a questionnaire conducted by post card. Table 3 The items of the (multiple answers) questionnaire survey ~) Goto-Islan d s ~=~=~' Sapporo e~~~:' T:: - control areas c ~~~i;~~: A'B'C'O towns : ; A:Tama oura '~) ~~ " B:Kisyu Naru ~~' :'::: ' c:Miiraku :i' D:Tomie B i' [:~i~;jl:::~:j~,j:;:::::::::". ;~::F~/:::'1: '~{~:;: Tol0'o ~ JAPAN Nagas ki l-';' r ~~l~;;~ic'y okinawa Fig. 2 The area of mass screening 1. Please state the main reasons for not participating in the mass screening program. Rtoo busy with work Cpresently fit, no problems Rnot at home during mass screening Rno trasportation to the health center Rdo not wish to participate Rpresently physicauy handicapped @the screening time takes too long Rafraid ofphysical examinations @screening costs too much Rpresently being treated at a local hospital Rplan to undergo another health check-up Ca fear ofbeing diagnosed to have "cancei' R other reasons 2. Are you willing to partlcrpate In this year s mass screening program Ryes Rno 3. Do you have any particular requests regarding the mass screening program ? - 14 -Issues involving long term non-participants 2) The second survey was an interview of the non-responders to the post card either by telephone or by horne visits. 3 ) The questionnaire results are shown in . 4 . The time periods of the survey The first survey was conducted for one week from July 7 to July 13, 1997. The second survey as conducted for two days from August 7 to August 8, 1997. 5 . Analysis of the survey All data collected were analyzed by computer using a software package named Relational Data Base "Kiri Ver.5" developed by the Management Engineering Research Institute Co. , and were analyzed statistical significance. EI . Results 1 . The overall response rate and the rate based ou age and set The response rate was 26.20/0 (231 out of 882 respondents) in the first survey. The total response rate was 37.30/0 (329 out of 882 respondents) including 79 respondents by telephone and 19 respondents based on a home visit. 4>, and included 152 of males and 177 of females. The aged distribution of the respondents was 51.30/0 in a mass screening program from one town. in their 70's, 40.30/0 in their 60's, 400/0 in their 80's and 26.90/0 in their 50's for males, 48.50/0 in their 60's, 43.40/0 in their 70's, 36.70/0 in their 80's and 31.40/0 in their 50's. Table 4 The aged distribution of the respondents for males and females 2 . The reasons for non-participants for males and females (multiple answers) Among males the reasons for non-participation included ~) " they were presently being regularly treated at a hospital" : 48 (20.20/0), R"they were fit, and had no problems" : 35 (14.70/0), R"they had other planned health check-ups" : 32 (13.40/0 ) and R"were too busy with work" : 29 (12.20/0). On the other hand, the reasons for non-participating females included (~)" they were presently being regularly treated at a hosprtal:' : 76 (27.70/0 ) , R"were physical handicapped" 31 (11.30/0), R"did not want to participate" 27 (99~) and ~ " they had received other planned health check ups" 25 (9.10/0) . The highest rate comprised 70.40/0 who responded either Fig. 3 The reasons of the non-participants for males and females (multiple answers) @screening cost too much Ra fear of being diagnosed to have ~cancer" @afraid of physical examinations @no transportation to the health center Rthe screening time takes too long Cnot at home during mass screening Cpresently physically handica p ped Cdo not wish to partiGipate Rtoo busy with work ~)presently being treated at a looal hospital @presently fit,no problems Rplan to under go another health cheok-up ~{,{ . , I .OIO.6 0811 .O 0.6/1 .4 "S{ *, ,2:4~, ~ *2~2'i ;6:3 , , 5.S 4.9 5. 1 E] female El male 1 5~5 O 5 10 - 15 -15 20 25 ~ 30 Kazuko ISHIHARA et al. that : in " they were presently being regularly treated screening test. . at a hospital" or " they had received other planned More difficult problems that need to be solved health check ups" However 26 1 ~ demonstrated a include ~D a fear of bemg diagnosed to have lack of understanding regarding the purpose and " cancer" (~) berng afraid of physical examinations, goals of mass screening. Such reasons included : " not R presently healthy no problems We consulted wantmg to partrcrpate" " fear of undergomg a with the local government regarding these issues physical examination" b " a fear of being diagnosed and it was thus decided to provide buses and move with cancer" , and so on. the starting time of mass screening up to 7:30 or one hour earlier than before. It was also decided to 3 . The reasons for non-participation by age. review the local government plans to improve the The age distribution of the subjects was overall health education of the local residents in approximately 500/0 in their 60's and 70's. order to better explain the need fcr mass screening Regarding individuals in their 60's and 70's the to help detect cancers, especially in the early stage, main reasons for non-participation were " already so that such patients can be successfully treated. If being treated at a local hospital" : 45 (36.30/0 ) for cancer can be detected at an early stage the overall those in their 60's and 36 (29.00/0) for those in their successful treatment rate will improve3~12). 70's. In addition, the answer "presently healthy, no To improve the mass screening program the problems" was also higher rate 20 (35.10/0 ) in their following steps are considered to be necessary ; l. 60's, in the group of individuals in their 60's and to regularly evaluate the health needs of the local 70 s and 15 (26 3 Vo) m thelr 70 s Regardmg "plan residents, 2. to regularly confer wrth the local to have another health check-up" the highest rate government, 3. to provide good medical advice to was for those m thelr 60 s and the answer " too the local residents, 4. to improve health education busy with work" was also the highest for those in for all local residents their 60's: 17 (32.00/0). 4 . The willingness to participate in future mass Acknowledgments screening We thank all the members of the Second A total of 82 individuals showed a willingness to Department of Surgery, Nagasaki University School participate in future mass screening, and included of Medicine, the Public Health Center of Naru and 38 males and 44 females. On the other hand, 73 the Naru town office for their help and were unwilling to participate in future mass coorperation in conducting the mass screening. screening, and consisted of 34 males and 39 females. In addition 90 individuals gave no answer. Ref erences IV . Discussion I . Kuroda Y, Mizutani A, Izawa K, Ito T, Tsuchiya According to the survey, we identified the main R,: Group examination of biliary tract. J Jpn reasons for non participation in mass screening. A Soc Clin Surg. 43: 260-264, 1982 (in Japanese). total of 70.40/0 including those who did not 2 . Tomioka T, Ikematsu Y, Yamamichi M et al: participate due to " presently being treated at Mass screening survey in Naru town in Nagasaki another hosprtal" and " they planned to have prefecture- Reference to the significance of another health check-up" . That is to say, over 700/0 ultrasonografy for biliary disease. J Jpn Bili of the non-participants were receiving some kind of Asso. 8: 264-271, 1994 (in Japanese). medical treatment. In addition, more coordination 3 . Oshima A, Hirata N, Ubukata T, Umeda K, is called for among those receiving " another Fujimori I: Evaluation of a mass screenrng planned health check-up" and those undergoing program for stomach cancer with a case-control " mass screening" . study design. Int.J. Cancer: 38, 829-833, 1986. Regarding the ways to improve the percentage of 4 . Fukao A, Tsubono Y, Tsuji I, Hisamichi S et participants in mass screening ; the most important al: The Evaluation of Screening for Gastric factors are : ~) provide free transportation to the Cancer in Miyagi Pref ecture . Ja pan : A health center, R reducing the time required for the Population Based Case-Control Study. Int. J. - 16 -Issues involving long term non-participants in Cancer: 60, 45-48, 1995. 5 . Saito H, Soma Y, Koeda J et al : Reduction in Risk of Mortality from Colorectal Cancer by Fecal Occult Blood Screening with Immuno-chemical Hamagglutination Test, A Case-Control Study. Int. J. Cancer: 61, 465-469, 1995. 6 . Hiwatashi N, Morimoto T, Fukao A et al : An Evaluation of Mass Screening Using Fecal Occult Blood Test for Colorectal Cancer in Japan, A Case-Control Study. Jpn. J. Cancer Res: 84, 1110-1112, 1993. 7 . Ishimoto K, Kiyokawa N, Fujita H, et al: Problems of Mass Screening for Neuroblastoma a-Analysis of False-Negative Cases. J. Pediatr, Surg: 25, 398-401, 1990. 8 . Bessho F, Hashizume K, Nakajo T, et al: Mass Screening in Japan increased the detection of infants with neuroblastoma without a decrease in cases in older children. J.Pidiatr: 119, 237-mass screening program from one town. 241, 1991. Okazaki N, Yoshino M, Yoshida T, Takayasu K, Moriyama N, Makuuchi M, Yamazaki S, Hasegawa H, Noguchi M, Hirohashi S,: Early diagnosis of hepatocellular carcinoma. Hepato-Gastroenterol: 37, 480-3, 1990. 10. Haribhakti SP, Kapoor VK, Gujral RB, Kaushik SP : Staging of carcinoma of the gallbladder-an ultrasonographic evaluation. Hepato-Gastroenterol: 44, 1245-5, 1997. ll. Ota J, Horino T, Taguchi T et al: Mass Screening for Breast Cancer Comparison of the Clinical Stages and Prognosis of Breast Cancer Detected by Mass Screening and in Out-Patient Clinics. Jpn. J. Cancer Res: 80, 1028-1034, 1989. 12. Shiromizu K, Ogawa M, Kamata H et al: Long-term Mass Screening in Uterine Cervical Carcinoma Eradication Strategy. Jpn.J. Clin: 20, 134-138, 1990. a 9 - 17 -KaZUkO　ISHIHARA　et　al．離島集団検診における未受診者の課題石原　和子1・冨岡　　勉1・今中志水　友加1・片穂野邦子1・押川悦子1・大熊陽子1・兼松恵子1・松本　麻里1隆之2・隅田　澄子3長崎大学医療技術短期大学部長崎大学医学部第二外科学教室奈留町保健センター要　旨　　五島奈留町において昭和46年から毎年継続して集団検診を行ってきて，平成10年で27年になる．総合検診が確立した昭和60年から平成7年までの11年間の集団検診のデータを基に調査を行い，昭和60年から平成2年の6年間を前期，平成3年から平成7年の5年間を後期とした．癌死亡率の推移を見ると，前期平均31．1％，後期平均27．3％と有意（P＜0．005）に漸減傾向を示した．平成7年の全国平均28．5％に比べても有意（P＜0．01）に低い値を示した．これは長期集団検診の効果として一応の結論を見た．しかし，離島の地域住民の健康維持増進に効果を与えるはずの集団検診に未受診者が多いという問題が提起された．そこで，5年間で一度も受診しなかった40歳以上の882名（男427名：女455名）を対象に未受診の理由に関するアンケート調査と電話・訪問面接を実施し，未受診者への対策と効果的な集団検診のあり方について考察した．　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　長崎大医療技短大紀　12：13－18，1998Key　Words 集団検診，未受診者，癌死亡率一18一

離島集団検診における未受診者の課題

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離島集団検診における未受診者の課題

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