{
  "abstract": "Objectives In Japan, national programs for five types of cancer screening have been offered nationwide. These programs are defined by screening modality, screening interval, and target age. The national programs set the starting age for cervical cancer at 20 years and 40 years for gastric, colorectal, lung, and breast cancer screening. However, there is no defined upper age limit. The screening interval is two years for gastric, breast, and cervical cancer screenings and annually for colorectal and lung cancer screenings. Conversely, workplace cancer screening programs have been arbitrary and lack any defined criteria. Most workplaces have provided cancer screening to employees during mandatory basic health check-ups. Both younger and older individuals may have access to cancer screening programs through workplaces and municipalities, leading to overscreening. Based on findings from a national survey, these rates, along with their characteristics, are compared.Method The National Comprehensive Life Survey conducted in 2022 was used for analysis. This survey is a questionnaire distributed to randomly selected individuals representing the national population. Most individuals transition from employee insurance to community-based health insurance upon their retirement, which is typically defined as between 60 and 65 years of age. From the age of 75, all individuals are covered with health insurance designed for older people. Considering this context, the age group is classified as follows: 20–39, 40–64, 65–74, and 75 years or older. First, the participation and overscreening rates for five cancer screenings, including those provided by municipalities and workplaces, were compared. Overscreening was defined as 20–39 years and 75 years or older for gastric, lung, colorectal, and breast cancer screenings, and 75 years or older for cervical cancer screening. Second, the proportion of cancer screening participation in workplaces and municipalities was calculated among each age group.Results The screening participant rates across all ages were 37.8% for gastric cancer, 40.6% for lung cancer, 36.1% for colorectal cancer, 33.3% for breast cancer, and 34.5% for cervical cancer. The overscreening rates among all participants were as follows: 23.7% for gastric cancer, 27.1% for lung cancer, 24.2% for colorectal cancer, 20.6% for breast cancer, and 6.1% for cervical cancer. Overscreening among younger age groups primarily occurred in workplaces, while among older age groups, it occurred in municipalities. The primal opportunity for accessing cancer screening shifted from the workplace for individuals aged 20–64 to municipalities for those aged 65 and older. It corresponded to the changes in health insurance coverage, which previously determined screening opportunities.Conclusions The lack of defined target age groups has led to overscreening which can harm participants by increasing the number of unnecessary examinations. Without an appropriate target age group, the expected mortality reduction by cancer screening cannot be achieved. Waste in screening leads to inequitable access to screening opportunities for real targets who need it. To reduce the overscreening of older participants in national programs, an upper age limit should be urgently established. In workplaces, providers and younger employees should be adequately informed about the potential harm caused by unnecessary screening.",
  "authors": [
    {
      "affiliations": [
        "Teikyo University, Tokyo, Japan"
      ],
      "name": "Chisato Hamashima"
    }
  ],
  "title": "031 Overscreening of cancer in Japan: can it be overlooked?",
  "uid": "c5540a11-b7f8-5c7f-accc-6a8cfeffd139"
}