A questionnaire survey of cervical and breast cancer screening among female employees and employees' spouses.

This study was approved by the Ethics Committee of the Osaka University Hospital (Approval number: 14361). This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines for cross-sectional studies. All methods were performed in accordance with relevant guidelines and regulations. Informed Consent. Informed consent was obtained from all the participants. Registry and the Registration No. of the study/trial. N/A. Animal Studies. N/A. Informed Consent. Informed consent was obtained from all the participants. Registry and the Registration No. of the study/trial. N/A. Animal Studies. N/A.

The percentage of male employee’s spouses aged 40 and over who receive cancer screening was significantly higher (54.5% (30/55)) than among the female employees aged 20–39 (18.2% (18/99)) ( p  < 0.05) ( Supplementary Table 1 (b) ). Cervical cancer screening, targeted at females aged 20 and over in Japan, was received by a significantly higher percentage of female employees in their 20s and 30s (96.2% (76/79)). We found that a small number of female employees in their 20s and 30s and the spouses of male employees had received screening for stomach, colorectal, lung, and breast cancer, which are usually targeted only at those aged 40 and over. In particular, 36.7% (29/79) of female employees in their 20s and 30s had received breast cancer screening, as had 54.6% (6/11) of male employee’s spouses in their 20s and 30s. The percentage of female employees in their 20s and 30s motivated to receive a screening because of receiving pro-screening information at their employment location was significantly higher (68.4% (54/79)). The percentage of respondents who took cancer screening for their health care was significantly higher among those in their 20s and 30s than among those in their 40 and over (80.0% (72/90), 66.8% (147/220), p  < 0.05). The percentage of female employees 40 and over who would be more likely to be willing to receive cancer screening if they could receive cancer screening on weekends and holidays was significantly higher (42.9% (42/98), p  < 0.05). On the other hand, significantly more female employees in their 20s and 30s were willing to receive cancer screening if they could receive it during work hours (48.5% (32/68), p  < 0.05).

Among female employees in their 20s and 30s, for whom the frequency of screening was known, 78.1% (32/41) were receiving cervical cancer screening significantly more frequently than every two years ( p  < 0.05) (Table 3 ). On the other hand, the percentage among male employee’s spouses aged 40 and over tended to be significantly lower, at 60.9% (14/23, p  < 0.05). Table 3 Health awareness and preventive behavior. Female employees ( n  = 277) Male employee’s spouse ( n  = 68) Total ( n  = 345) n (%) n (%) n (%) n (%) n (%) n (%) 20–39 years old ( n  = 99) Over 40 years old ( n  = 178) 20–39 years old ( n  = 13) Over 40 years old ( n  = 55) 20–39 years old ( n  = 122) Over 40 years old ( n  = 233) Are you concerned about periodontal disease and tooth decay? Yes 87 (87.9) 160 (89.9) 10 (76.9) 50 (90.9) 97 (86.6) 210 (90.1) No 12 (12.1) 18 (10.1) 3 (23.1) 5 (9.1) 15 (13.4) 23 (9.9) Are you concerned about cancer? Yes 82 (82.8) 155 (87.1) 9 (69.2) 46 (83.6) 91 (81.3) 201 (86.3) No 17 (17.2) 23 (12.9) 4 (30.8) 9 (16.4) 21 (18.7) 32 (13.7) Are you managing your diet for health care? Yes 49 (49.5) 92 (51.7) 7 (53.8) 35 (63.6) 56 (50.0) 127 (54.5) Not either 27 (27.3) 48 (27.0) 4 (30.8) 6 (10.9) 31 (27.7) 54 (23.2) No 23 (23.2) 38 (21.3) 2 (15.4) 14 (25.5) 25 (22.3) 52 (22.3) Do you exercise or walk for health care? Yes 43 (43.4) 84 (47.2) 2 (15.4) 27 (49.1) 45 (40.2) 111 (47.7) Not either 16 (16.2) 25 (14.0) 3 (23.1) 9 (16.4) 19 (16.9) 34 (14.6) No 40 (40.4) 69 (38.8) 8 (61.5) 19 (34.5) 48 (42.9) 88 (37.7) Are you receiving dental checkups for health care? Yes 79 (79.8) 147 (82.6)* 9 (69.2) 35 (63.6)** 88 (78.6) 182 (78.1) Not either 5 (5.1) 10 (5.6) 0 (0.0) 3 (5.5) 5 (4.4) 13 (5.6) No 15 (15.1) 21 (11.8)** 4 (30.8) 17 (30.9)* 19 (17.0) 38 (16.3) Do you think dental checkups are effective in preventing periodontal disease and tooth decay? Yes 98 (99.0) 171 (96.1) 13 (100.0) 55 (100.0) 111 (99.1) 226 (97.0) Not either 1 (1.0) 7 (3.9) 0 (0.0) 0 (0.0) 1 (0.9) 7 (3.0) No 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) Do you think cancer screening are effective in preventing cancer? Yes 95 (96.0) 153 (85.9) 11 (84.6) 50 (90.9) 106 (94.6) 203 (87.1) Not either 3 (3.0) 21 (11.8) 2 (15.4) 4 (7.3) 5 (4.5) 25 (10.7) No 1 (1.0) 4 (2.3) 0 (0.0) 1 (1.8) 1 (0.9) 5 (2.2) *Significantly more, **significantly less, < 0.05, chi-square test and residual analysis. Only valid responses were included in the analysis. Health awareness and preventive behavior. 20–39 years old ( n  = 99) Over 40 years old ( n  = 178) 20–39 years old ( n  = 13) Over 40 years old ( n  = 55) 20–39 years old ( n  = 122) Over 40 years old ( n  = 233) *Significantly more, **significantly less, < 0.05, chi-square test and residual analysis. Only valid responses were included in the analysis. Among female employees in their 20s and 30s who receive cervical cancer screening more frequently than every two years, the percentage of women who receive only one type of screening system (types A-D) was large, at 70.0% (23/30), and the percentage of those who receive occupational health checkups (B) was the largest, at 30.0% (9/30) (Table 4 ). Among the female employees classified as B or E, the percentage of those in their 20s and 30s who had received an occupational health checkup was 46.7% (14/30). Table 4 Status of receiving cancer screening and reasons for receiving cancer screening. Female employees Male employee’s spouse Total 20–39 years old Over 40 years old 20–39 years old Over 40 years old 20–39 years old Over 40 years old n (%) n (%) n (%) n (%) n (%) n (%) Have you had any kind of cancer screening? Yes, regularly 31(31.3)** 78 (43.8) 5 (38.5) 30 (54.5)* 36(32.1)** 108(46.3)* Several times irregularly 32 (32.3) 81 (45.5)* 5 (38.5) 21 (38.2) 37 (33.0) 102 (43.8) Only once 16 (16.2)* 7 (3.9)** 1 (7.7) 3 (5.5) 17 (15.2)* 10 (4.3)** Never had a cancer screening 18 (18.2)* 10 (5.7)** 2 (15.3) 1 (1.8)** 20 (17.9)* 11 (4.7)** I don’t remember / Don’t know 2 (2.0) 2 (1.1) 0 (0.0) 0 (0.0) 2 (1.8) 2 (0.9) Respondents who had cancer screening regularly, irregularly, or once ( n  = 310) Stomach cancer screening Yes 7 (8.9)** 62 (37.4)* 1 (9.1) 21 (38.9) 8 (8.9)** 83 (37.7)* No 72 (91.1)* 104(62.6)** 10 (90.9) 33 (61.1) 83 (91.1)* 137(62.3)** Colorectal cancer screening Yes 18(22.8)** 91 (54.8)* 2 (18.2) 31 (57.4) 20(22.2)** 122(55.5)* No 61 (77.2)* 75 (45.2)** 9 (81.8) 23 (42.6) 70 (77.8)* 98(44.5)** Lung cancer screening Yes 2 (2.5)** 15 (9.0) 1 (9.1) 17 (31.5)* 3 (3.3)** 32 (14.6)* No 77 (97.5)* 151 (91.0) 10 (90.9) 37(68.5)** 87 (96.7)* 188(85.4)** Breast cancer screening Yes 29(36.7)** 147 (88.6)* 6 (54.6) 47 (87.0)* 35(38.9)** 194 (88.2)* No 50 (63.3)* 19 (11.4)** 5 (45.4) 7 (13.0)** 55 (61.1)* 26 (11.8)** Cervical cancer screening Yes 76 (96.2)* 140(84.3)** 11 (100.0) 45 (83.3) 87 (32.0)* 3 (7.9)** No 3 (3.8)** 26 (15.7)* 0 (0.0) 9 (16.7) 185(68.0)** 35 (92.1)* Does the following describe reasons for receiving a cancer screening? Received a notice from the local government in which you reside. Yes 31 (39.2) 88 (53.0) 6 (54.6) 31 (57.4) 37 (41.1)** 119 (54.1)* No 48 (60.8) 78 (47.0) 5 (45.4) 23 (42.6) 53 (58.9)* 101(45.9)** Received a notice at information at an employment location Yes 54 (68.4)* 100 (60.2) 2 (18.2)** 22(40.7)** 56 (62.2) 122 (55.5) No 25(31.6)** 66 (39.8) 9 (81.8)* 32 (59.3)* 34 (37.8) 98 (44.5) Symptoms of concern Yes 14 (17.7) 37 (22.3) 1 (9.1) 7 (13.0) 15 (16.7) 44 (20.0) No 65 (82.3) 129 (77.7) 10 (90.9) 47 (87.0) 75 (83.3) 176 (80.0) Cancer experience of someone close to you Yes 5 (6.3)** 33 (19.9)* 1 (9.1) 9 (16.7) 6 (6.7)** 84 (19.1)* No 74 (93.7)* 133(80.1)** 10 (90.9) 45 (83.3) 42 (93.3)* 178(80.9)** Health care for yourself Yes 15 (19.0) 55 (33.1) 3 (27.3) 18 (33.3) 18 (20.0)** 73 (33.2)* No 64 (81.0) 111 (66.9) 8 (72.7) 36 (66.7) 72 (80.0)* 147(66.8)** Recommendations from a partner Yes 1 (1.3) 1 (0.6)** 0 (0.0) 6 (11.1)* 1 (1.1) 7 (3.2) No 78 (98.7) 165 (99.4)* 11 (100.0) 48(88.9)** 89 (98.9) 213 (96.8) Recommendations from parents Yes 5 (6.3) 5 (3.0) 0 (0.0) 0 (0.0) 5 (5.6) 5 (2.3) No 74 (93.7) 161 (97.0) 11 (100.0) 54 (100.0) 85 (94.4) 215 (97.7) Recommendations from a friend Yes 0 (0.0) 8 (4.8) 0 (0.0) 1 (1.9) 0 (0.0) 9 (4.1) No 79 (100.0) 158 (95.2) 11 (100.0) 53 (98.1) 90 (100.0) 211 (95.9) Recommendations from a family doctor Yes 11 (13.9) 17 (10.2) 0 (0.0) 5 (9.3) 11 (12.2) 22 (10.0) No 68 (86.1) 149 (89.8) 11 (100.0) 49 (90.7) 79 (87.8) 198 (90.0) Respondents who had cancer screening irregularly, once or never had a cancer screening ( n  = 197) Does the following describes reasons to be more willing to receive cancer screenings? Free of cost Yes 49 (74.2) 59 (60.2) 6 (75.0) 20 (80.0) 55 (74.3) 79 (64.2) No 17 (25.8) 39 (39.8) 2 (25.0) 5 (20.0) 19 (25.7) 44 (35.8) Available for cancer screening at work Yes 45 (68.2)* 53 (54.1) 2 (25.0) 4 (16.0)** 47 (63.5)* 27 (46.3)** No 21(31.8)** 45 (45.9) 6 (75.0) 21 (84.0)* 57(36.5)** 66 (53.6)* Available for cancer screening on weekends and holidays Yes 18 (27.3) 42 (42.9)* 3 (37.5) 3 (12.0)** 21 (28.4) 45 (36.6) No 48 (72.7) 56 (57.1)** 5 (62.5) 22 (88.0)* 53 (71.6) 78 (63.4) Available for cancer screening at night Yes 7 (10.6) 16 (16.3)* 0 (0.0) 0 (0.0) 7 (9.5) 16 (13.0) No 59 (89.4) 82 (83.7)** 8 (100.0) 25 (100.0) 67 (90.5) 107 (87.0) Available for cancer screening at a convenient location Yes 40 (60.6) 55 (56,1) 7 (87.5) 16 (64.0) 47 (64.5) 71 (57.7) No 26 (39.4) 43 (43.9) 1 (12.5) 9 (36.0) 27 (36.5) 52 (42.3) Available for cancer screening during work hours Yes 32 (48.5)* 40 (40.8) 1 (12.5) 1 (4.0)** 33 (44.6) 41 (33.3) No 34(51.5)** 58 (59.2) 7 (87.5) 24 (96.0)* 41 (55.4) 82 (66.7) Strong recommendation by someone Yes 9 (13.6)* 1 (1.0)** 1 (12.5) 0 (0.0) 10 (13.5)* 1 (0.8)** No 57(86.4)** 97 (99.0)* 7 (87.5) 25 (100.0) 64 (86.5)** 122 (99.2)* Easy to make an appointment Yes 29 (43.9) 37 (37.8) 3 (37.5) 14 (56.0) 32 (43.2) 51 (41,5) No 37 (56.1) 61 (62.2) 5 (62.5) 11 (44.0) 42 (56.8) 72 (58.5) Available to receive a cancer screening with child Yes 8 (12.2) 3 (3.1)** 2 (25.0)* 1 (4.0) 10 (13.5)* 4 (3.3)** No 58 (87.8) 95 (96.9)* 6 (75.0)** 24 (96.0) 64 (86.5)** 119 (96.7)* Short waiting time Yes 21 (31.8) 31 (31.6) 3 (37.5) 4 (16.0) 24 (32.4) 35 (28.5) No 45 (68.2) 67 (68.4) 5 (62.5) 21 (84.0) 50 (67.6) 88 (71.5) *Significantly more, **significantly less, < 0.05, chi-square test and residual analysis. Only valid responses were included in the analysis. Status of receiving cancer screening and reasons for receiving cancer screening. *Significantly more, **significantly less, < 0.05, chi-square test and residual analysis. Only valid responses were included in the analysis. Among the respondents who received cervical cancer screening every two years, the percentage of those who received only population-based screening every two years tended to be high. Among the respondents who received cervical cancer screening less frequently than every two years, there was no trend in the cancer screening system they used, but a certain proportion of the respondents received cervical cancer screening by an occupational health checkup. The percentage of respondents who received a detailed examination among those found to have abnormalities in the screening process was generally high, at around 90% for all ages (Table 3 ). Although breast cancer screening is targeted to females aged 40 and over, among the respondents in their 20s and 30s, 30.9% (33/107) had received breast cancer screening. Especially among the female employees in their 20s and 30s, for whom the frequency of receiving breast cancer screening was known, 71.4% (5/7) were receiving breast cancer screening more frequently than every two years (Table 5 ). Among the respondents who receive breast cancer screening more frequently than every two years, the proportion of those in their 20s and 30s who received occupational health checkups, including one screening system or a combination of multiple systems of cancer screening, was relatively high, at 66.7% (4/6) and 42.5% (17/40) in their 40s and above (Table 6 ). Table 5 Details of status of receiving cervical cancer screening. Female employees Male employee’s spouse Total 20–39 years old Over 40 years old 20–39 years old Over 40 years old 20–39 years old Over 40 years old n (%) n (%) n (%) n (%) n (%) n (%) Have you had a cervical cancer screening? Yes, regularly 34 (35.1) 65 (37.8) 6 (50.0) 30 (56.6) 40 (36.7) 95 (42.2) Several times irregularly 27 (27.8) 63 (36.6) 4 (33.4) 10 (18.9) 31 (28.4) 73 (32.4) Only once 19 (19.6) 22 (12.8) 1 (8.3) 6 (11.3) 20 (18.4) 28 (12.5) Never had a cancer screening 17 (17.5) 22 (12.8) 1 (8.3) 7 (13.2) 18 (16.5) 29 (12.9) Respondents who had cancer screening regularly, irregularly, or once Were there any abnormalities found at cervical cancer screening? Yes 16 (20.0) 27 (18.5) 1 (9.1) 8 (17.4) 17 (32.7) 35 (32.0) No 64 (80.0) 119 (81.5) 10 (90.9) 38 (82.6) 74 (67.3) 157 (68.0) Respondents who were found to the abnormalities in the screening Have you received a detailed examination? Yes 14 (87.5) 26 (96.3) 1 (100.0) 7 (87.5) 15 (88.2) 33 (94.3) No 2 (12.5) 1 (3.7) 0 (0.0) 1 (12.5) 2 (11.8) 2 (5.7) Respondents who had cancer screening regularly or irregularly Frequency of receiving cervical cancer screening More frequently than every two years 32 (78.1) 41 (63.0) 2 (40.0) 14 (60.9) 34 (73.9) 55 (62.5) Every two years 3 (7.3) 12 (18.5) 1 (20.0) 4 (17.4) 4 (8.7) 16 (18.2) Less frequently than every two years 6 (14.6) 12 (18.5) 2 (40.0) 5 (21.7) 8 (17.4) 17 (19.3) * Significantly more, ** significantly less, < 0.05, chi-square test and residual analysis. Only valid responses were included in the analysis. Table 6 Details of status of receiving cervical cancer screening by frequency. Female employees Male employee’s spouse Total 20–39 years old Over 40 years old 20–39 years old Over 40 years old 20–39 years old Over 40 years old n (%) n (%) n (%) n (%) n (%) n (%) More frequently than every two years Which cancer screening system was used to conduct the cervical cancer screening that you received? A 4 (13.3) 3 (7.5) 0 (0.0) 0 (0.0) 4 (12.5) 3 (5.6) B 9 (30.0) 15 (37.5) 0 (0.0) 5 (35.7) 9 (28.1) 20 (37.0) C 8 (26.7) 5 (12.5) 0 (0.0) 1 (7.1) 8 (25.0) 6 (11.1) D 2 (6.7) 2 (5.0) 0 (0.0) 2 (14.3) 2 (6.3) 4 (7.4) E 7 (23.3) 15 (37.5) 2 (100.0) 6 (42.9) 9 (28.1) 21 (38.9) Did the cancer screenings you received include cancer screenings conducted as occupational health checkups? Yes 14 (46.7) 20 (50.0) 2 (100.0) 9 (64.3) 16 (50.0) 29 (53.7) No 16 (53.3) 20 (50.0) 0 (0.0) 5 (35.7) 16 (50.0) 25 (46.3) Every two years Which cancer screening system was used to conduct the cervical cancer screening that you received? A 2 (66.7) 7 (58.3) 1 (100.0) 1 (33.3) 3 (75.0) 8 (53.3) B 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) C 0 (0.0) 3 (25.0) 0 (0.0) 1 (33.3) 0 (0.0) 4 (26.7) D 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) E 1 (33.3) 2 (16.7) 0 (0.0) 1 (33.3) 1 (25.0) 3 (20.0) Did the cancer screenings you received include cancer screenings conducted as occupational health checkups? Yes 0 (0.0) 1 (8.3) 0 (0.0) 1 (33.3) 0 (0.0) 2 (13.3) No 31 (100.0) 11 (91.7) 1 (100.0) 2 (66.7) 4 (100.0) 13 (86.7) Less frequently than every two years Which cancer screening system was used to conduct the cervical cancer screening that you received? A 0 (0.0) 2 (16.7) 0 (0.0) 0 (0.0) 0 (0.0) 2 (11.8) B 1 (16.7) 2 (16.7) 0 (0.0) 3 (60.0) 1 (12.5) 5 (29.4) C 1 (16.7) 3 (24.0) 0 (0.0) 0 (0.0) 1 (12.5) 3 (17.7) D 0 (0.0) 1 (8.3) 0 (0.0) 1 (20.0) 0 (0.0) 2 (11.7) E 4 (66.6) 4 (33.3) 2 (100.0) 1 (20.0) 6 (75.0) 5 (29.4) Did the cancer screenings you received include cancer screenings conducted as a service by National Health Insurance Association (Opportunistic screening)? Yes 1 (16.7) 3 (25.0) 1 (50.0) 4 (80.0) 2 (25.0) 7 (41.2) No 5 (83.3) 9 (75.0) 1 (50.0) 1 (20.0) 6 (75.0) 10 (58.8) Only valid responses were included in the analysis. (A) All the cancer screenings that were received were screenings that were conducted as a residents’ screening by local governments (Population-based screening). (B) All the cancer screenings that were received were screenings that were conducted as an occupational health checkup provided by a company’s health insurance association for welfare purposes (Occupational health checkups). (C) All the cancer screenings that were received were screenings that were conducted as a part of examination using an insured medical care regulated by the government (Insured medical care). (D) All the cancer screenings that were received were screenings that were conducted as a personal medical checkup fully reimbursed by the examinee (Personal medical checkup). (E) Cancer screenings received were either A to D at each examination (did not consistently receive cancer screening by the same cancer screening system). Details of status of receiving cervical cancer screening. * Significantly more, ** significantly less, < 0.05, chi-square test and residual analysis. Only valid responses were included in the analysis. Details of status of receiving cervical cancer screening by frequency. Only valid responses were included in the analysis. (A) All the cancer screenings that were received were screenings that were conducted as a residents’ screening by local governments (Population-based screening). (B) All the cancer screenings that were received were screenings that were conducted as an occupational health checkup provided by a company’s health insurance association for welfare purposes (Occupational health checkups). (C) All the cancer screenings that were received were screenings that were conducted as a part of examination using an insured medical care regulated by the government (Insured medical care). (D) All the cancer screenings that were received were screenings that were conducted as a personal medical checkup fully reimbursed by the examinee (Personal medical checkup). (E) Cancer screenings received were either A to D at each examination (did not consistently receive cancer screening by the same cancer screening system). Among respondents who received breast cancer screening every two years, the proportion of those who received breast cancer screening every two years only by population-based screening or by occupational health checkups tended to be high, with 31.6% (6/19) and 42.1% (8/19) of respondents in their 40s and over, respectively. Among the respondents who were receiving breast cancer screenings less frequently than every two years, the type of cancer screening system varied, but a certain proportion of the respondents used occupational health checkups. The percentage of respondents who received a detailed examination among those found to have abnormalities during screening was generally high, at around 80–90% for all ages (Tables 5 and 6 ). Analysis of factors that correlated with receiving more frequent cervical cancer screening than the recommended every two years revealed no significant factors in univariate analysis but not by multivariate analysis; the presence or absence of a family doctor was independently correlated (adjusted OR 3.69, 95%CI: 1.06–12.84, p  = 0. 04) (Table 7 ). This may have been caused by family doctors recommending annual rather than biannual screening. In contrast, no significant factors were detected when the factors correlated with receiving more frequent breast cancer screening were analyzed (Table 8 ). Table 7 Details of status of receiving breast cancer screening. Female employees Male employee’s spouse Total 20–39 years old Over 40 years old 20–39 years old Over 40 years old 20–39 years old Over 40 years old n (%) n (%) n (%) n (%) n (%) n (%) Have you had a cervical cancer screening? Yes, regularly 7 (7.3)** 55 (31.1) 4 (36.3) 27 (50.0)* 11 (10.3)** 82 (35.5)* Several times irregularly 5 (5.2)** 78 (44.1)* 0 (0.0)** 15 (27.8) 5 (4.7)** 93 (40.3)* Only once 15 (15.6) 26 (14.7) 2 (18.2) 7 (13.0) 17 (15.9) 33 (14.3) Never had a cancer screening 69 (71.9)* 18 (10.1)** 5 (45.5) 5 (9.2)** 74 (69.1)* 23 (9.9)** Respondents who had cancer screening regularly, irregularly, or once Were there any abnormalities found at cervical cancer screening? Yes 4 (15.4) 30 (19.1) 1 (16.7) 11 (22.4) 5 (15.6) 41 (19.9) No 22 (84.6) 127 (80.9) 5 (83.3) 38 (77.6) 27 (84.4) 165 (80.1) Respondents who were found to have abnormalities in the screening Have you received a follow up detailed examination? Yes 3 (75.0) 28 (93.3) 1 (100.0) 9 (81.8) 4 (80.0) 37 (90.2) No 1 (25.0) 2 (6.7) 0 (0.0) 2 (18.2) 1 (20.0) 4 (9.8) Respondents who had cancer screening regularly or irregularly Frequency of receiving cervical cancer screening More frequently than every two years 5 (71.4) 23 (46.9) 1 (100.0) 18 (66.7) 6 (75.0) 41 (54.0) Every two years 0 (0.0) 17 (34.7) 0 (0.0) 3 (11.1) 0 (0.0) 20 (26.3) Less frequently than every two years 2 (28.6) 9 (18.4) 0 (0.0) 6 (22.2) 2 (25.0) 15 (19.7) * Significantly more, ** significantly less, < 0.05, chi-square test and residual analysis. Only valid responses were included in the analysis. Table 8 Details of status of receiving breast cancer screening by frequency. Female employees Male employee’s spouse Total 20–39 years old Over 40 years old 20–39 years old Over 40 years old 20–39 years old Over 40 years old n (%) n (%) n (%) n (%) n (%) n (%) More frequently than every two years Which cancer screening system was used to conduct the cervical cancer screening that you received? A 0 (0.0) 2 (9.1) 0 (0.0) 0 (0.0) 0 (0.0) 2 (5.0) B 2 (40.0) 2 (9.1) 1 (100.0) 8 (44.5) 3 (50.0) 10 (25.0) C 0 (0.0) 3 (13.7) 0 (0.0) 2 (11.1) 0 (0.0) 5 (12.5) D 1 (20.0) 4 (18.2) 0 (0.0) 2 (11.1) 1 (16.7) 6 (15.0) E 2 (40.0) 11 (50.0) 0 (0.0) 6 33.3) 2 (33.3) 17 (42.5) Did the cancer screenings you received include cancer screenings conducted as a service by the National Health Insurance Association (Opportunistic screening)? Yes 3 (60.0) 6 (27.3) 1 (100.0) 11 (61.1) 4 (66.7) 17 (42.5) No 2 (40.0) 16 (72.3) 0 (0.0) 7 (38.9) 2 (33.3) 23 (57.5) Every two years Which cancer screening system was used to conduct the cervical cancer screening that you received? A 0 (0.0) 5 (29.4) 0 (0.0) 1 (50.0) 0 (0.0) 6 (31.6) B 0 (0.0) 7 (41.2) 0 (0.0) 1 (50.0) 0 (0.0) 8 (42.1) C 0 (0.0) 1 (5.9) 0 (0.0) 0 (0.0) 0 (0.0) 1 (5.3) D 0 (0.0) 1 (5.9) 0 (0.0) 0 (0.0) 0 (0.0) 1 (5.3) E 0 (0.0) 31 (17.6) 0 (0.0) 0 (0.0) 0 (0.0) 3 (15.7) Did the cancer screenings you received include cancer screenings conducted as a service by the National Health Insurance Association (Opportunistic screening)? Yes 0 (0.0) 7 (41.2) 0 (0.0) 1 (50.0) 0 (0.0) 8 (42.1) No 0 (0.0) 10 (58.8) 0 (0.0) 1 (50.0) 0 (0.0) 11 (57.9) Less frequently than every two years Which cancer screening system was used to conduct the cervical cancer screening that you received? A 0 (0.0) 3 (33.3) 0 (0.0) 4 (66.7) 0 (0.0) 7 (46.7) B 0 (0.0) 3 (33.3) 0 (0.0) 2 (33.3) 0 (0.0) 5 (33.3) C 0 (0.0) 2 (22.3) 0 (0.0) 0 (0.0) 0 (0.0) 2 (13.3) D 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) E 2 (100.0) 1 (11.1) 0 (0.0) 0 (0.0) 2 (100.0) 1 (6.7) Did the cancer screenings you received include cancer screenings conducted as a service by the National Health Insurance Association (Opportunistic screening)? Yes 2 (100.0) 4 (44.4) 0 (0.0) 2 (33.3) 2 (100.0) 6 (40.0) No 0 (0.0) 5 (55.6) 0 (0.0) 4 (66.7) 0 (0.0) 9 (60.0) Only valid responses were included in the analysis. (A) All the cancer screenings that were received were screenings that were conducted as a residents’ screening by local governments (Population-based screening). (B) All the cancer screenings that were received were screenings conducted as an occupational health checkup provided by a company’s health insurance association for welfare purposes (Occupational health checkups). (C) All the cancer screenings that were received were screenings that were conducted as a part of examination using an insured medical care regulated by the government (Insured medical care). (D) All the cancer screenings that were received were screenings that were conducted as a personal medical checkup fully reimbursed by the examinee (Personal medical checkup). (E) Cancer screenings received were either A to D at each examination (not consistently receive cancer screening by the same cancer screening system). Details of status of receiving breast cancer screening. * Significantly more, ** significantly less, < 0.05, chi-square test and residual analysis. Only valid responses were included in the analysis. Details of status of receiving breast cancer screening by frequency. Only valid responses were included in the analysis. (A) All the cancer screenings that were received were screenings that were conducted as a residents’ screening by local governments (Population-based screening). (B) All the cancer screenings that were received were screenings conducted as an occupational health checkup provided by a company’s health insurance association for welfare purposes (Occupational health checkups). (C) All the cancer screenings that were received were screenings that were conducted as a part of examination using an insured medical care regulated by the government (Insured medical care). (D) All the cancer screenings that were received were screenings that were conducted as a personal medical checkup fully reimbursed by the examinee (Personal medical checkup). (E) Cancer screenings received were either A to D at each examination (not consistently receive cancer screening by the same cancer screening system). Tables 9 and 10 shows the proportion of each type of cancer screening system in the total number of cervical and breast cancer screenings received. The greatest number of both cervical and breast cancer screenings were conducted during occupational health checkups (Table 11 ). The proportion of receiving cervical cancer screening by insured medical care was significantly higher ( p  < 0.05). The proportion of receiving breast cancer screening by personal medical checkup was also significantly higher ( p  < 0.05). Table 9 Analysis of factors correlated with more frequently receiving cervical cancer screening than once every two years. Characteristic Comparison n Unadjusted OR (95%CI) p -value Adjusted OR (95%CI) p -value Group Male employee’s spouse 21 Reference Reference Female employees 88 1.52 (0.48–4.79) 0.47 1.08 (0.26–4.42) 0.91 Age 20–39 years old 38 Reference Reference Over 40 years old 71 0.40 (0.12–1.31) 0.13 0.48 (0.12–1.90) 0.30 Marriage status Unmarried 25 Reference Reference Married 84 0.81 (0.24–2.69) 0.73 1.36 (0.26–7.19) 0.72 Presence of children Don’t have 58 Reference Reference Have 51 1.82 (0.66–4.98) 0.25 1.82 (0.45–7.34) 0.40 Presence of chronic illness Don’t have 28 Reference Reference Have 81 0.68 (0.21–2.23) 0.52 0.40 (0.10–1.62) 0.20 Medication history of taking pill Don’t have 82 Reference Reference Have 27 7.84 (0.997–61.65) 0.050 6.99 (0.80–60.71) 0.08 Presence of family doctor Don’t have 36 Reference Reference Have 73 2.42 (0.90–6.51) 0.079 3.69 (1.06–12.84) 0.040 Status of joining cancer insurance No / Don’t know 47 Reference Reference Yes 62 1.10 (0.41–2.91) 0.85 0.95 (0.31–2.95) 0.93 Are you concerned about cancer? No 14 Reference Reference Yes 995 0.71 (0.15–3.47) 0.68 0.56 (0.10–3.17) 0.51 Do you think cancer screening is effective in preventing cancer? No / Not either 8 Reference Reference Yes 101 1.54 (0.29–8.24) 0.62 2.10 (0.31–14.18) 0.45 Table 10 Analysis of factors correlated with more frequently receiving breast cancer screening than once every two years. Characteristic Comparison n Unadjusted OR (95%CI) p -value Adjusted OR (95%CI) p -value Group Male employee’s spouse 22 Reference Reference Female employees 46 0.27 (0.07–1.05) 0.06 0.15 (0.02–1.14) 0.07 Age 20–39 years old 7 Reference Reference Over 40 years old 61 Omitted* Omitted* Omitted Omitted* Marriage status Unmarried 17 Reference Reference Married 51 4.09 (1.28–13.09) 0.018 4.71 (0.83–26.83) 0.08 Presence of children Don’t have 37 Reference Reference Have 31 0.44 (0.15–1.27) 0.13 2.27 (0.38–13.52) 0.37 Presence of chronic illness Don’t have 21 Reference Reference Have 47 0.67 (0.21–2.16) 0.5 0.59 (0.14–2.49) 0.47 Medication history of taking pill Don’t have 56 Reference Reference Have 12 2.37 (0.47–11.95) 0.30 1.90 (0.28–12.92) 0.51 Presence of family doctor Don’t have 22 Reference Reference Have 46 2.20 (0.74–6.53) 0.15 2.71 (0.57–12.85) 0.21 Status of joining cancer insurance No / Don’t know 22 Reference Reference Yes 46 1.18 (0.39–3.57) 0.76 1.37 (0.32–5.79) 0.67 Are you concerned about cancer? No 5 Reference Reference Yes 63 1.67 (0.26–10.82) 0.59 4.63 (0.28–75.40) 0.28 Do you think cancer screening is effective in preventing cancer? No / Not either 6 Reference Reference Yes 62 1.22 (0.21–7.27) 0.83 1.44 (0.18–11.57) 0.73 *There were 0 women aged 20–39 years in the group who had been received breast cancer screening every two years. Analysis of factors correlated with more frequently receiving cervical cancer screening than once every two years. 1.52 (0.48–4.79) 1.08 (0.26–4.42) 0.40 (0.12–1.31) 0.48 (0.12–1.90) 0.81 (0.24–2.69) 1.36 (0.26–7.19) 1.82 (0.66–4.98) 1.82 (0.45–7.34) 0.68 (0.21–2.23) 0.40 (0.10–1.62) 7.84 (0.997–61.65) 6.99 (0.80–60.71) 2.42 (0.90–6.51) 3.69 (1.06–12.84) 1.10 (0.41–2.91) 0.95 (0.31–2.95) 0.71 (0.15–3.47) 0.56 (0.10–3.17) 1.54 (0.29–8.24) 2.10 (0.31–14.18) Analysis of factors correlated with more frequently receiving breast cancer screening than once every two years. 0.27 (0.07–1.05) 0.15 (0.02–1.14) 4.09 (1.28–13.09) 4.71 (0.83–26.83) 0.44 (0.15–1.27) 2.27 (0.38–13.52) 0.67 (0.21–2.16) 0.59 (0.14–2.49) 2.37 (0.47–11.95) 1.90 (0.28–12.92) 2.20 (0.74–6.53) 2.71 (0.57–12.85) 1.18 (0.39–3.57) 1.37 (0.32–5.79) 1.67 (0.26–10.82) 4.63 (0.28–75.40) 1.22 (0.21–7.27) 1.44 (0.18–11.57) *There were 0 women aged 20–39 years in the group who had been received breast cancer screening every two years.

A questionnaire-based survey was conducted to clarify the status of receiving cervical and breast cancer population-based screening, occupational health checkups, insured medical care, and personal medical checkups among female employees and male employee’s spouses of Sunstar, Inc. The response rate among spouses was unknown because the number of male employees who have spouses could not be determined. Responses were received from 277 employees and 68 spouses (Table 1 ). The number of female respondents in their 20s was significantly higher among employees (18.0% (50/277)) than among spouses (7.4% (5/68)) ( p  < 0.05). Female employees were significantly more likely to be childless than the spouses of employees (58.5% (162/277), 17.7% (12/68), p  < 0.05). Table 1 Respondent characteristics. Female employees ( n  = 277) Male employee’s spouse ( n  = 68) Total ( n  = 345) n % n % n % Age 20–29 50* 18.0 5** 7.4 55 15.9 30–39 49 17.7 8 11.7 57 16.5 40–49 70 25.3 22 32.4 92 26.7 50–59 96 34.7 27 39.7 123 35.7 60 or over 12 4.3 6 8.8 18 5.2 Marriage status Unmarried 117 42.2 - - - - Married 160 57.8 - - - - Presence of children Don’t have 162* 58.5 12** 17.7 174 50.4 Have 115** 41.5 56* 82.3 171 49.6 Presence of chronic illness Don’t have 92 33.2 23 33.8 115 33.3 Have 185 66.8 45 66.2 230 66.7 Medication history of taking pill Don’t have 206 74.4 57 83.8 263 76.2 Have 71 25.6 11 16.2 82 23.8 Presence of family doctor Don’t have 95** 34.3 34* 50.0 129 37.4 Have 182* 65.7 34** 50.0 216 62.6 Status of joining medical insurance I have insurance for my dependents 6** 2.2 20* 29.4 26 7.5 I have my own insurance 251* 90.6 41** 60.3 292 84.6 Don’t know 20 7.2 7 10.3 27 7.8 Status of joining cancer insurance Yes 154 55.6 38 55.9 192 55.7 No 109 39.4 28 41.2 137 39.7 Don’t know 14 5.0 2 2.9 16 4.6 Cancer screening Have been examined before 245 88.5 65 95.6 310 89.8 Never examined before / Don’t know 32 11.5 3 4.4 35 10.2 Smoking Smoke daily / Occasional smoker 2 0.7 0 0.0 2 0.6 Used to smoke but not anymore 30 10.8 2 2.9 32 9.3 Never smoked 245 88.5 66 97.1 311 90.1 Alcohol drinking habit Drink daily / Occasional drinker 205* 74.0 39** 57.3 244 70.7 Not in the habit of drinking 72** 26.0 29* 42.7 101 29.3 *Significantly more, **significantly less, < 0.05, chi-square test and residual analysis. Only valid responses were included in the analysis. Respondent characteristics. *Significantly more, **significantly less, < 0.05, chi-square test and residual analysis. Only valid responses were included in the analysis. Regarding having a family doctor, female employees were significantly more likely to have one than did the spouses (65.7% (182/277) vs. 50.0% (34/68), p  < 0.05); in particular, female employees were more likely to have a family doctor in the fields of dentistry (41.5% (115/277) vs. 23.5% (16/68), p  < 0.05) and gynecology (25.3% (70/277) vs. 10.3% (7/68), p  < 0.05) (Table 2 ). Table 2 Details of responses on presence of chronic illness and family doctor. Female employees ( n  = 277) Male employee’s spouse ( n  = 68) p -value Total ( n  = 345) n  % n % n % Presence of chronic illness Periodontal disease Yes 24 8.7 4 5.9 0.62 28 8.1 No 253 91.3 64 94.1 317 91.9 Tooth decay Yes 21 7.6 4 5.9 0.79 25 7.3 No 256 92.4 64 94.1 320 92.7 Menstrual cramps, irregular periods, premenstrual syndrome Yes 53 19.1 8 11.8 0.21 61 17.7 No 224 80.9 60 88.2 284 82.3 Uterine or ovarian disease* Yes 33 11.9 9 13.2 0.83 42 12.2 No 244 88.1 59 86.8 303 87.8 Presence of family doctor Internal medicine Yes 103 37.2 22 32.4 0.48 125 36.2 No 174 62.8 46 67.7 220 63.8 Dentistry Yes 115 41.5 16 23.5 0.006 131 38.0 No 162 58.5 52 76.5 214 62.0 Gynecology Yes 70 25.3 7 10.3 0.008 77 22.3 No 207 74.7 61 89.7 268 77.7 Other Medical Departments Yes 103 37.2 16 23.5 0.034 119 34.5 No 174 62.8 52 76.5 226 65.5 * Uterine fibroids, endometriosis, ovarian cysts. Fisher’s exact test (Extended). Only valid responses were included in the analysis. Details of responses on presence of chronic illness and family doctor. * Uterine fibroids, endometriosis, ovarian cysts. Fisher’s exact test (Extended). Only valid responses were included in the analysis. Most female employees and spouses were concerned about periodontal disease, tooth decay, and cancer, regardless of age ( Supplementary Table 1 (a) ). Most female employees and wives, regardless of age, considered dental and cancer screening effective for health care and cancer prevention. The percentages of female employees and spouses taking health-related actions, such as managing their diet, exercise, or walking, were generally around half in all age groups. The percentage of female employees aged 40 and over who received dental checkups for health care was significantly higher (82.6% (147/178)) than for similarly aged spouses (30.9% (17/55)) ( p  < 0.05).

The Sunstar Group is a cluster of subsidiaries of Sunstar SA based in Switzerland. The Japanese subsidiary Sunstar KK is headquartered in Takatsuki City, Osaka Prefecture, Japan. Their occupational healthcare system started as a corporate welfare program in 2008. The number of eligible Sunstar Group female employees and the spouses of male employees present during the survey period of March 15 and July 20, 2023, was a total of 1,815 women. Female employees were asked by the company to cooperate with our survey in person. Married male employees were asked to have their spouses complete the survey. Leaflets with a QR code were distributed and responses were collected through a Google questionnaire form between March 15 and July 20, 2023. Our survey consisted of questions regarding the following characteristics: respondent age, marriage status, presence of children, presence of chronic illnesses, medication history, presence of a family doctor, status of having medical insurance, status of having cancer insurance, habits of smoking and alcohol drinking, health awareness, cancer preventative behaviors, cancer screening history and reasons for receiving cancer screening. Fisher’s exact test, χ2 test, and residual analysis were used for comparisons between employees and female spouses and comparisons by age (20–39 vs. 40 and over) for each question. A p -value of < 0.05 was considered to be significant. Factors correlated with more frequently receiving cervical and breast cancer screenings than once every two years were analyzed by both univariate and multivariate logistic regression analysis.

In Japan, the previously declining incidence of cervical and breast cancers has reversed course over the past several decades. Historically, in the late 1970s, cervical cancer was declining because of improved cervical pre-cancer screening, but around 2000 this trend reversed and cases have increased sharply 1 . In 2019, 10,879 women were diagnosed with cervical cancer and 2,887 died from it in 2020 2 . The incidence and mortality rates for cervical cancer are 16.8 and 4.6, respectively, per 100,000 women 2 . Cervical cancer is predominantly caused by integration into the host genome of high-cancer-risk strains of the human papillomavirus (HPV); the cancer is further promoted by habitual smoking 3 . Despite a recent decline in smoking by Japanese women, the increased risks of earlier HPV infection due to an earlier age of initiation of sexual intercourse has resulted in the recent increase in cervical cancer among women in their 20s to 40s 4 . This unfortunate trend is predicted to continue well into the future 5 . Cervical cancer screening by cytological diagnosis is an established strategy for secondary intervention against the advancement of abnormalities in cervical cancer. In England, cervical cancer incidence decreased rapidly following an increase in cervical screening rate due to the development of a national reach-out call-and-recall system and incentive payments to general practitioners 6 . In Japan, the national cancer screening rate has not yet reached 50%, although it is slowly increasing due to the implementation of a free-screening coupon system and other measures 7 , 8 . Cervical cancer screening is an effective secondary prevention measure, but its negatives include less than perfect standalone sensitivity, with significant false negatives and false positives, overdiagnosis concerning the spontaneous resolution of precancerous lesions, and the risk of increased premature delivery due to conization for cervical intraepithelial neoplasia stage 3 (CIN3) 9 , 10 . The best primary prevention of cervical cancer is HPV vaccination. In Japan, public subsidies for HPV vaccination began in fiscal year 2010 (FY2010) as an emergency promotion program; it was a huge success and became a routine vaccination program in April 2013 11 . From FY 2010 to 2012, the HPV vaccination rate in age-eligible teen girls exceeded 70% 12 . However, following media reports of potentially serious adverse side effects, Japan’s Ministry of Health, Labour, and Welfare (MHLW) announced the suspension of its proactive recommendation for the HPV vaccine in June 2013. These events had long-lasting negative effects on HPV vaccination coverage, a condition which dragged on for almost eight years 13 . Finally, in FY2022, the MHLW rebooted its recommendations for the HPV vaccine and also began a three-year catch-up vaccination program to reach back to unvaccinated women. The effectiveness of HPV vaccination in the prevention of cervical cancer has been widely reported in other countries 14 , 15 . Of note, Japan was slow to introduce the HPV vaccine, and then, for eight years, a baseless extreme HPV vaccine hesitancy robbed a generation of girls of the protection they deserved. As a result, the effectiveness of HPV vaccination, the primary means of cervical cancer prevention, has been stymied in Japan, leading to predictions of future increases in cervical cancer incidence in Japan 16 – 18 . The fallback for prevention will be cervical cancer screening, so recommendations regarding screening need to be strengthened 19 . As with cervical cancer, the incidence of breast cancer in Japan has also recently increased significantly; 97,142 people were diagnosed with breast cancer in 2019, and 14,650 died in 2020; incidence and mortality rates from breast cancer are 150.0 and 23.1, respectively, per 100,000 women 20 . Mortality rates for women with breast cancer in Japan and South Korea are increasing and approaching rates observed in non-Asian countries 21 . Risk factors for the development of breast cancer included low age at menarche, high age at menopause, never having had a baby, high age at first birth, and never having breastfed 22 . Significant increases in incidence due to westernization of lifestyles in some parts of Asia are predicted to lead to higher future global breast cancer rates 23 . Breast cancer screening is an effective preventive strategy against breast cancer mortality. A combined analysis of several randomized controlled trials in subjects aged 40–74 showed a reduction in breast cancer mortality associated with mammographic screening, and it is now a recommended population-based screening 24 , 25 . The negatives of breast cancer screening include examination pain, radiation exposure, and overdiagnosis due to false positives 24 . Japan’s cancer screening is divided into two main categories: population-based screening and opportunistic screening 26 . Population-based screening is conducted to reduce the mortality rate for the entire population. In Japan, this category corresponds to cancer screening for residents conducted by local governments. On the other hand, opportunistic screening includes cancer screenings other than population-based screening. This latter category corresponds to occupational health checkups, insured medical care, and personal medical checkups. For Japan’s population-based screening, cervical cancer screening is recommended once every two years for women aged 20 and older, whereas breast cancer screening is recommended once every two years only for women aged 40 and older. The Comprehensive Survey of Living Conditions conducted by the Household Statistics Office of the MHLW asks whether a person has received a cancer screening within the past two years, and this information provides the following estimate of the cancer screening rate in Japan. In their FY2022 survey, the cervical cancer screening rate in the past two years was 43.6% among those aged 20–69, and the breast cancer screening rate was 47.4% among those aged 40–69 8 . However, details such as which types of cancer screening were received and how often they were received were unknown. Each local government manages its cancer screening data, such as uptake, recall, work-up examination rates, the rate of not knowing about screening, the cancer detection rate, and the acceptable value of the positive predictive value as process indicators for population-based screening 27 . In addition, there is no governmental management entity for opportunistic screenings (occupational health checkups, insured medical care, and personal medical checkups), so their status is unclear. The purpose of our newest study was to clarify the status of cervical cancer and breast cancer population-based screening, occupational health checkups, insured medical care, and personal medical checkups among female employees and male employee’s spouses of a company, Sunstar, Inc.

In our study, the proportion of female employees in their 20s and 30s who received cancer screening of any kind regularly was significantly lower (31.3%) but the proportion who had received cervical cancer screening was significantly higher (96.2%), indicating a high awareness of the importance of cervical cancer screening, but it is also the only screening covered by insurance or subsidy for that age group ( Supplementary Table 1 (b) ). The significantly most frequent reason for receiving cervical cancer screening was because of pro-screening information received from their employer, suggesting that the company providing pro-screening information had been appropriately effective. On the other hand, a lower proportion of the male employees’ spouses in their 20s and 30s were compelled by information provided by their spouses’ employer, highlighting the challenges of providing health information secondhand. The MHLW recommends cervical cancer screening every two years, but the proportion of female employees and male employees’ spouses who were receiving cervical cancer screening more frequently than every two years was more than half, regardless of whether they were in their 20–30 s or 40s and older. The proportion was extremely high, particularly among female employees in their 20s and 30s (78.1%) (Table 3 ). Among those who received cervical cancer screening more frequently than every two years, for example, among female employees in their 20s and 30s, the proportion of those who received all their screening at occupational health check-ups was 30.0%, and when screening systems and occupational health check-ups were included, the total proportion of those who received screening more frequently than every two years was 46.7%, or about half of the respondents (Table 4 ). It was suggested that this may be due to the benefit of receiving occupational health check-ups stimulated by receiving a notice from the employer, but that scenario is also causing the intervals between screenings to be shorter than recommended for some women. Although the invasiveness of cervical cancer screening is negligible, screening more frequently than recommended only marginally reduces the number of missed cases. This point raises the question of whether the cost and minimal bother are worth the minuscule protection benefit accrued. Unnecessary screening increases the likelihood of false positives and results in additional testing for a disease that may resolve spontaneously. False positives are a physical and emotional burden for patients, and an economic burden for patients and employers. Among the respondents who received cancer screening every two years, more than half of the respondents, regardless of whether they were female employees or employees’ spouses and whether they were in their 20s and 30s or their 40s or older, were more likely to receive cancer screening at population-based screening (Table 3 ). This suggests that population-based screening is taking place for cervical cancer screening at appropriate intervals and that it is the occupational health checkups that are causing the higher frequency of cancer screening than the recommended every two years. From this perspective, we can’t recommend additional cervical cancer screening by occupational health checkups. It is currently more appropriate to recommend cervical cancer screening be conducted by population-based screening. However, among the respondents who received cancer screening less frequently than every two years, a certain proportion of these were conducted during occupational health checkups, so there is a reasonable concern that losing cervical cancer screening by occupational health checkups could result in a complete loss of the opportunity to receive cancer screening for a small group of individuals. The most realistic suggestions for screening opportunities could include the following. First, accurate records of cervical cancer screening status and the screening system used should be kept and monitored. Women who received screenings more frequently than every two years by combined occupational health checkups and population-based screening should be educated to receive screenings only every two years, predominantly by population-based screening. Finally, those eligible for screening who received it less frequently than every two years should be educated to seek free screening during their occupational health checkups, and the occupational clinics should be informed or have records of the last screening. Testing for HPV infection will soon be a part of routine cervical cancer screening 28 . It will be recommended that HPV-negative cases receive cervical screening only every five years instead of two. We will recommend that the HPV-positive but cytologically normal cases receive follow-up cervical screening one year later. This will complicate the screening process and will require a detailed monitoring of the status of everyone’s HPV and cervical screening results. We should take this opportunity to develop a nationwide system for accurately collecting and sharing the status of cervical-related medical examinations among health professionals for all screening-eligible women. For breast cancer screening in Japan, the targeted age group is 40 years and over, but there were 30.8% (33/107) of the respondents in their 20s and 30s who had already received breast cancer screening (Table 5 ). In particular, among respondents in their 20s and 30s, 66.7% (4/6) of those who received screening more frequently than every two years received screening either only by occupational health checkups or in combination with another cancer screening system and screening by occupational health checkups (Table 6 ). Without evidence of predisposition for breast cancer, this constitutes excessive or inappropriate screening from the point of view of radiation exposure and the risk of false positives. One factor that correlated with excessive cervical cancer screening was having a family doctor (Table 7 ). A certain proportion of cervical cancer screening (28.2%) was provided by gynecologists and insured medical care (Tables 9 and 10 ). Gynecologists responsible for screening should be educated to better understand the appropriate intervals for screening and not be influenced by financial interests. In conclusion, our survey revealed that cervical and breast cancer screening for a corporate entity was being performed with inappropriate frequency through their provided occupational health checkups. Proper guidance to women and their screening providers should be given on appropriate screening record-keeping and screening intervals. Table 11 Total number and breakdown of cancer screening. Cervical cancer screening ( n  = 745) Breast cancer screening ( n  = 597) A 196 (26.3%) 186 (31.2%) B 274 (36.8%) 231 (38.7%) C 210* (28.2%) 76** (12.7%) D 65** (8.7%) 104* (17.4%) (A) Cancer screenings that were conducted as a residents’ screening by local governments (Population-based screening). (B) Cancer screenings that were conducted as an occupational health checkup provided by a company’s health insurance association for welfare purposes (Occupational health checkups). (C) Cancer screenings that were conducted as a part of examination using an insured medical care regulated by the government (Insured medical care). (D) Cancer screenings that were conducted as a personal medical checkup fully reimbursed by the examinee (Personal medical checkup). Total number and breakdown of cancer screening. (A) Cancer screenings that were conducted as a residents’ screening by local governments (Population-based screening). (B) Cancer screenings that were conducted as an occupational health checkup provided by a company’s health insurance association for welfare purposes (Occupational health checkups). (C) Cancer screenings that were conducted as a part of examination using an insured medical care regulated by the government (Insured medical care). (D) Cancer screenings that were conducted as a personal medical checkup fully reimbursed by the examinee (Personal medical checkup). The strength of this study is that it provides a detailed description of the status and frequency of cervical and breast cancer screening and their overuse in some cases. On the other hand, as it is a questionnaire survey, biased misremembering cannot be ruled out. There is also a possibility that many of the responses came from women with a higher-than-normal level of health awareness. In addition, the number of responses from male employees’ spouses was less than optimal, so there is a concern that comparisons between employees and employee spouses were not made fairly. Importantly, this study was conducted within a single company, so a large-scale study of other companies, of different sizes and other industries, would be needed to generalize the results.

Below is the link to the electronic supplementary material. Supplementary Material 1 Supplementary Material 1