2020 WINTER
A magazine for women's health
HORMONE THERAPY EXPLAINED
Friday, March 13, 2020 The Ritz-Carlton Tokyo 6:00 p.m. to 11:00 p.m.
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CONTENTS 2 4 6 8 10 14
Hormone therapy explained Solving a sensitive vaginal dryness and breast cancer
Winter 2020
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You think you should feel better I won't let secondary cancer stop me from travelling J-TOP interview with Dr. Nakashima and Dr. Kikuchi Enjoy the flavors of fall with Chinese Cuisine
From the Foundation
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(Follows English section) 1. Share your Story in PiNK! 2. What I Can Do 3. RFTC Japan Charity Event Reports 7. RFTC Japan Outreach Program Report 9. RFTC Japan Products 10. RFTC Japan Recommendations 11. Monthly Self-Examination
RFTC® Japan is a registered NPO with the Tokyo Metropolitan Government since 2004. Our mission is to eradicate breast cancer in Japan as a life-threatening disease through education, timely screening, and treatment. Through our activities, the Foundation funds education initiatives, clinical examinations and mammography machines; donates funds to organizations that promote activities specific to the mission of the Foundation; and develops and executes community outreach programs. We have donated six mammography machines to six clinics in areas where women are underserved, more than 14,000 women have benefited from mammograms, with over 3,600 funded screenings. The Foundation holds three annual events open to the general public to raise funds in support of our cause. PiNK is Japan's one and only magazine dedicated to breast cancer. Some 18,000 copies of this quarterly magazine are distributed free-of-charge nationwide through medical institutions, cooking studios, sports shops, libraries and sponsoring companies. Please contact inquiries@rftcjapan.org for subscriptions. For more information about how to donate, become a sponsor, and/or volunteer for RFTC® Japan, please visit rftcjapan.org
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Hormone therapy explained We look at this common breast cancer treatment, why and when itâs given, and what to do if youâre struggling with side effects
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ormone therapies â such as the drugs tamoxifen and anastrozole â have been part of the treatment for breast cancer for many years. But different people may be offered different drugs for different amounts of time, and this can cause some confusion.
Understanding receptors Whether or not youâve been offered hormone therapy depends on your âhormone receptor statusâ. âThe hormone oestrogen can stimulate some breast cancers to grow,â explains Carolyn Rogers, a clinical nurse specialist at Breast Cancer Care. âThere are a number of hormone therapies, and they work in different ways to block the effect of oestrogen on the cancer cells.â Hormone therapy is only prescribed when breast cancer has receptors within the cell that bind to the hormone oestrogen. âThese are known as oestrogen receptor positive breast cancers,â says Carolyn. âAll breast cancers are tested for oestrogen receptors using tissue from a biopsy or after surgery.â
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Over 70% of breast cancers are oestrogen receptor positive.
known as secondary breast cancer, hormone therapy can be given to keep the cancer under control.
When itâs given Different drugs Hormone therapies are used to treat primary breast cancer as well as breast cancer that has come back or spread. In primary breast cancer (when cancer hasnât spread beyond the breast or lymph nodes under the arm), hormone therapy is usually given after surgery, chemotherapy or radiotherapy. âItâs given to reduce the chance of breast cancer returning in the same breast or spreading somewhere else in the body,â says Carolyn. âIt can also reduce the chances of developing a new breast cancer in the same or opposite breast.â Sometimes hormone therapy is given before surgery to try to shrink the breast cancer. Occasionally itâs given when someone canât have surgery, because of other medical conditions for example. In this case, the treatment wonât get rid of the breast cancer, but it can slow its growth and in some people may shrink it. If breast cancer has spread to another part of the body,
One thing that can cause confusion is that different people are given different hormone therapy drugs. If youâve been offered one drug, you might understandably wonder why a friend is taking a different one.
Carolyn says: âDifferent hormone therapy drugs work in different ways, and the type youâre offered depends on whether youâve been through the menopause.â Tamoxifen, for example, is suitable for women both before and after the menopause. The drugs known as aromatase inhibitors, on the other hand, are suitable only for women after the menopause. âAfter the menopause, oestrogen is no longer made by the ovaries,â explains Carolyn. âBut some oestrogen is still produced in the body fat using an enzyme, which is a type of protein, called aromatase. Drugs like anastrozole, exemestane and letrozole stop this enzyme from working â hence the name aromatase inhibitor â which means thereâs less oestrogen in the body.â In some circumstances, women who have not yet reached the
menopause are given injections to stop their ovaries from producing oestrogen and take either an aromatase inhibitor or tamoxifen as well.
usually given for as long as itâs keeping the cancer under control.
Carry over effect
Hormone therapies cause side effects. And while for many people these start to improve within months, for other people they last longer. Different drugs can cause different side effects. Tamoxifen, for example, commonly causes menopausal symptoms, particularly hot flushes. While also causing menopausal symptoms, aromatase inhibitors can lead to joint pain and stiffness, and thinning of the bones â a condition known as osteoporosis. Coping with the day-to-day side effects of hormone therapy can be hard, and the desire to stop taking the drugs early can be very strong. Several studies have reported that many women stop taking their hormone therapy drugs sooner than recommended. However, Carolyn stresses that itâs important to discuss this with a healthcare professional. âIf for any reason you want to stop taking your hormone therapy, talk to your specialist first,â she says. âThis is because not taking the drug for the recommended time means you may increase your risk of your breast cancer coming back.â Your specialist team will be able to suggest ways to cope with the side effects or improve them. They can also tell you whether itâs possible to change to a different treatment.
Another area of confusion is around the length of time you need to take hormone therapy for. âHow long you take hormone therapy for and which type you take will vary according to your individual situation,â says Carolyn. âYou may take hormone therapy for five to ten years, and this may be a combination of different drugs. âTrials have shown that taking it for this length of time reduces the chance of the cancer coming back or a new cancer developing.â And when you stop taking hormone therapy, does the protection it offers suddenly disappear? âHormone therapy has a âcarry-over effectâ,â says Carolyn. âThis means that even when you stop taking it, you still get the benefit for several years.â If youâre taking hormone therapy to treat cancer that has spread, itâs
Side effects
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SOLVING A SENSITIVE VAGINAL DRYNESS AND BREAST CANCER Vaginal dryness is a very common side effect of some breast cancer treatments. Katie Parsons explores some things that might help.
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e get lots of calls to our Helpline about vaginal dryness. But while itâs common, it can be a difficult subject to bring up. âIt is embarrassing so it is not talked about,â says Debby Holloway, nurse consultant in gynaecology. But, she says, women should be able to have an open conversation about it with their healthcare professional. Vaginal dryness wonât get better on its own, so seeking help to manage it is important.
Some breast cancer treatments block or reduce the amount of the hormone in your body. Because oestrogen helps maintain the vaginaâs moisture and elasticity, a lack of it can cause the vagina to become dry and less supple, and may make sex or intimacy painful. If itâs not treated it can get worse, and may lead to loss of sex drive and emotional problems alongside the physical ones. âIf it hurts when you have sex,â says Debby, âthis can lead to not wanting to have sex as there is a fear it can hurt. This circle is difficult to break.â
All about oestrogen
Ways to help dryness
âVaginal dryness happens due to a lack of oestrogen,â explains Debby.
âThere are many different products that can be used for vaginal dryness,â
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says Debby, âand some of them are available on prescription or can be bought from a chemist or online.â While you might want to try some of the products mentioned on these pages, talk to your specialist team too. Vaginal dryness and irritation can also be caused by an infection, so itâs a good idea to see your GP to rule this out.
1. Try moisturisers or lubricants Vaginal moisturisers â such as ReplensMD, Senselle or Hyalofemme â provide long-term relief for dryness and discomfort, and are not just for use during sex. You can use most types every few days, and theyâre most effective when used regularly over time. Moisturisers are usually applied with a pessary (a small, soluble block that dissolves in the vagina) or tampon-style applicator. Vaginal lubricants are shorter acting than moisturisers, and only provide temporary relief. Theyâre intended to help prevent friction and pain during sex and intimacy, and
work best if used by both you and your partner. Lubricants are available as a pessary or a tube of liquid or gel. You could try Yes, Pasante TLC or Sylk. Itâs worth trying different brands. You might prefer some to others and you can use lubricants and moisturisers alongside each other. But donât be tempted to substitute moisturisers or lubricants with Vaseline, hand cream or body lotion.
2. Ask about oestrogen products The most commonly used treatment for vaginal dryness is hormone replacement therapy (HRT), but this is not usually recommended for women after a diagnosis of breast cancer. However, some specialists may prescribe a topical hormone treatment, which is applied directly to the area, to help reduce dryness and discomfort. This could be an oestrogen pessary, vaginal tablet or cream. When you use vaginal oestrogens, itâs thought that very small amounts of the hormone are absorbed into the body. Therefore, vaginal oestrogen may be more safely prescribed for
women taking tamoxifen, because tamoxifen is thought to counteract any oestrogen entering the bloodstream. If youâre taking an aromatase inhibitor â such as letrozole, anastrozole or exemestane â vaginal oestrogen is not usually recommended. But it might be worth asking your specialist team if switching to tamoxifen is an option.
3. Intercourse can help If itâs comfortable for you, sexual intercourse can stimulate blood flow to the vagina and help maintain its suppleness and elasticity. Using a vibrator or masturbating can also help in the same way.
SIX OTHER THINGS THAT MIGHT HELP ⢠⢠â¢
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If penetrative sex is too painful, consider other forms of intimacy. Keep lubricants near the bed so you donât have to get up to find them. Donât use scented soaps, lotions, bath oils or panty liners as these can dry out the vaginal area. Try switching to a different washing powder or fabric conditioner, as some can irritate the area. If you smoke, try to cut down or give up completely. If you need to have a smear test and are experiencing vaginal dryness, tell the nurse or doctor beforehand so theyâre aware.
4. Exercise your pelvic floor Doing regular pelvic floor exercises can increase blood flow and relax
your pelvic muscles. Knowing how to relax these muscles can help ease pain during sex or intimacy, and also help you feel more relaxed during procedures such as a smear test. You can feel your pelvic floor muscles if you try to stop the flow of urine when you go to the toilet (but donât do this often because it can be harmful to the bladder). To strengthen your pelvic floor, sit comfortably and squeeze these muscles 10 to 15 times in a row. Donât hold your breath or tighten your stomach, buttock or thigh muscles at the same time. When you get used to doing this regularly, you can try holding each squeeze for a few seconds. Every week, add more squeezes, and rest the muscles between sets.
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uzanne was invited for routine breast screening for the first time at the age of 52. âI went for my first mammogram and was not really worried at all,â says Suzanne, 56, from Manchester. âI was breast aware and checked my breasts on a fairly regular basis.â A week later, a letter arrived asking her to go back for further assessment. âI was still not really worried,â she says, âand went to that appointment not even slightly concerned.â Suzanne had heard that women were more likely to be recalled after their first mammogram. After more scans, however, Suzanne was told it looked likely she had cancer. âI was thrown into a completely different world,â she says. After she was diagnosed with breast cancer, Suzanne went on to have a lumpectomy followed by chemotherapy, trastuzumab and the hormone drug letrozole.
It was scary For many women, the end of hospital treatment can be a challenging and worrying time, when regular appointments and contact with healthcare professionals suddenly come to an end. But Suzanne initially felt she was coping well. âI tried to see the cancer as a temporary thing,â she says. âI put my life on hold for six months, then when I came out of treatment I thought: great, time to get on with life. I tried to carry on as normally as I could. Iâm not the sort of person who ever needs to ask for help. âAnd I was fine for 18 months or so. I was quite positive, but it came back to bite me.â A year-and-a-half or so after her hospital treatment ended, Suzanne started experiencing anxiety and having panic attacks.
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You think You should feel better Eighteen months after her breast cancer treatment ended, Suzanne Stolberg started having panic attacks. She tells us about the support that made a difference.
âI really didnât know what I was worrying about. You think you should be feeling better, happy and positive,â says Suzanne, who burst into tears at an appointment with her oncologist when he asked how she was. âHe helped me through this and pointed out that ending treatment in many ways can be harder than going through treatment. âHe prescribed antidepressants, which I was reluctant to take at first. I got some counselling support as well. This helped me work out what my new normal was. âIt was quite scary, and it might have helped if I had known before that this might happen.â
Five years on Suzanne is now coming up to the five-year anniversary of her diagnosis in April 2014. âIâm much better than when I was 18 months ago,â she says. âI stopped work for a year, invested in looking after myself, working out what I wanted to do with the rest of my life and the relationships I wanted with those I love. I now have much healthier relationships with our family, friends and my body.â âI know that if I get to five years then statistically Iâm good for many more. But Iâm aware that you never really know whether itâs gone away. Itâs not really fear, but an awareness.â Seeing a counsellor has been a great help. âThe ability to have someone outside your family and friends, who will listen when you talk about your scariest thoughts and fears, is essential,â says Suzanne. âFamily and friends donât always understand,â she says. Suzanne is reminded of one friend who, when she heard about Suzanneâs diagnosis, changed her Facebook profile picture to an old photo of her and Suzanne. âIâm not dying!â she thought.
Five years on Suzanne is now coming up to the five-year anniversary of her diagnosis in April 2014. âIâm much better than when I was 18 months ago,â she says. âI stopped work for a year, invested in looking after myself, working out what I wanted to do with the rest of my life and the relationships I wanted with those I love. I now have much healthier relationships with our family, friends and my body.â âI know that if I get to five years then statistically Iâm good for many more. But Iâm aware that you never really know whether itâs gone away. Itâs not really fear, but an awareness.â Seeing a counsellor has been a great help. âThe ability to have someone outside your family and friends, who will listen when you talk about your scariest thoughts and fears, is essential,â says Suzanne. âFamily and friends donât always understand,â she says. Suzanne is reminded of one friend who, when she heard about Suzanneâs diagnosis, changed her Facebook profile picture to an old photo of her and Suzanne. âIâm not dying!â she thought. Suzanne doesnât necessarily feel that cancer has changed her. âCancer did not make me a better person,â she says, âbut I probably make better decisions. I still get stressed and frustrated by the small things, like if someone cuts me up when Iâm driving. But now Iâm able to recognise that those are small things.â
I came away with a much better understanding of the different ways breast cancer can affect people
Silly things In 2018, Suzanne was one of 32 models who appeared in Breast Cancer
Careâs annual fundraising fashion show. âThe Show was brilliantâ she says. âIt was great to meet other women in so many different situations. I had never had any contact with younger women with breast cancer, and obviously the issues for them are very different.â âI came away with a much better understanding of the different ways breast cancer can affect people.â Does Suzanne have any advice for other women in her situation? âHave a support network that doesnât just include family and friends,â she says. âIt could be an online forum, telephone support, or face-to-face counselling. I just think itâs so important that you can talk about all the silly or daft things that you canât do with friends and family.â
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I won't let secondary breast cancer stop me from travelling
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Travel blogger Jenni Sheldon tells us how sheâs as determined as ever to see the world, despite her cancer diagnosis.
oing back five years, I was scared of flying. I would never have considered going further than Europe, even though I dreamt of travelling the world. Fast forward a couple of years and I was diagnosed with breast cancer. It made me realise what genuine fear was. I thought, if I can get through chemotherapy and side effects of cancer treatment, I can sit on a plane for a
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few hours. My travel adventures really started.
Planning my trips During treatment, I kept dreaming of all the places I was going to visit. It got
me through the dark days. When I was at my lowest, I would plan the places I was going to see when I got well again. I didnât have a family or work to concentrate on and I really think it helped me get through the treatment. It took me over a year to have the physical strength, as well as the courage, to do my first major trip outside of Europe.
âAs long as I can carry on travelling, I will find a way.â
I went to China on my own, and it was such an eye-opener. I then explored Thailand, Cuba, America⊠People said I was an inspiration. I hated that. I didnât want to talk about my cancer and I really didnât think I was doing anything different from everyone else who had been through a cancer diagnosis.
When my first reader contacted me to say I gave her the willpower to book the trip she had been wanting to do â and that she had the best time â it made all my blogging seem worthwhile.
Getting back out there In December 2017 I started to feel unwell. Thinking I had worn myself out with all the travelling, I spent some time at home. But my symptoms got worse. In January I was diagnosed with secondaries. My breast cancer had spread to my liver, lungs and bones.
Travelling after cancer I started blogging about my travels, mainly to tell my friends what I was getting up to. But then fellow cancer patients started asking me for advice and I started opening up about my cancer experience and how it affected my travels. I realised when people were saying I was brave and an inspiration to be able to travel independently, it was because they were scared of doing the same even though they wanted to. So I shared my stories as a way of convincing others in a similar situation that travelling can still be done. I wanted to encourage people to take the trip as you really donât know whatâs around the corner in life. Travelling after a cancer diagnosis is possible. It may have to be done slightly differently and require a little more planning, but itâs still manageable.
be so much more open about my treatment. Cancer is part of my travel experience now and always will be.
I was absolutely devastated, but the main thing upsetting me was that I still had so many places to visit. Chemotherapy started again, but I didnât stop planning my trips. The research for my future adventures, and the thought of getting back out there again, got me through what seemed an even scarier experience than the first time round. During chemo, I started travelling the UK when I was feeling well enough. I was still sharing my stories and the support I was getting online was wonderful. Now, my followers already knew about me and I felt I could
I won't stop I will not let secondary cancer stop me from travelling. There are a few more obstacles in my way now, such as insurance premiums. But there are companies out there that specialise in travelling with cancer. My advice is to contact them by phone, even if you get a ridiculously high quote online, as they still might insure you at a lower rate. I have symptoms such as nausea, fatigue and peripheral neuropathy, so I factor in rest time. I know I canât be nonstop sightseeing, even though I want to see everything, so I prioritise the places I really want to visit and take it a little slower. When I was told I would be having treatment every three weeks for the foreseeable future, I truly believed that it was the end of my travels, especially long-haul. How can you go somewhere far from home for only a few days? But as time passed, I started to realise I can still visit these places. I might not be able to go off months at a time, but I will just have to do shorter trips. I will not let this stop me. As long as I can carry on travelling, I will find a way.
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J-TOP INTREVIEW WITH INTERVIEWERS: MARIA SAKIKO SUZUKI & YUKI SHIBUYA
Dr. Kazuaki Nakashima Profile Senior Staff Division of Breast Imaging/Breast Intervention Radiology and Division of Clinical Physiology Shizuoka Cancer Center
Dr. Nakashima, please tell me about your field of specialization. Dr. Nakashima I am a diagnostic radiologist. My main job is to examine CT and MRI scans to make a diagnosis. At the Shizuoka Cancer Center, where I work, I belong to Japanâs only clinical department specializing in imaging diagnosis of the mammary gland, the Division of Breast Imaging/Breast Intervention Radiology and the Division of Clinical Physiology. Although I do imaging diagnosis of the whole body, including the head or the stomach, my main job is to make a diagnosis through the examinations of mammography, ultrasound of the mammary gland, MRI, and other images related to the mammary gland. I also work in an outpatient clinic where I make diagnoses by examining patients and doing needle biopsies. Patients diagnosed with breast cancer are referred to breast surgery and internal medicine doctors. For patients with benign lesions that only require follow-ups, they might continue to come periodically to the outpatient clinic for examinations. Currently, how many diagnostic radiologists are there in Japan? Dr. Nakashima Not as many as there should be. There are approximately 40,000 diagnostic radiologists in the United States while there are about 5,000 in Japan. The population in the United States is about
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2.5 times the size of Japan â but even taking the population difference into account, the number is small. The job of a diagnostic radiologist is closely related to the development of medical equipment. For example, 20 years ago, we could take dozens of CT scans per patient, but thanks to the development of the screening equipment, we can now take several hundred or even several thousand detailed images with tremendous speed. Screening equipmentâs accuracy and speed have exponentially increased over the years, but there has not been an equivalent increase in the number of diagnostic radiologists. Many radiologists today are faced with a tremendous increase in their workload. Whatâs more, there are only a few radiologists who specialize in the mammary gland. We are working hard to increase this number. What lead you to become a radiologist? Dr. Nakashima Initially, I was interested in cranial nerves and wanted to be a neurologist. However, in my final year before graduation, I met a radiologist who was working as chief of staff. Through him, I decided to become a radiologist. Even after I joined the radiology department, I was still interested in cranial nerves, owing to my study of cranial nerve images at graduate school. I never thought that I would be specializing in the mammary glands.
What led you to specialize in the mammary gland? Dr. Nakashima I decided to take an exam because the mammary gland is one of the organs radiologists regularly examine. Before the exam, I barely had a chance to screen a mammography, but I studied hard and managed to get a good score on the exam. Then work related to mammograms and ultrasound started to come. That motivated me to study even more, go to academic conferences, and publish my own studies. Then, things started to get more interesting. As I repeated this process, my work became more focused on mammary glands. I also wanted to learn more about the field to help me teach and train young diagnostic radiologists. This led me to join the Division of Breast Imaging/Breast Intervention Radiology and Division of Clinical Physiology at the Shizuoka Cancer Center four years ago. I had to make sacrifices along the way, but choosing something is to let go of another, and I am satisfied with my decision. Tell us about J-TOP. How did you find out about J-TOP? Dr. Nakashima Unfortunately, there are very few diagnostic radiologists who know about J-TOP. This was also true for me, and I had never heard about it until I was informed by Dr. Kikuchi. As soon
as I heard about it, I went to a J-TOP workshop in early 2018, followed by a summer training trip to MD Anderson Cancer Center during the summer. It all happened so quickly, but it was a very fulfilling year. Diagnostic radiologists are somewhat unique in a way that we can spend our days staring at the screen and barely talking to anyone. Of course, some collaborations are made, but it is an area that doesnât often require active communication. We like to work independently and seldom take leadership positions. So it was very refreshing to see and experience J-TOPâs âmultidisciplinary team science approach.â This was a field where radiology was not as involved in the past. What was most memorable for you during your five weeks at JME? Dr. Nakashima Observing surgeons, radiologists, and pathologists hold discussions with one another after surgery. They were examining the screening images and discussing whether the tumor was properly extracted. This is unthinkable in Japan, given our normal policies. To give oneâs opinion comes with a lot of responsibility, and so I was deeply impressed by how vocal and involved the radiologists at MD Anderson were in clinical practice. It taught me that if you want to establish trust and work well with other departments, the way was to assume a sense of responsibility, take risk, and get involved. I also had several opportunities to observe doctors interpret radiographic images. Seeing physicians come in to ask the opinion of radiologists left a real impression on me. My department, the Division of Breast Imaging/Breast Intervention Radiology and Division of Clinical Physiology at the Shizuoka Cancer Center is unique in Japan, and I found that our job descriptions were similar to the breast radiologists at MD Anderson. This helped me learn many things that were helpful for my practice. I also got to observe how work is done and see how different some practices were from what we are familiar with in
Japan, and how similar other practices were, which reassured me that what we are doing is right. I would love to hear about it in more detail. Dr. Nakashima I think when it comes to accuracy and safety during interpreting radiographic images, performing a needle biopsy and surgical procedures, I found that MD Anderson and institutions in Japan have the same standard. If I were to mention one difference, it would be the approach that they take to multi-institution studies to come up with universal methods that anyone can do, whereas in Japan it is more craftsman-like. By âcraftsmanlike,â I mean doctors may have a high level of skill, but their skills are often hard for others to imitate. In Japan, there are not many multi-institution studies in the field of diagnostic radiology, so I want to conduct studies and communicate to find universal, good methods. Thatâs was a big take away from my time there. It was interesting when you said you want to educate the next generation. Please tell me more about it. Dr. Nakashima I want to increase the number of radiologists who specialize in the mammary gland examinations when making a diagnosis. To achieve this, Iâm making steady efforts to talk to people and send out my studies to any diagnostic radiologists who are interested. I think people only join in where there is a degree of energy. Actually, this year, a new diagnostic radiologist joined saying he wanted to specialize in the mammary gland. Because Shizuoka Cancer Center has a unique Department of Mammary Gland Imaging Diagnosis, I hope we can become an institution where we accept many more young doctors in the future. For you, what was the appeal of becoming a radiologist? Dr. Nakashima I became a radiologist because I had always liked imaging, but I also think
that diagnostic imaging is at the core of medicine, and you can directly operate latest machinery and work there. Also, in the United States, radiologists are referred to as the âdoctorâs doctor.â Radiologists donât have much chance to talk with patients directly, but have many opportunities to talk with other doctors. They often exchange opinions with the patientâs physician to give advice, and although Iâm very specialized in the mammary gland, another appeal of our job is that diagnostic radiologists can examine the whole body. Please tell me about your current vision and mission. Dr. Nakashima My mission is, through studies and education, to construct a new imaging diagnosis system that can accurately diagnose breast cancer before it becomes advanced. It is currently difficult to eliminate breast cancer altogether, so I want to make sure that it is found before reaching a life-threatening stage so patients can receive treatment. My vision is that by using such innovative imaging diagnosis system methods and finding cancer in the early stages, we can reduce the number of advanced breast cancer from society as much as possible. Recently, I have had very advanced breast cancer patients arriving weekly. At times like that, there is nothing you can do unless patients come to get tests at hospitals equipped with the latest imaging diagnosis. Thatâs when I feel the limitations of a diagnostic radiologist. There are so many people who leave tumors for too long. Many people notice abnormalities, but are afraid to go to the hospital. I really want to share more information on these issues in a positive way. Thank you very much for this valuable conversation.
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J-TOP INTREVIEW WITH INTERVIEWERS: MARIA SAKIKO SUZUKI & YUKI SHIBUYA
Dr. Mari Kikuchi Profile Division Director, Breast Region Diagnostic Imaging Center Cancer Institute Hospital of JFCR
Dr. Kikuchi, please describe the nature of your work. Dr. Kikuchi A: I am a practicing radiologist, a medical doctor specializing in diagnostic imaging. My specialty is fundamentally concerned with the diagnosis of the entire human body using imaging techniques such as CT and MRI scans, but my sub-specialty focuses specifically on the breast, or breast imaging. I examine mammograms, ultrasounds, MRIs and other diagnostic images and write reports which include information like the site of any anomalies, any potential suspected diseases, and any recommended next steps. Should any anomalies be detected during a mammogram screening, an ultrasound exam will be performed to determine the presence or absence of malignancy. If malignancy is suspected, a needle biopsy will then be performed. If these test results reveal the presence of cancer, we must then determine whether to perform surgery, partial or complete removal of the affected tissue or organ, or whether to begin radiation treatment. In order to make this determination an MRI is taken that allows us to visualize the extent of the growth of the tumor. Doctors in my field use this sequence of diagnostic imaging to make a comprehensive diag-
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nosis and write up a report, including essential information such as the extent of the cancer as well as any metastasis present, providing the attending surgeon or oncologist with crucial information and performing a largely unseen yet essential supporting role in the diagnostic and treatment process. What inspired you to specialize in breast cancer specifically? Dr. Kikuchi: Prior to my previous position at the National Cancer Center Hospital, I spent some nine years working at St. Lukeâs International Hospital. By chance, I moved there just as I was starting to think that I would like to specialize in a particular field. St. Lukeâs performed a great number of breast cancer surgeries and saw many patients for breast imaging. I had had virtually no experience reading mammograms while at university and was a complete novice when it came to breast imaging, but as I witnessed the pathologists, surgeons, and radiologists I worked with holding conferences and collaborating with one another, I was deeply impressed. The number of breast cancer patients is also increasing, so I thought that if I was going to have a specialization, breast imaging would be a good choice.
Holding detailed conferences with other specialists create a collaborative relationship that you simply cannot get by just interpreting diagnostic images by yourself. Creating a space to share your opinions from the vantage point of your own field while considering those of others and asking and answering each otherâs questions creates a two-way line of communication and collaborative relationship that I have found to be very worthwhile. What do you mean by âconferenceâ? Dr. Kikuchi: âConferenceâ in this instance refers to a meeting where a team of health care providers join together to analyze a given patientâs case. For example, in a pre-operative conference everyone involved will re-examine the individual patientâs case. This allows us to ensure that any surgical procedure we perform is consistent with the test results we have, to identify any areas of particular concern, and to share any other relevant details prior to proceeding with the surgery. Post-operative conferences are likewise held. These are conferences where we meet after a given period of time has passed since the surgery to consider things like the results of the surgery, pathology results, progress
reports and other information which may be useful for further diagnosis and treatment. Please tell us about J-TOP. How did you find out about J-TOP? Dr. Kikuchi: Back in 2017 an oncologist at the National Cancer Center, Dr. Shimomura, introduced me to J-TOP, saying that this year they were recruiting doctors specializing in diagnostic imaging for the first time and that I should consider applying. I attended that yearâs workshop and then the summer Japanese Medical Exchange (JME) program. What impacted you the most during your five weeks at JME? Dr. Kikuchi: I was most surprised by the different healthcare system: it was completely different to the one we have in Japan. First of all, the insurance system works differently, so certain tests that are routinely performed in Japan may not be performed in the US. I saw the biggest differences in the use of MRIs. In Japan, the out-of-pocket cost to the patient for a breast MRI is usually around Â¥10,000. So in Japan prior to surgery an MRI is almost always taken, but at MD Anderson they usually only performed mammograms and ultrasound tests. On the other hand, needle biopsy was much more commonly performed than it is in Japan. The reason they perform such detailed needle biopsy procedures is because they do not take MRIs to diagnose the extent of the tumor. I found out that the main reason is that the cost of an MRI in the United States is around ten times higher than in Japan. Because of the large number of needle biopsy procedures and intraoperative pathological diagnoses performed, the number of pathologists also far outnumbered those working at either the National Cancer Center or the Cancer Institute. The outpatient system was also different. In Japan, a patient will usually first go for an outpatient exam at the breast surgery department. MD Anderson, on
the other hand, was divided into sections such as âBreast Undiagnosed Clinicâ and you would only go for an outpatient visit once all testing is complete. In Japan, typically you would first have an outpatient visit and then undergo testing, and the results of the tests would determine where you would go next. Patient waiting hours were also shorter at MD Anderson. I thought that Japan could learn something from this system, but at the same time I realized that costs were dramatically higher than they are in our hospitals. Another aspect that I thought was very positive was and that they use a risk assessment tool and an MRI was performed only in cases deemed to be high risk, and performing only mammograms and ultrasounds on lower risk patients. Using risk assessment tool to categorize patients by level of risk and offer different screening methods appropriate to that level eliminates unnecessary screening. Since the use of inappropriate screening methods still leaves the possibility that you could miss something, I thought this was a very good system. Is this system used in Japan? Dr. Kikuchi: Not yet. This assessment tool requires all kinds of data, including statistics and genetics, and Japan is behind in this respect. Even if we wanted to look at the data from Japanese people living in the United States, there are generally too many different factors that come into play, such as lifestyle, so bringing that data to Japan is not as useful. That inspired me to want to work towards developing similar assessment tools here in Japan. Why do you think it is that Japan is behind? Dr. Kikuchi: I think it is because more people are diagnosed with breast cancer in the US and Europe than in Japan, and there is a greater need for breast cancer screening. There is a nationwide effort in the
US to promote screening, so it is on a whole different level. Screening rates are incomparable to that of Japan â more than 80%. However, the need for breast cancer screening in Japan is currently increasing, and since there is a need for individualized screening I believe we first need a reliable risk assessment system in order to make any headway. I think this is our next challenge going forward. What is your vision for the future? Dr. Kikuchi: I would like to develop a risk assessment system for Japanese people. In order to do so we would need data and knowledge not just from radiologists but from different disciplines, so I would like to have the chance to work together as part of a team to create such a system. I couldnât have come up with this idea all on my own, rather it was because of the guidance I received from the doctors and staff at JME, and through envisioning what I would like to do over the next 10 years, that I came to this conclusion. JME inspired me to collaborate with others to make this possible, so I feel very fortunate to have been given the opportunity to study abroad. As we continue to make progress in the field of AI and the development of other new technologies, the future of diagnostic imaging is bound to improve as well. Although the risk of cancer depends on a variety of factors such as age and family history, due to a lack of information many people think that they need to get screened just in case. But this in turn creates a series of pointless tests. If we could gather the data we need, we could cut back on unnecessary examinations. Of course there are challenges, but I believe that we can overcome these and create an effecient screening system based on individual risk a reality here in Japan. Thank you for your time.
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â Boiled Pork â Autumn Eggplant and Boiled Pork Appetizer in a Fragrant Leek Sauce â Yakisoba (stir-fried noodles) with Mushroom and Seafood Sauce â Nori Seaweed and Ginger Soup â Seasonal Fruit Scented with Liquor
Enjoy the flavors of fall with Chinese Cuisine
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PiN K ⢠WIN T ER 2 0 2 0
Recipe provided by: Tokyo Gas âFoodâ Information Center
Recipe
Boiled Pork The boiled pork is served as an appetizer, while the pork broth can be reused for yakisoba stir fried vegetables and soup. You can save time for the soup by boiling the daikon radish and kombu seaweed together with the meat. Ingredients
[B] 5cm Kombu seaweed (5 x 1cm square cut) 150g of 1cm cubed daikon radish
TOTA L 4 9 8 KC A L
| COOKING TIME : 2 5 MINUTES
Preparation 1 Place the pork and ingredients A in a pot and bring to a medium heat while covering with a drop lid. Once the ingredients come to a boil, skim the foam from the surface and add ingredients B. Set the timer to 25 minutes and boil with the lid partially covering the pot.
âŒ
Advice Pork Thigh: Use a lean cut that has been defrosted at room temperature. Once boiled, 400g of pork thigh without fat will weigh approximately 250g.
(E XCLUDING WAITING TIME)
2 Once the meat is cooked through, turn off the heat and leave to marinade in the pot with the lid closed.
Use a ceramic plate as the drop lid. The weight of the lid will keep the pork underwater and helps the meat to boil until tender.
âŒ
400g pork thigh (unsliced) [A] 5 cups water Leek stem to taste Ginger peel to taste 1 tablespoon Japanese sake
Tokyo Gas Cooking Class Tokyo Gas provides the gas every kitchen needs to cook a good meal. Our mission is to enrich your life through the art of cooking. The three essentials of Tokyo Gas Cooking Class 1 Each cooking class is an independent, stand-alone class. You can try out a recipe whenever you have some free time. 2 We believe that anyone can experience the joy of cooking. 3 Our lessons can teach you new things about Japanese culture and its aesthetics, time-saving recipes, eco-cooking, bread baking, sweets and more. â» Classes are conducted in Japanese only.
Precautions for using gas stoves, grills and ovens â Always turn the ventilation fan on. â Read the instruction manual carefully to use the equipment correctly and safely.
Interested in learning how to cook? We're looking for students. www.tg-cooking.jp
Pi NK ⢠WI NT ER 2020
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Recipe
Autumn Eggplant and Boiled Pork Appetizer in a Fragrant Leek Sauce Nutritious, grilled eggplant and soft, boiled pork go perfectly together in leek sauce. Ingredients for 6 servings 3 medium sized eggplants 3 tablespoons vegetable oil 250g boiled pork 2 large tomatoes [A] 1 teapspoon sugar Ãź tablespoon coarsely grounded black pepper 2 tablespoons soy sauce 2 tablespoons vinegar Cilantro to taste
1 8 7 KC A L P E R P E R S O N | C O O K I N G T I M E : 1 5 M I N U T E S
Preparation 1 Remove the tops of the eggplants and slice them vertically in half. Make thin diagonal marks onto the skin of the eggplants. Brush vegetable oil on the skin. Grill eggplants on both sides for 8 minutes on a double-sided grill without water on high temperature.
â–ź
Advice Turn off the heat to the sesame oil when it begins to smoke and immediately pour in
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PiN K â€Ë WIN T ER 2 0 2 0
2 Mince the leek, ginger and garlic, put in a heatproof container and add doubanjiang. 3 Heat the sesame oil over a medium heat and add the results of step 2 and heat until fragrant. Mix with ingredients A to make the sauce. 4 Cut the eggplants from step 1 and the tomatoes and into bite size chunks. Slice the boiled pork thinly. 5 Plate the ingredients step 4 colorfully on the serving dish and pour over the sauce from 3 as desired.
the leek, ginger and garlic to add fragrance. Be careful not to overheat the oil.
Recipe
Yakisoba (stir-fried noodles) with Mushroom and Seafood Sauce Crispy wok-fried noodles covered in a delicious sauce made with plenty of mushrooms and seafood. This big dish of comfort food is guaranteed to leave you satisfied.
100g white shimeji mushrooms 100g white maitake mushrooms 100g eryngii mushrooms 3 shiitake mushrooms 1 bunch bok-choy œ leek stalk 10g ginger 1 clove garlic 9 pieces or 150g scallops 150g boiled octopus [A] œ tablespoon Japanese sake 1 pinch of salt 600g steamed Chinese noodles Vegetable oil to taste [B] 2 cups pork broth œ tablespoon oyster sauce œ tablespoon soy sauce œ teaspoon salt Apinch of sugar A pinch of pepper [C] 3 tablespoons cornstarch 3 tablespoons water
3 8 9 KC A L P E R P E R S O N | C O O K I N G T I M E : 3 0 M I N U T E S
Preparation 1 Remove the stems from the white shimeji mushrooms and cut into small pieces along with the white maitake mushrooms. Cut off the bottoms of the eryngii mushrooms and slice the body into 7 mm rings. Remove the stems from the shiitake mushrooms and slice thinly. 2 Divide the bok choy between the stems and leaves and slice the leaves roughly and the stems into roughly 2 cm wide pieces. Cut the leeks vertically into quarters then cut those quarters into 1 cm long pieces. Mince the ginger and garlic. 3 Slice the scallops and boiled octopus thinly and marinate in ingredients A. 4 Loosen the steamed Chinese noodles and divide into 6 equal parts. 5 Heat a wok on a high temperature and add 1-2 tablespoons of vegetable oil and stir-fry the ingredients from step 4. Adding more oil as needed, fry both sides of the noodles until fragrant over a medium heat. Once crispy, remove and put on a plate.
Advice Steamed Chinese noodles are hard to loosen when cold, so itâs best to defrost them at room temperature. If you have a
âŒ
Ingredients for 6 servings
[D] 12 gingko nuts (boiled) 6 quail eggs (boiled) Vinegar and karashi Japanese mustard to taste
. 6 Add more oil to the wok and warm on a medium heat. Fry the ginger, garlic and leeks until fragrant, and then add ingredients from step 1 and heat over high to medium heat. 7 Add the bok-choy and fry, adding the ingredients B (high heat) and add step 3 when this comes to a boil. Once the contents come back to the boil, add ingredients C to thicken and add ingredients D and mix over medium heat. 8 Pour step 7 over the fried noodles in from step 5 and add vinegar and karashi mustard to taste.
wok that heats up to the edge, you can cook between 2-3 portions of noodles at once depending on the size.
Pi NK ⢠WI NT ER 2020
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Recipe
Nori Seaweed and Ginger Soup This is an easy-to-make soup that combines the fragrance of the seashore with the spicy heat of ginger. Ingredients for 6 servings 1 piece of toasted nori seaweed 15g ginger Leek 5cm long [A] 3 cups pork broth 5 squares of kombu seaweed (1cm boiled squares each) 150g daikon radish in 1cm boiled cubes [B] œ teaspoon salt Œ teaspoon soy sauce A pinch of pepper
1 5 KC A L P E R P E R S O N | C O O K I N G T I M E : 10 M I N U T E S
Preparation 1 Cut the nori into 1cm squares. Mince the ginger coarsely and cut the leek vertically into 4 quarters, then and slice those quarters into 1cm lengths. 2 Add ingredients A and the ginger to a pot and heat on a medium heat to high temperature, skimming any foam from the
surface. Adjust the taste with ingredients B and add the leeks, adjusting the heat to low. 3 Pour step 2 into a bowl, and garnish with the nori seaweed.
Recipe
Seasonal Fruit Scented with Liquor Make the choice to pep up delicious, seasonal fruit to have a refreshing taste will spread over your palate. Ingredients for 6 servings 18 Kyoho grapes œ tablespoon of your favorite liquor
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PiN K ⢠WIN T ER 2 0 2 0
2 7 KC A L P E R P E R S O N | C O O K I N G T I M E : 1 5 M I N U T E S
Preparation 1 Boil water in a pot, and briefly blanch the grape. Once blanched, immediately plunge into cold water, and peel.
2 Place in a bowl and add your favorite liquor to coat.
ããªãã®ã¹ããŒãªãŒã ãèããäžããïŒ
Share your story in PiNK! PiNK ã«çµéšè«ãå¯çš¿ããŠã¿ãŸãããïŒ Would you like us to publish your story?
åéèŠé Requirements â¶
5,000 ã 6,000 æåã®åçš¿
Article of 1,000 â 1,100 words
åçš¿ã¯ããœã³ã³ã§äœæããŠãã ããããŸããå°å·ç©ã CD ã§å çš¿ããéµéããã ããå Žåãæ²èŒã®æç¡ã«ãããããè¿åŽã ãããŸãã®ã§ãããããããäºæ¿ãã ããã Please compose your draft in Word or any other comparable format. Please note that hardcopies or CDs with the article sent by mail will not be returned regardless of publication status. Also, please be reminded that the purpose of the article is to inspire, give hope and provide positive support to others in Japan regarding early diagnosis, treatment and care of breast cancer. æ¬æã§è§ŠããŠããã ãããç¹ïŒ ïŒ ä¹³ãããèŠã€ããçµç·¯ ïŒ å®æçãªãã³ã¢ã°ã©ãã£ãŒæ€èšºãåããŠããã ïŒ å®æçãªèªå·±æ€èšºãè¡ã£ãŠããã ïŒ ä¹³ãããšèšºæãããæã®ã¹ããŒãž ïŒ æ²»çå 容 ïŒæè¡ãæããå€çæ³ã ãã«ã¢ã³çæ³ãªã©å ·äœçã«ïŒ ïŒ è¬ãæçšãããå Žåã¯ãã®çš®é¡ãšæé Please include in your article draft: 1 How you found out you had breast cancer; 2 Whether or not you regularly had annual mammography screenings;
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For article submissions or any queries, please contact: â Email: pink@rftcjapan.org â TEL: 03-4520-8650 3 4 5 6
â·
Whether or not you regularly conducted self-examinations; At which stage you were diagnosed; What kinds of treatment you underwent (surgery, chemotherapy, hormone therapy, etc.); and What types of drugs you were prescribed if any.
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PiN K ⢠WIN T ER 2 0 2 0
CHARITY EVENT REPORTS
Casino Night 2019 & Run for the Cure®/Walk for Life 2019
Casino Night 2019 ã«ãžããã€ã 2019
TEXT BY MARI A SAK IKO S U ZU K I / PH OTO S BY ST E VE MO R IN
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Pi NK ⢠WI NT ER 2020
3
RFTC Japan held Casino Night 2019, one of its biggest annual charity events, on Friday, September 13th in The RitzCarlton Tokyoâs Grand Ballroom, attended this year by 207 supporters.
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uests were greeted with a warm welcome from MCs Maxwell Powers and Janica Sims before enjoying the New Orleans style buffet prepared by Chef Shan Ahluwalia, now the favorite guest chef of Casino Night. After dinner came the Live Auction, which saw guests bid on nine wonderful prizes. Following the Live Auction was the much anticipated gaming! In the foyer, blackjack, poker, roulette, and craps tables were prepared for the guests to enjoy for two hours. The blackjack tables, manned by our dedicated volunteers, proved to be the most popular attraction of the night. Guests also enjoyed magic performances by close-up magician extraordinaire Tomohiro Maeda and bid on prizes in the silent auction. After the gaming, guests returned to the ballroom for a beautiful and relaxing live jazz performance by Keith Williams and Mark Tourian, followed by the announcement of the raffle prize winners at the conclusion of the night. This year, the combined sales of tickets, game chips, raffle coupons and the live and silent auctions raised ¥9,850,891. We hope that everyone left the event with a deepened understanding and commitment to bringing about the end of breast cancer in Japan. On behalf of all those who benefit from our mission, we would like to thank our guests, sponsors, and volunteers for your generous support.
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PiN K ⢠WIN T ER 2 0 2 0
Run for the Cure®/Walk for Life 2019 ã©ã³ãã©ãŒã¶ãã¥ã¢ / ãŠã©ãŒã¯ãã©ãŒã©ã€ã 2019 TEXT BY MARI A SAK IKO S U ZU K I / PH OTO S BY JO H A N BR O O KS
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RFTC Japanâs annual charity fun run and walking event, Run for the Cure®/Walk for Life, took place on Saturday, November 30th. This marked the runâs 17th anniversary, and over 1,300 participants â comprised of 42 corporate and private teams, individuals, volunteers and sponsors â gathered at Hibiya Park Fountain Area under a cloudless winter sky.
T
he participants, along with their families, friends, and colleagues, joined the 10K and 5K runs and 3K walk around the Shiba Park and Toranomon Hills area. USAGI, a wadaiko (Japanese drums) group gave a live performance to get the participants pumped up, while a
6
PiN K ⢠WIN T ER 2 0 2 0
wide variety of food and drinks were available from food trucks in the park. Guests could also win one of 42 raffle prizes, thanks to the support of sponsors like United Airlines, Grand Hyatt Tokyo, Andaz Tokyo, and many more. Thanks to Education First, we were also able to award a special prize to a breast cancer survivor. Thanks to the generous support of sponsor FWD Japan, one of this yearâs highlights was the attendance of talent and former pop idol group SKE48 member Miki Yakata and popular model Misaki Izuoka, also known as izu, as special guests. They not only supported the event, but also joined in and completed the 10K run! Thanks to everyone who took part, whether they were running, walking, sponsoring us or helping on the day as volunteers, this year, we managed to raise a total of Â¥8,033,617. On behalf of everyone who is helped by Run for the Cure®/Walk for Life, we would like to thank each and every one of you for your generous support.
ãã£ãªãã£ãŒã€ãã³ããéããŠåã£ããå¯ä»
éã¯ãåœå£äœã§çºè¡ã»ç¡æé åžããŠãããã
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æ¬å šåœã®äŒæ¥ãåŠæ ¡ãèªæ²»äœã§éå¬ããã
ãŠããã ããŠããä¹³ããã»ãããŒãä¹³ãããµ
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ãPiNK Beauty Partyããªã©ãRFTC Japanã® ã³ãã¥ããã£ãŒã¢ãŠããªãŒãããã°ã©ã ã®æŽ» åè³éãšããŠæŽ»çšãããŸãã
The revenue from our charity events goes to the Foundationâs community outreach programs. This includes the Foundationâs free quarterly bilingual PiNK magazine, our breast cancer seminars held at companies, schools, and community centers throughout Japan, and âPiNK Beauty Partyâ our community event for breast cancer survivors.
Letâs be friends!
RFTC Japanã®ãåéã«ãªã£ãŠãã ããïŒ @rftcjapan @RFTCJapan Run for the Cure Foundation
Outreach Program Report ã¢ãŠããªãŒãããã°ã©ã ã¬ããŒã
Text by Maria Sakiko Suzuki
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Our breast cancer seminars are a core outreach program of RFTC Japan, and we were busier than ever in the second half of 2019. Aflac Japan, a long-time supporter of the Foundation, organizes annual breast cancer seminars for their employees, and in August we visited their offices in Chofu and Osaka, as well as their Shinjuku Headquarters. Seminars were also held at Andaz Tokyo and IBM Japan. Our collaboration with AIG Japan, which began last year, expanded in September, and in addition to giving two seminars at their Toyama site, we were given the opportunity to visit their Okinawa, Matsuyama, and Nagasaki offices in September and October. We held a total of eight seminars, attended by approximately 380 employees. This reaffirmed the demand for our seminars in regions all across Japan. It was the first time we had visited these
8
PiN K â€Ë WIN T ER 2 0 2 0
prefectures, and we hope that it is only the beginning of a wider geographic outreach. Breast Cancer Awareness Month in October started with a seminar at JP Morgan. JP Morgan has hosted a seminar every year since 2017. In addition, we had a seminar at AXA Life Insurance Co., Ltd. for the first time, and held three seminars at the headquarter of another of our biggest partners, New Balance Japan. We ended the month with three classes with high school students at the American School in Japan (ASIJ). We also returned to ASIJ and set up a booth at their December Winterfest. Although many of our breast cancer seminars are requested from companies, anyone can make a free application, including schools, municipalities, and individuals. We began November with a seminar at CBRE, and we also had the chance to visit our partners at Servcorp Japan and United Airlines. We are very happy to have had the opportunity to host our
seminars with the staff of our corporate partners company who have supported our organization for many years. In December, we gave a total of three seminars at the Tokyo and Osaka branches of Mizuho Bank. This is our second year of collaborating with Mizuho Bank, and this year we were able to collaborate with the Mizuho Health Insurance Association, which allowed us to do the seminars with the full support of their medical staff. 2019 was full of new experiences, and we were proud to reach almost 1,300 people across all of our seminars. We would like to express our sincere appreciation and gratitude to everyone who has made this achievement possible. We strongly believe in the value and necessity of what we do, and in 2020 we will continue to revise our seminars and share our knowledge with an everwidening group of people. We humbly ask for your continued support.
RFTC® JAPAN PRODUCTS Online Shop
rftcjapan.org/product-category/products
RFTC JAPAN T-shirt
RFTC JAPAN Cap NEW DESIGN BACK
Black ¥ 1,000
NEW!
ãªã¹ã¹ã¡ïŒ
2019
S/M/L/XL ¥ 1,000
2018
2017
S/M/L/XL
S/M/L/XL
Â¥ 1,000
Â¥ 1,000
2016
Pink/White ¥ 500
2015
Until Thereâs a Cure Pink Band S/XL Only
S/L/XL Only
Â¥ 1,000
Â¥ 1,000
RFTC® Japanã¯ãRun for the Cure®/Walk for Lifeã€ãã³ãã®ãªãªãžãã«T-ã·ã£ãã«ã ãã¥ãŒãã©ã³ã¹ãžã£ãã³ã®åè³ããããŠããŸãã
MïŒL Â¥ 300
Our Run for the Cure®/Walk for Life event t-shirt is sponsored by New Balance Japan.
Shop online or email us your order. After we get back to you
åååãè³Œå ¥ç¹æ°ããååãäœæãé»è©±çªå·ããèšå ¥ã®ãããã¡ãŒã«ã§ãç³ã蟌ã¿äž
payment to the account below with your full name.
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with shipping fees and stock availabilities, please make a Bank fees should be incurred by purchaser.
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E-mail: inquiries@rftcjapan.org
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Tokuhi) Run for the Cure Foundation
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Monthly Self-Examination èªå·±æ€èšºã§ãã€ãã®æ觊ãèŠããŠãå°ããªå€åãæ©ãæãåããŸãããã æ©æçºèŠãããªãã®èžããããŠåœãæããŸãã
You know your body better than anyone else.
Know your normal, so you can detect the slightest abnormality immediately.
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When to Examine ççãçµãã£ãŠãä¹³æ¿ã®ç·åŒµãè «ãããªãæãæé©ã§ããççãäžèŠåãªå Žåã éçµããŠããå Žåã¯ãæ¯æåãæ¥ã決ããŠãã§ãã¯ããŸãããã
Itâs best to self-examine after your menstruation cycle, when breasts are less tender or
swollen. If your cycle is irregular or you have reached menopause, pick a date you can easily remember and check every month.
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Self-Exam Procedure
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Raise your arms in front of a mirror and examine for irritation, swelling or discharge.
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Next, feel and explore your breast area within the
boundaries connecting armpit, rib, collarbone area and shoulder for lumps.
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Draw three coin-sized circles in one spot,
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finger, middle finger and ring
medium and deep.
finger to feel and check your breast. Use the following patterns below to check.
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Check by following the vertical or âup and downâ pattern and
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breast sand repeat with the other side.
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cover the entire breast. Use your left hand to check your right
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Move horizontally by moving your middle finger one joint over.
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You can lie down with one arm tucked behind
your head, or you can self-examine while taking
a bath or shower. Check your breast every month with whichever method you find easiest.
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If you any changes or abnormalities, contact your doctor immediately.
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recommended that women receive a mammography once a year.
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