Ai Miyoshi

The association between additional radiotherapy after systemic chemotherapy and the prognosis of stage FIGO 2018 IVB cervical cancer

Abstract Objective Systemic platinum‐based chemotherapy is the first‐line treatment of choice for metastatic cervical cancer. While subsequent radiotherapy after primary chemotherapy is a potential option, its benefit remains unclear. This multicenter retrospective study aimed to evaluate whether post‐chemotherapy radiotherapy improves the prognosis of metastatic cervical cancer. Methods We retrospectively analyzed 46 eligible patients, including 22 patients receiving chemotherapy‐alone and 24 patients receiving chemotherapy followed by subsequent radiotherapy. Medical records were retrospectively reviewed for patient characteristics, subsequent treatment modality, adverse events during the treatment course, metastasis site, recurrence or progression, and recurrence sites. Fisher exact test or chi‐squared test, the Mann–Whitney U test, log‐rank test, and Cox proportional hazards model were used. Results The 2‐year overall survival (OS) rate for all patients was 47%, with the median OS of 24.8 months. Patients receiving chemotherapy alone (chemotherapy‐alone group) had a 2‐year OS rate of 23%, while those receiving subsequent radiotherapy (chemotherapy‐radiotherapy group) had a significantly higher OS rate of 67% (HR = 2.83, P  = 0.006). The 2‐year progression‐free survival (PFS) rates were 9% and 33%, respectively (HR = 3.25, P  = 0.010). Serious adverse events occurred in 46.2% of the chemotherapy‐alone group and 29.2% of the chemotherapy‐radiotherapy group during subsequent treatment ( P  = 0.249). Conclusion Post‐chemotherapy radiotherapy may improve the prognosis of metastatic cervical cancer without increasing serious adverse events. Further prospective studies are warranted to validate these findings.

Health consciousness and cervical cancer screening rates in HPV-unvaccinated girls: comparison from HPV-recommended and HPV-recommendation-suspended program periods

In Japan, the vast majority of females between 13 and 24 are now unvaccinated for HPV and thus unprotected from HPV-caused cervical cancer. We analyzed the differences among these unvaccinated females regarding their understanding of the HPV vaccine, its role in cervical cancer prevention, and their need for cervical cancer screening - based on whether they refused vaccination when their government's recommendation for HPV vaccination was still in effect (

Contemplating HPV vaccination in Japan during the time of COVID-19

The Coronavirus Disease 2019 (COVID-19) pandemic has been growing, including in Japan where it has been estimated that as many as 3.1% of patients positive for new CoV strain SARS-CoV-2 might die of COVID-19-related respiratory failure. Meanwhile, human papillomavirus (HPV) is spreading in Japan. The fatality rate for HPV-associated cancers after infection with HPV is as much as that for COVID-19 in Japan, although the time to disease is much longer for HPV. Among advanced countries, the cervical cancer screening rate in Japanese females is very low. The Japanese Ministry of Health, Labor and Welfare (MHLW) suspended its official recommendation for HPV vaccination in June 2013 due to alleged adverse post-vaccination events in several young girls, such as chronic pain and motor impairment, which were repeatedly reported in the media. Subsequently, the rate for vaccinating girls plummeted from approximately 70% to the current rate of 1% or less. Women should accept HPV vaccination for the eventual prevention of cervical cancer with the same passion they are for COVID-19 testing.

Educational intervention for women in Japan coming of age for cervical cancer screening who grew up during the suspended HPV-vaccination-program

Girls born in 2001 became eligible for subsidized HPV vaccination when they reached 12 years old in 2013, but that was the year when the Japanese MHLW suspended its official governmental recommendation for HPV vaccination. Those girls will now reach 20 years of age this year, 2021, and they will become eligible for cervical cancer screening. We report on the effects of an educational intervention with an information sheet about their current unvaccinated defenselessness for HPV and the necessity for early and repeated cervical cancer screening as a way to improve their intention to have that screening and their attitude toward HPV vaccination. Among the educated women, 75.2% had a positive intention toward having cervical cancer screening, 24.8% had a negative intention. Educational intervention can significantly promote the intention of having cervical cancer screening in women who had experienced the suspension of the MHLW's official recommendation for HPV vaccination. As a result of this simple intervention, they were more likely to think that HPV vaccination was needed for themselves.

Challenge to improve Japan's deplorable HPV vaccination rate by local government actions

AbstractAimIn Japan, in 2013, following reports of several alleged adverse reactions in young girls following vaccination, the previously successful national human papillomavirus infection (HPV) vaccination program collapsed rapidly. In the 8 years since vaccination rates have hovered near zero. In October of 2020, in an attempt to mitigate this lingering disaster, the Japanese Ministry of Health, Labor, and Welfare (MHLW) agency finally revised its HPV vaccination informational leaflet that was designed to be distributed by local governments nationwide. Prior to this revision, Toyonaka City, in Japan's Osaka province, had already begun sending out their own unique leaflet to girls in the targeted 6th–10th grades. As a preview of how MHLW's revised leaflet might eventually succeed, we have studied the HPV vaccination results from Toyonaka City's experiment.MethodThis study was a population‐based analysis that compared the monthly rates of new vaccinations in girls of a targeted grade school age group. We looked at rates before and after the leaflets were sent by Toyonaka City's Division of Health Promotion and Senior Services.ResultsThe vaccination rates between April 2020 and March 2021 were improved across all grades; 1.2% in 6th grade (p = 0.000185), 2.5% in 7th grade (p < 0.0001), 3.5% in 8th grade (p < 0.0001), 6.8% in 9th grade (p < 0.0001), and a remarkable 16.5% in 10th grade (p < 0.0001).ConclusionWhen a local government sends an HPV informational leaflet targeted at young girls, it can significantly improve their HPV vaccination rates.