Abstract P6-12-04: Delayed hospital visits in patients with breast cancer after the great East Japan earthquake and the subsequent Fukushima Daiichi nuclear power plant accident: A retrospective comparative analysis
Authors: Ozaki A , Tsubokura M , Nomura S , Morita T , Ochi S , Kato S , Saji S , Yokota T , Leppold C , Tanimoto T , Kami M , Tsukada M , Ohira H 
Published: May 2016

Abstract
Introduction
In breast cancer, delay in first presentation and self-interruption of continuous treatment are associated with lower survival. It has been suggested that risk factors for such behavioral patterns include poor social support.
Minamisoma City, located within a 30 kilometers radius from Fukushima Daiichi nuclear power plant, has experienced rapid change in social structures following the Great East Japan Earthquake and the subsequent power plant accident. There has been a mass evacuation among young and middle-aged generations for fear of potential irradiation, and this has resulted in the separation of families and friends. These changes may have resulted in a deterioration of social support for residents, which could consequently lead to changed patterns of behavior in diseases such as breast cancer.
Objectives
This study compared the behavioral patterns before and after the disasters in patients with breast cancer in Minamisoma City.
Methods
We retrospectively analyzed data from patients with breast cancer who were diagnosed from January 2008 through March 2015 in the two main cancer centers in Minamisoma City. Demographic and clinical information was extracted from medical records, including age, stage, pathological findings, treatment, and the reason for the first hospital visit. The main outcome was a change of interval from the appearance of initial symptoms to the first hospital visit before and after the disasters. We also assessed whether continuous follow-up was maintained after the disasters. We used an unpaired t-test for numerical variables and a chi-squared test for categorical variables.
Results
A total of 102 and 97 patients were diagnosed with breast cancer before and after the disasters, respectively. There were no statistically significant differences between the 2 groups concerning average age (61 years old vs. 61 years old, p=1), stage 3 or 4 cancer (18% vs. 17%, p=0.81), invasive cancer (92% vs. 93%, p=0.87) and symptomatic patients (75% vs. 74%, p=0.74), respectively. However, after the disasters, there were significant increases in the ratio of patients with more than a one-year delay from the appearance of the initial symptom to the first hospital visit (5.4% vs. 15%, p&lt;0.05). The patients with more than a one-year delay had a significantly higher ratio of advanced stage cancer compared with patients who visited a hospital earlier. Continuous follow-up was maintained in all patients diagnosed after the disasters.
Discussion
The characteristics of patients were not significantly different before and after the disasters, while the ratio of patients with more than a one-year delay of the first hospital visit significantly increased after the disasters. Although information on social capital and other sociodemographic factors was not available, we speculate that poor social support due to changed social structures after the disasters might contribute to delay in first presentation in symptomatic breast cancer patients. Further study is warranted to clarify the factors associated with delayed hospital visits, in order to establish effective health interventions in the aftermath of mass disasters.
Citation Format: Ozaki A, Tsubokura M, Nomura S, Morita T, Ochi S, Kato S, Saji S, Yokota T, Leppold C, Tanimoto T, Kami M, Tsukada M, Ohira H. Delayed hospital visits in patients with breast cancer after the great East Japan earthquake and the subsequent Fukushima Daiichi nuclear power plant accident: A retrospective comparative analysis. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-12-04.