title: Social isolation and cancer management after the 2011 triple disaster in Fukushima, Japan: A case report of breast cancer with patient and provider delay.
abstract: Breast cancer patients may present with patient delay or experience provider delay-2 factors which can lead to a late-stage diagnosis and poor prognosis. Mass disasters drastically change social structures, and have the potential to contribute to these delays. However, there is little information available on patient and provider delay related to cancer after disasters. In March 2011, an earthquake, followed by a tsunami and nuclear accident struck Fukushima, Japan. In July 2014, a 59 year-old Japanese widow, living alone, presented to our hospital with a lump and pain in her right breast, which had originally appeared in April 2011 and continuously deteriorated for 3 years and 3 months. She was diagnosed with stage IIIB right breast cancer. Detailed history revealed that she was exposed to social isolation in the aftermath of the disasters due to evacuation of her friends and daughter. Although she regularly saw her general practitioner, she did not disclose her breast symptoms for 1 year and 5 months, at which time she was falsely diagnosed with intercostal neuralgia. She did not seek further medical attention for the breast symptoms for another 1 year and 10 months, despite multiple clinic visits for unrelated reasons. The present disasters, particularly the nuclear disaster, seem to have led to the social isolation of local residents, reducing their opportunities to discuss health concerns with others and seek subsequent medical attention.This case highlights that social isolation may contribute to patient and provider delay in breast cancer patients, as accentuated in this disaster setting.
authors.affiliation: aDepartment of Surgery bDepartment of Research cDepartment of Radiation Protection, Minamisoma Municipal General Hospital, Minamisoma, Fukushima dDepartment of Internal Medicine, Jyoban Hospital of Tokiwakai Group, Iwaki eDepartment of Medical Oncology, Fukushima Medical University fResearch Institute of Innovative Medicine, Jyoban Hospital, Iwaki, Fukushima gMedical Governance Research Institute, Minato-ku, Tokyo, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Ozaki
authors.forename: Claire
authors.initials: C
authors.lastname: Leppold
authors.forename: Masaharu
authors.initials: M
authors.lastname: Tsubokura
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Tanimoto
authors.forename: Shigehira
authors.initials: S
authors.lastname: Saji
authors.forename: Shigeaki
authors.initials: S
authors.lastname: Kato
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kami
authors.forename: Manabu
authors.initials: M
authors.lastname: Tsukada
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Ohira
mesh_terms: D001943:Breast Neoplasms / Q000523:psychology*; D057210:Delayed Diagnosis; D004190:Disasters; D005260:Female; D062406:Fukushima Nuclear Accident; D006801:Humans; D007564:Japan; D008875:Middle Aged; D012934:Social Isolation; D013997:Time Factors