Objective: This study investigated the psychosocial aspects of risk-reducing salpingo-oophorectomy in Japan. Methods: The subjects were 16 patients who underwent risk-reducing salpingo-oophorectomy at the Cancer Institute Hospital. Worry about cancer, emotional state and cancer-specific distress level were evaluated using a four-point Likert scale, the Profile of Mood States-Short Form and the Impact of Event Scale-Revised, respectively, before and 1 year after the surgery. In addition, the subjects were interviewed regarding their expectation for the risk-reducing surgery, the effects of the surgery, and the recovery from surgery, before the surgery and at 1, 6 and 12 months after the surgery. A t-test or Wilcoxon rank-sum test was used for the analysis, and literal analects were prepared for the interview and the answers were organized per question item using NVIVO10. Results: The results revealed that the total score for worry about breast cancer and ovarian cancer (P = 0.021) as well as the Impact of Event Scale-Revised (P = 0.021) were significantly lower 1 year after surgery, compared with the values before the surgery. Regarding the preoperative expectations for the surgery, the expectation for reducing the cancer risk was the highest. The reported effects of risk-reducing salpingo-oophorectomy on life included the appearance of menopausal symptoms, a loss of motivation and poor concentration; more effects were reported at 1 year after surgery than at 6 months after surgery. Conclusions: These results suggest that risk-reducing salpingo-oophorectomy can be effective for reducing worry about breast cancer and ovarian cancer and cancer-specific distress as well as contributing to a reduction in mortality from fallopian tube and ovarian related cancer.

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Individuals carrying pathogenic BRCA1 or BRCA2 mutations have an increased lifetime risk of breast and/or ovarian cancer. The incidence of breast cancer amongst disease-free BRCA mutation carriers under surveillance and the clinical and pathological characteristics of those who subsequently develop the disease remain unclear in Japan. We reviewed the records of 155 individuals with BRCA1 or BRCA2 mutations identified by genetic testing between January 2000 and December 2016. At the time of genetic testing, 26 individuals with one of these mutations had no history of breast cancer and were therefore enrolled in a surveillance program that included biannual ultrasonography, clinical breast examination, annual mammography, and conditional magnetic resonance imaging for the early detection of primary breast cancer. During the surveillance period, 5 individuals with BRCA1 or BRCA2 mutations were diagnosed with primary breast cancer. The mean surveillance duration until breast cancer diagnosis was 48 months. The incidence of primary breast cancer during surveillance in initially disease-free BRCA mutation carriers was 4.23%/year. In two cases, the tumors were only detectable on MRI. The case 5 patient who presented with a tumor that was detected by self-examination, which then grew rapidly, had stage IIB triple-negative breast cancer. In conclusion, our results show that some challenges exist in the early detection of breast cancers in BRCA1 or BRCA2 mutation carriers. There are also some difficulties in approaching those individuals in Japanese society.

Groups of mice were fed for 2 weeks on isocaloric diets containing 5, 7, 20 and 40% (w/w) casein, respectively, then injected intraperitoneally with group B streptococci, and observed for their survival rates. The mice fed 7% or 20% casein had lower mortalities than those fed 5% or 40% casein. In order to explain the different survival rates, other groups of mice were fed on the experimental diets and examined for the number of leukocytes in the blood, of spleen cells and thymocytes, for IgG and IgM antibody titres to the streptococci, for haemolytic titres of sera, the amount of complement component 3 (C3), for chemiluminescence and opsonic activity of peritoneal exudate cells (PEC) and spleen cells (SP), production of superoxide anion from PEC and SP, and production of immunoglobulins from cultured SP. After 2 weeks on a 7 or 20% casein diet mice showed increased serum levels of IgM antibodies reactive with the whole bacterial cells on days 3–5 when they were immunised with a sublethal dose of group B streptococci. The mice fed on the 7% casein diet also showed a higher C3 titre than the other diet groups when assayed by enzyme immunoassay. Furthermore, opsonophagocytic activity was highest when PEC or SP taken from mice on the 20% case in diet were incubated with radiolabelled microorganisms in the presence of fresh serum taken from the 7% casein group. The production of superoxide anions from PEC and SP was lowest in the mice fed on 5% casein when activity was expressed as nano‐mol per animal. It is suggested from these results that the greater activity of phagocytic cells in the presence of increased amounts of C3 and IgM explains the heightened resistance in the mice fed on a 7% casein diet, and that suppressed opsonophagocytic activity resulting from the decreased number of leukocytes in the blood and other phagocytic cells explains the lowest resistance in the 5% casein group. However, mice fed on a 40% casein diet showed all these immunological parameters untouched, and their lowered resistance could not be explained. Different factors seem to be operative in them.