We evaluated the significance of aberrant DNA methyltransferase 1 (DNMT1) protein expression during gastric carcinogenesis. The protein expression of DNMT1, Muc2, human gastric mucin, E-cadherin, and proliferating cell nuclear antigen was examined immunohistochemically in gastric cancers and corresponding noncancerous mucosae from 134 patients. The DNA methylation status of the CpG islands of the p16, human MutL homologue 1 (hMLH1), E-cadherin, and thrombospondin-1 (THBS-1) genes and the methylated in tumor (MINT)-1, -2, -12, and -31 clones was examined by methylation-specific polymerase chain reaction and combined bisulfite restriction enzyme analysis. Epstein-Barr virus (EBV) infection was detected by in situ hybridization. Nuclear immunoreactivity for DNMT1 was not detected in any of the noncancerous epithelia, except in proliferative zones (positive internal control), but was found in 97 (72%) of the gastric cancers. DNMT1 overexpression correlated significantly with poorer tumor differentiation (P < 0.001), but not with the phenotype (gastric type versus intestinal type) of the cancer cells. It also correlated significantly with DNA hypermethylation of the CpG islands of the hMLH1 (P ‫؍‬ 0.024) and THBS-1 genes (P ‫؍‬ 0.043), and with the CpG island methylator phenotype in the gastric cancers (P ‫؍‬ 0.007). Reduced E-cadherin expression correlated significantly with poorer tumor differentiation (P ‫؍‬ 0.002), DNA hypermethylation of the E-cadherin gene (P < 0.001) and DNMT1 overexpression (P ‫؍‬ 0.014). DNMT1 overexpression was also associated with EBV infection (a potential etiological factor in gastric car- DNA methylation plays an important role in transcriptional regulation and chromatin remodeling in mammalian cells.1 Both overall DNA hypomethylation and more regional DNA hypermethylation have been well documented in various cancers.1-8 Aberrant DNA methylation may be involved in carcinogenesis as a result of 1) increased gene mutagenicity because of deamination of 5-methylcytosine to thymine; 2) a possible association of aberrant DNA methylation with allelic loss; and 3) repression of gene transcription through methylation of CpG islands in regulatory regions of specific genes, including tumor-suppressor genes.

Objective: It is widely assumed that there are multiple levels (from individual to policy level) of problems involving disparities in cancer care for people with mental disorders. However, few studies have comprehensively investigated issues as perceived by medical professionals. The purpose of the present study was to identify a wide range of issues in cancer care for people with mental disorders and offer corresponding solutions for both cancer care professionals and psychiatric care professionals. Methods:We distributed open-ended questionnaires to 754 healthcare professionals in various medical facilities, including designated cancer hospitals, psychiatric hospitals, and other local healthcare/welfare facilities. Participants were asked to describe issues in cancer care for people with mental disorders.

Objectives To reduce cancer care disparities, this study aimed to clarify the difficulties in cancer care for people with mental disorders as perceived by cancer care providers. Methods Cancer care providers at 17 designated cancer hospitals in Japan were surveyed using mail questionnaires. Respondents were asked to rate 29 items related to difficulties or insufficiencies in cancer care for patients with mental disorders on a five‐point Likert scale. We analyzed the proportion of respondents who answered “difficult/insufficient” in each item. We also calculated the proportions of responders stratified according to the presence of psychiatric support systems within their hospitals. Results A total of 388 (58.4%) cancer care providers responded. Among the issues related to “difficulties in diagnosing and treating cancer,” support for decision‐making, assessment of treatment adherence, and assessment of physical symptoms were perceived as most difficult (73.5%–81.5% of respondents). Among the issues related to ‘difficulties or insufficiencies in collaboration among multidisciplinary health care providers,’ the issue of advance consultation and sharing information with the patient's primary psychiatric care provider was perceived as most difficult (52.2%). Among the issues related to “insufficiencies of in‐hospital and community medical systems,” education to provide reasonable accommodation was perceived as most insufficient (47.4%). The perceived difficulties of over half of the issues varied significantly between hospitals depending on the level of psychiatric support systems. Conclusions This study clarified the difficulties of cancer care in patients with mental disorders as perceived by cancer care providers. Some issues may be resolved by psychiatric liaison teams.

ObjectivesWe examined the efficacy of case management (CM) interventions to encourage participation in colorectal cancer screening for patients with schizophrenia. This study aimed to clarify patients’ acceptability of the intervention and the helpful components of the intervention. Simultaneously, the study aimed to determine the acceptability, appropriateness and feasibility of the intervention from the perspective of psychiatric care providers.Study design and settingThis study was a secondary qualitative analysis of a mixed-method randomised controlled trial that evaluated the efficacy of the CM approach to encourage participation in cancer screening for people with schizophrenia. The intervention comprised education and patient navigation for colorectal cancer screening. Interviews were conducted with patients who received the intervention and staff from two psychiatric hospitals in Japan who delivered the intervention.ParticipantsOf the 172 patients with schizophrenia who participated in the trial, 153 were included. In addition, three out of six providers were included.Data collection and analysisUsing a structured interview, the case manager asked participants about patient acceptability and the helpful components of the intervention. Content analysis was conducted for the responses obtained, and the number of responses was tabulated by two researchers. For the interviews with the providers, opinions obtained from verbatim transcripts were extracted and summarised.ResultsForty-three of the 56 patients perceived that the intervention was acceptable. For the intervention component, inperson counselling with an explanation of the screening process by psychiatric care providers was most frequently reported by the patients as helpful (48 of the 68 respondents). Psychiatric care providers evaluated the intervention as acceptable, appropriate and easy to understand and administer. However, providing the intervention to all patients simultaneously was considered difficult with the current human resources.ConclusionsThis study showed that the CM intervention was perceived as acceptable by patients and acceptable and appropriate by psychiatric care providers.Trial registration numberUMIN000036017.

Background: The aim of the present study was to examine whether the increasing trend in cancer screening rates over time in Japan differs between individuals with and without serious psychological distress (SPD). Methods: We analyzed a national representative cross-sectional dataset from the 2007, 2010, 2013, and 2016 Comprehensive Surveys of Living Conditions of Japan. We included people under the age of 69 years who met the national program criteria for each type of cancer screening (colorectal, gastric, and lung: n = 94,690, 94,957, and 94,751, respectively). SPD was defined as a score of ≥13 on the Kessler 6 scale. We calculated these cancer screening rates with 95% confidence intervals, stratified by presence or absence of SPD to determine whether cancer screening rates over time between 2007 and 2016 differ between individuals with and without SPD. Results: Cancer screening rates in the non-SPD group increased steadily over time from 2007 to 2016 (colorectal, gastric, and lung: 31.4%–46%, 37.2%–44.8%, and 32.1%–51.7%, respectively). They also increased similarly over time in individuals with SPD (colorectal, gastric, and lung: 24.5%–36.3%, 30.2%–37.8%, and 24.8%–39.9%, respectively); however, the rates remained significantly lower than those of people without SPD in all survey years. Conclusions: Between 2007 and 2016, cancer screening rates increased similarly over time in individuals with and without SPD. However, gaps in cancer screening in people with SPD remained unresolved.