The Great East Japan Earthquake and the Fukushima nuclear power plant accident in 2011 caused extensive damage to the coastal region of Fukushima, Japan. This is that seventh year since the accident, however, the lives of local residents continue to be endangered by the outflow of the health workers and shutdown of the local health facilities in addition to societal changes such as rapid depopulation and population ageing. To achieve a full recovery from the disaster, it is imperative to understand the full extent of disaster-related health effects, and to establish health care systems which promote physical, psychological and social well-being among the local residents. 
 In this project, we focus on cancer, which is the leading cause of death in Japan. This project aims to undertake a comprehensive assessment of cancer risk following the nuclear disaster, looking beyond the biological effects of radiation exposure, and to produce evidence necessary to rebuild local health care systems to promote both physical health and overall well-being of local cancer patients and residents in the disaster-struck area. Specifically, we plan to assess: 1) the cancer mortality rate pre- and post-disaster, 2) the cancer healthcare system pre- and post-disaster, 3) the attendance rate of cancer screenings pre- and post-disaster, and 4) the ways in which both physical health and overall well-being are promoted through the cancer care and screening programs for local residents. It could be said that disaster-affected areas in Fukushima present phenomenon that are representative of what Japan as a country will face in the future, such as depopulation and rapid population ageing. We suggest that the findings obtained from this project will contribute not only to health promotion in affected areas of Fukushima, but additionally to the creation of new values in society through a case study of cancer in a disaster area that has experienced problems relevant to Japan more widely.

＜Outline of our projects＞
We evaluated the impact of the Great East Japan Earthquake and the subsequent nuclear disaster on the local health care system in the coastal areas of Fukushima, with a particular focus on cancer, and explored ways to improve the well-being of cancer patients and their families.

Project 1 (evaluation of the process before making a medical consultation)
We assessed the impact of consultation delays on the cancer stage of symptomatic breast cancer patients in Minamisoma during the five years after the earthquake and found that the proportion of patients diagnosed with stage III/IV (advanced cancer) increased as the time from symptom detection and consultation increased.

Project 2 (evaluation of the process after a medical consultation)
We examined the interval from the first medical consultation to the treatment inception in the breast cancer patients in the coastal area of Fukushima pre- and post-disaster and showed that there was no significant change such interval. In addition, a large part of the breast cancer patients continued to receive the care without self-interruption once the treatment began, and many patients had regular access to health information in the course of their treatments.

Project 3 (evaluation of the cancer screening data)
We evaluated the temporal trend in the breast cancer screening participation rate in Minamisoma during the 10 years pre- and post-disaster and found that the participation rate, which had originally been at a low level, further dropped in the two years after the disaster, and gradually improved to the original level over the next few years. While the residents living without family members had a lower participation rate than their counterparts, an evacuation from the original residence was only slightly associated with a decreased participation rate.

Project 4 (assessment of the well-being)
We assessed the association of well-being with disaster experiences and family members' experiences of cancer treatment in an online survey of residents inside and outside of Fukushima. Well-being was found to be lower in the absence of recovery prospects after disaster experiences and in the low satisfaction with the care received by their family members. It was suggested to be important to continue cancer care in a way that satisfies family members of cancer patients and possibly the patients themselves even after disasters.

＜Achievement of our project＞
Project 2 has already been published in a peer-reviewed English-language journal and has been submitted as an achievement of our project.