Discussion
We reported a case of advanced breast cancer patient whose initial diagnosis was delayed by 2 years in Fukushima, Japan, mainly due to the combined effects of Typhoon Hagibis and the COVID-19 pandemic. If she had been consulted earlier, she might have been able to receive treatment for her breast cancer before she developed bone metastasis.
This case shows that undiagnosed breast cancer patients tend to postpone their first medical consultation in the event of a disaster, and this effect may be strengthened especially for patients who tend to delay seeking help. A notable finding of this case is that living with other family members partly prevented her from making initial medical consultation. Although social support from family or friends is extremely important for the treatment and recovery process of breast cancer patients,16 it may also have a negative impact as shown in this case. Therefore, it is important to understand the characteristics of each patients and treat them individually.
At the same time, it is important to recognize that delays in medical consultation may occur before healthcare professionals and others have contact with those patients, which may limit the actual measures taken. In order to deal with this problem, it is essential to cooperate with media such as newspapers and television to further raise people’s awareness of breast cancer symptoms and encourage patients to accurately recognize the severity of their symptoms so that they can seek initial advice from their family or friends. Also, especially in this case, it would have been necessary to intervene to her work place or home to ensure that the patient could receive appropriate medical care, for example, by establishing an environment where the patient could easily take time off work, or by sending someone who could take care of her mother instead of her.
In addition, in the event of a disasters during the COVID-19 pandemic, it is necessary to handle the situation with precautions to prevent the spread of infection. Generally, those affected by disasters are vulnerable to infectious diseases due to overcrowded shelters, environmental changes and poor personal hygiene.17Furthermore, since many people have refrained from social interactions for fear of infection, various support activities that have been carried out in the past disasters, such as child care, transportation of supplies, and soup kitchens,18 may be reduced. In order to ensure access to medical services even in such a situation, it is also important to share information on hospitals and evacuation centers where medical treatment is available, and to expand telemedicine services.
In conclusion, we experienced a breast cancer patient whose medical consultation was delayed for a long time due to the combined effects of the COVID-19 pandemic and the typhoon. Especially in the current situation of the COVID-19 pandemic, it is important to communicate the risks of breast cancer and the benefits of screening by effectively utilizing the media to encourage patients to seek timely medical care. In addition, it is important to approach patients individually by providing consultation services for patients and their families, or reminding patients to visit the hospital.
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