乳がん「怖がらずに正しく理解し、輝いてほしい」 イベント控え山内英子医師語る

乳がん体験者らが交流するイベント「RUN & WALK」が7月5日、東京で開かれる。イベントを中心的に進めてきた聖路加国際病院の山内英子医師に乳がん医療の現状などについて聞いた。
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第23回日本乳癌学会学術総会

乳がん体験者や家族、医療者らがランニングやウォーキングで交流するイベント「RUN & WALK for Breast Cancer Survivors」が7月5日、東京・臨海副都心のシンボルプロムナード公園で初めて開かれる。イベントでは、「乳がんサバイバー」と呼ばれる乳がん経験者「サバイバー」によるファッションショーやフラダンス、トークショーなどもある。

このイベントの主催は第23回日本乳癌学会学術総会(会長・中村清吾昭和大医学部乳腺外科教授)で、乳がん患者やその家族をはじめ、広く一般からの参加を募っている。イベントを中心的に進めてきた聖路加国際病院の乳腺外科医、山内英子ブレストセンター長に、イベントの趣旨や乳がん医療の現状などについて聞いた。山内さんは「怖がらずに正しく理解し、社会で輝いてほしい」と語った。

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インタビューに応じる聖路加国際病院の乳腺外科医、山内英子ブレストセンター長=東京都中央区

――イベントは今回が初開催ですが、目的を聞かせてください。

乳がん患者や「乳がんサバイバー」と呼ばれる経験者に対する理解を深め、彼らが医療者や社会とつながることで、もっと生きやすい社会を作ろうという取り組みです。社会の中でサバイバーがどう生活してどう輝いているかをもっと見ていかないと、良い治療ができないと考えています。サバイバーの方から話を持ちかけられ、日本乳癌学会として実施することにしました。

乳がんは早期発見じゃなきゃ怖いと思っている人が少なくありません。私のところにきて乳がんと診断されると「この世の終わりだ」と後ろ向きに受け止めてしまう人も多いです。例えば、たばこを吸うとがんになるから怖いのでたばこを止めましょうとか、生活習慣を変えないとがんになるよとか、そういうがん教育がずっとなされてきました。それで、がんと診断された人は「もうおしまいだ」と思ってしまうのです。

検診が大事だと伝えるためにも、いままでとは違った方向性が必要です。がんになっても社会で輝いて、前よりますます美しく生きることができると伝えることで、乳がんは怖くないと思ってほしいのです。

――まだまだ、正しく理解されていなことが多いのですね。

「がんと診断されました」と自分の職場に伝えると、「もうだめだから仕事をやめなさい」と言われるケースがまだまだ多いです。でも、日本人の2人に1人ががんと診断される時代が近くくるとされているんです。それにもかかわらず理解されていないことが多く、いまだに仕事を辞めたり、結婚できなくなったりということが起きています。ステージ(病期)などにもよりますが、がんになっても普通に社会で働けるわけですし、社会の理解を深めて偏見をなくしたいと思います。イベントなどで、サバイバーの人たちが社会に出て輝いていると見せることは啓発になると思っています。

がんと聞くと、毎日やせ衰えていくと思うかもしれませんが、薬の副作用などによるホルモンのアンバランスもあり太る方もいるんです。さらに、太ることによってがん再発のリスクが高くなるというデータもあります。だから、みんなで一緒に運動するという啓発もとても大事なのです。アメリカなどでは、こういったイベントで集まった資金を研究に投じたりもしています。日本でも、イベントをそういった患者さんのための研究の財源確保のファンドレイジング的なことにつなげていきたいと思います。

――日本の乳がん患者の特徴はなんでしょうか。

日本では年間8万人が乳がんと診断され、うち命を落とすのは1万人です。つまり、7万人が社会にいるということです。日本人では近年増えてきて、生涯、女性の12人に1人が乳がんになるとも言われています。

欧米での患者は60代、70代が中心ですが、日本は30~50代が多いんです。これから仕事のキャリアを積んでいくとか、子育てをやっていくという年代で、社会との関わりが非常にあります。日本はこれから女性の社会進出をもっと推し進めていくわけで、そういった理解は欠かせないのです。

日本で増えているのは、欧米化した生活習慣の影響が大きいと思います。乳がんはホルモン環境と関係があります。初潮の年齢が低くなって成熟が早くなる一方で出産年齢は遅くなっています。すると、ホルモンの曝露が長くなります。出産しない人は乳がんのリスクが高まります。日本では、いま50代くらいの人が幼いころから、食生活などで欧米化した生活が強まっていて、その生活習慣の変化が影響していると考えられます。そんな中、遺伝情報や生活習慣のビッグデータを使って、がんの予防もできるようになってきています。

――患者さんへの対応も変わってきていますよね。

ある会社は、「20代でも乳がん検診をして力を入れている」と言います。でも、実は20代の人は検診をしちゃいけないし、見つかりにくくもあるんです。見つからなくて、「じゃあ、ちょっと怪しいけれど半年後にまた検査」などと言われたら、その半年の間、その女性は不安で不安でしょうがなくなりますよね。また、分からないから針を刺して調べようとすると体への負担が増えるし被曝の問題もある。検診はやればやるほどいいと思っている人も多いのですが、そうではないということです。

かつて「不治の病」だったがんは、いまでは「慢性疾患」になっています。遺伝的な背景の解析も進み、その人に合った検診や、選択肢を提供できるように変わってきました。さらに将来はもっとデータが集まります。進歩してきている医学に対して、社会のがんに対する理解を深める、そこに一石を投じられればと思います。

…………

山内英子(やまうち・ひでこ) 聖路加国際病院 乳腺外科 ブレストセンター長。1987年順天堂大学医学部卒業。聖路加国際病院外科レジデントを経て、1994年渡米。ハーバード大学ダナファーバー癌研究所、ジョージタウン大学ロンバーディ癌研究所でリサーチフェローおよびインストラクター。ハワイ大学にて外科レジデント、チーフレジデントを終了後、ハワイ大学外科集中治療学臨床フェロー、南フロリダ大学モフィット癌研究所臨床フェロー。2009年4月聖路加国際病院乳腺外科医長をへて、2010年6月より乳腺外科部長およびブレストセンター長。米国外科学集中治療専門医、米国外科認定医。

…………

イベントの種目は、ランニング(5キロ、16歳以上、参加費1500円)▽ウオーキング(同)▽サポーターと走ろうランニング(2人1組、2キロ、小学生以上、参加費2500円。小中学生は保護者と参加する)の3種。参加賞はオリジナルTシャツ。トークショーや抽選会など、同時にさまざまなイベントが企画されている。申し込みなど問い合わせは運営事務局のサイトまで

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