TOKYO -- Dr. Nobuo Okazaki is experimenting with what the Japanese consider a radical new technique in the treatment of cancer. He tells his patients the truth.
Lying about cancer is the custom in Japan. Eight out of 10 doctors say they lie to cancer patients. They tell them it is a stomach ulcer, a vaginal cyst -- anything that avoids the truth. They say it's better not to shock and sadden the patient.
Emperor Hirohito, 87, is the most famous case.
All the major newspapers have reported Hirohito has cancer, but they did so only after editors learned the emperor was too weak to read newspapers. Hirohito's imperial palace aides refuse to name his disease.
Lying about cancer is such an open secret that it is beginning to breed distrust of doctors, says Okazaki, an internal medicine specialist at the National Cancer Center hospital, the country's top cancer treatment facility. So he has started a quiet movement to change the custom and restore trust in doctors.
'I had a patient who died suspecting, but not knowing, he had cancer,' Okazaki said. 'He died doubting his family, doubting me and everyone. It was so lonely for him.
'You can console people who are shocked, but you cannot help a person who doesn't trust anyone.'
But the custom lives on. The Japanese, in their constant pursuit of politeness, avoid discussing unpleasant topics. And what could be more unpleasant than cancer? The Cancer Center Hospital itself is avoided because the name is too blunt for some.
Cancer is especially taboo among the rich and famous.
'We have only a few patients here who are very powerful or famous,' said Dr. Keiichi Suemasu, deputy director of the Cancer Center. Politicians avoid the hospital, fearing that if people know they have cancer they could lose their next election.
The emperor's brother, Prince Takamatsu, who died of lung cancer last year, was tested at the Cancer Center and found to have a probability of cancer. But his family hospitalized him at the Red Cross Medical Center 'because of several kinds of considerations from many directions,' said Suemasu.
Throughout Hirohito's long battle with cancer, his physicians never consulted the Cancer Center experts.
'If a doctor was invited from the Cancer Center, it would strongly suggest that the disease could be cancer,' said Suemasu. 'If the emperor was admitted to the hospital, people would be almost 100 percent sure his disease is cancer.'
So what's wrong with that?
In the Japanese mind, a cancer diagnosis is tantamount to issuing a death sentence.
There is little public awareness of cancer, perhaps because it is so studiously avoided. Most people do not realize some cancers can be stopped, especially when detected early.
The Japanese also have a stigma against cancer patients.
'Many people believe the superstition that cancer is inherited,' said Hiroshi Minami, professor of sociology at Hitotsubashi University. He said parents try to avoid their children marrying into a family in which someone has had cancer.
But the major reason for avoiding the truth about cancer is a desire not to upset the patient. The Japanese 'try to keep things smooth,' Okazaki said.
Now, however, with the Cancer Center in the lead, Japanese doctors are starting to tell patients about their cancer. Some doctors use a referral to the Cancer Center as a way of breaking the news.
'We tell the truth but very indirectly,' said Suemasu.
Some younger doctors or those influenced by study abroad are more direct. They often consult with the family and tell the patient if the family agrees to it.
But about 80 percent of the families ask that the patient not be told, Okazaki said.
Japanese doctors do not have the pressure of malpractice lawsuits that forced American doctors to begin telling patients about their cancer 25 years ago, and there is no significant patient's rights movement in Japan.
But doctors and families are slowly forging a consensus that teling the patient is best.
