{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:52:37Z","timestamp":1785538357760,"version":"3.56.0"},"reference-count":35,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Despite clinical advances, breast cancer screening adherence remains stagnant in Japan (<50%) compared with the United States (>70%). Understanding distinct cross-cultural barriers is essential; however, traditional methodologies often fail to capture visceral, real-world individual experiences and hidden deterrents to screening.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aims to characterize and compare cross-cultural informatics profiles of barriers to breast cancer screening across Japanese-language and English-language social media discourse.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We developed an automated natural language processing pipeline on a cloud-based informatics platform to analyze 46,823 screening-related posts (30,027 in Japanese and 16,796 in English) from X (formerly Twitter) collected in 2025, derived from an initial 76,955 posts after noise exclusion. The methodology integrated large language model\u2013assisted sentiment polarity scoring with strict negation-handling, co-occurrence network topology analysis, and advanced distributional visualizations, including raincloud and ridgeline plots. Subgroup comparisons (prescreening vs postscreening and ultrasound with vs without mammography) were evaluated.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among the 46,823 screening-related posts, overall sentiment distributions showed no practically meaningful cross-cultural divergence (Cohen\n d<\/jats:italic>\n =0.049); however, domain-specific analyses revealed sharp disparities in barrier prevalence. Within the English-language cohort containing 16,796 posts, discourse exhibited a concentrated, moderate negative sentiment regarding systemic barriers, featuring \u201cCost\u201d as the primary barrier (n=1239, 7.4%), while \u201cPain\u201d ranked considerably lower (n=842, 5.0%). In contrast, the Japanese-language cohort containing 30,027 posts was heavily bottlenecked by psychosomatic barriers, governed by a tightly interconnected network of \u201cPain,\u201d \u201cFear,\u201d and \u201cAppointment.\u201d \u201cPain\u201d emerged as the overwhelmingly dominant barrier (n=5788, 19.3%). In the English-language cohort, \u201cDense\u201d breasts emerged as a prominent clinical topic due to elevated public awareness, distinct from the financial narrative. The Japanese subgroup analyses identified a temporal transition from anticipatory psychological anxiety (\u201cFear,\u201d 739\/3805, 19.4%) and logistical concerns (\u201cAppointment,\u201d 1556\/3805, 40.9%) before screening to a strong persistence of the discomfort memory of \u201cPain\u201d (1160\/7419, 15.6%). Furthermore, sentiment scores for mammography were significantly more negative than those for ultrasound alone (\n P<\/jats:italic>\n <.001, Cohen\n d<\/jats:italic>\n =0.264), and pain-related descriptors for ultrasound spiked from 5.0% (106\/2110, ultrasound alone) to 18.2% (733\/4017) when performed concurrently with mammography.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Despite comparable overall emotional equilibrium, a fundamental dichotomy emerged. The English-language discourse predominantly reflects US-specific systemic financial burdens, whereas the Japanese experience is characterized by emotional volatility transitioning from anticipatory anxiety to a tightly interconnected \u201cPain-Fear-Appointment\u201d network. Physical discomfort of mammography dominates the screening narrative, overshadowing concurrent painless modalities like ultrasound. Improving adherence in Japan requires individualized pain-mitigating compression protocols and optimized clinical workflows to decouple mammographic discomfort from supplemental screening, thereby preventing pain-associated defensive avoidance and reducing logistical hurdles to improve equitable access.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/97772","type":"journal-article","created":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T20:11:43Z","timestamp":1785528703000},"page":"e97772-e97772","source":"Crossref","is-referenced-by-count":0,"title":["Social Media Discourse on Breast Cancer Screening Barriers in Japanese and English: Cross-Sectional Infodemiology 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