異常なし: What the Annual Check Never Looks At

If you work for a company in Japan you are examined once a year, you are handed a document afterwards, and in most years that document says 異常なし. It is reasonable to read that as a statement about your health. It is not one. It is a statement about eleven specific things, and the list of what those eleven things are is short, public, and almost never shown to the person being examined.

So here is the list, and then here is everything that is not on it. Neither half is a secret and neither half is anybody’s fault — the clinic is doing exactly what the regulation requires, your employer is complying precisely, and nobody in that building has been given a reason to tell you what the regulation leaves out. The result is nonetheless that a woman can be examined every year for fifteen years, be told she is fine every time, be correctly told it, and have never once been checked for most of the things this library keeps pointing at.

One thing to say before it starts, because it changes how the page should be read: this house has nothing to sell you on this subject. There is no hour here that substitutes for any of it, and the entire recommendation at the end is a phone call to an office. That is unusual enough in this library that it is worth naming, and it is the reason this page can be blunter than most.

The annual examination employers are required to provide is defined in Article 44 of the Occupational Safety and Health Regulations, and the whole of it is this: a review of your medical and work history; a check for symptoms you report and signs a doctor observes; height, weight, waist, vision and hearing; a chest X-ray and, where indicated, sputum; blood pressure; an anaemia test; liver function; blood lipids; blood glucose; urine; and an electrocardiogram. Eleven groups. That is the list.

It is also less than it appears, because several of those may be omitted when a doctor judges them unnecessary — and for the blood work and the electrocardiogram there are age brackets under which omission is routine rather than exceptional. A woman in her late twenties may find that what actually happened was a height measurement, a blood pressure cuff, a urine cup and a chest X-ray.

None of which is a scandal. The statute exists to catch the conditions that industrial medicine was built around — cardiovascular risk, metabolic disease, liver damage, occupational lung disease — and it catches them reasonably well. It was never designed as a general survey of a person, and it does not claim to be one. The problem is entirely in the gap between what it is and what the words 健康診断 and 異常なし sound like to the person holding the paper.

Nothing gynaecological. No cervical screening, no pelvic examination, nothing about your cycle beyond whatever you volunteer in the questionnaire. Nothing about your breasts — no mammography, no ultrasound, no clinical examination. No thyroid function test, despite thyroid disease being substantially more common in women and presenting as precisely the tiredness and low mood that get attributed to everything else. No bone density, which matters increasingly from midlife. And nothing about mental health beyond the questions you are asked and answer while fully dressed in a room with a queue outside.

And then the one that is worth reading twice, because it is the most consequential and the least known. The statutory anaemia test is haemoglobin and red blood cell count. Those measure whether you are anaemic now. They do not measure ferritin, which is your iron store — and iron stores fall a long way before haemoglobin does. So a woman can be exhausted for three years, be tested every single year, be told 貧血はありません every single time, be told it entirely correctly, and have almost no iron left in her body. The test that would show it is not on the list and will not be run unless somebody specifically asks for it.

If you want the cleanest proof that this is a design rather than an accusation, it is this: the ministry has had a review panel sitting since the end of 2023 on the question of whether to add women’s health items to the general periodic examination, with a dedicated paper on it in mid-2024. Whatever that panel eventually decides, a committee deliberating whether to add something is the most reliable available evidence that it is not there now.

Here is the part that turns this page from a complaint into something you can act on this week. Most of what is missing from the workplace examination does exist in this country, is free or close to it, and sits behind a completely different door: the municipal cancer screening programme, run by your city rather than your employer. It has nothing to do with your company, requires no permission from anybody there, and will never be mentioned at work, because it is not their statute.

Under the national guidance the municipal programme offers cervical screening from the age of twenty, every two years, and breast screening by mammography from the age of forty, every two years, alongside the stomach, colorectal and lung programmes. Since 2024 the cervical guidance has a second route as well: where a municipality has chosen to offer it, an HPV test on its own, from thirty, every five years, instead of the two-yearly cytology. Which route your city runs, what it charges, and whether it posts you a coupon or waits for you to apply are all local decisions, so the one reliable instruction is to check your own city rather than trust any general account of it, this one included.

The practical failure mode is worth naming precisely, because it is almost universal and has nothing to do with negligence. The coupon arrives in an envelope with the tax papers, it is put in a drawer, and the year passes. She has not decided against screening. She has never once made a decision about it at all. Putting it in the calendar the day it arrives is, in terms of years of life, probably the highest-value thirty seconds available to a woman in this country.

Part of why this is so hard to see clearly is that a woman in Japan is inside up to three separate examination systems, written under different laws, paid for by different parties, aimed at different things — and she experiences all of them as 健診, the check-up, an annual event that happens to her.

The first is the one above: the employer’s statutory examination under occupational safety law, eleven item groups, aimed at fitness for work and industrial disease. The second is the 特定健康診査, which runs from forty to seventy-four, is the responsibility of your health insurer rather than your employer, and exists under the elderly medical care law for a specific purpose — metabolic syndrome. Waist, blood pressure, lipids, glucose. It is a good programme for what it is aimed at, and what it is aimed at is not you as a whole person either. The third is 人間ドック, which is voluntary, is paid for by you or subsidised by your insurer or your company, and is the only one of the three that was ever designed to survey a person rather than a risk.

Knowing which one you had last year changes what its result meant. A woman of forty-two at a company has usually had the first and the second on the same morning, in the same building, with one sheet of paper at the end — and that sheet is the union of two narrow lists rather than a broad one. Nothing was hidden from her. Two purposes were simply added together and handed over under a single word.

Everything above assumed an employer, and a very large number of the women this library is written for do not have one — the full-time homemaker, the part-timer below the hours threshold, the freelancer, the woman who left work to care for somebody. For them the annual examination does not exist at all, and the gap is not eleven items wide. It is total.

What does exist for her, and is rarely explained, is this. If she is insured as a dependent on a spouse’s policy, the insurer carries the same 特定健康診査 duty toward her from forty that it carries toward him, and the notice usually goes to the household — which means it often reaches her husband’s hands and stops there. If she is on 国民健康保険, the municipality runs it. And the cancer screening programme described above belongs to residents rather than to employees, so it was never conditional on working in the first place: the cervical and breast programmes were always hers.

This is worth being direct about, because the shape of it is familiar from several other pages here. A woman who stopped being examined when she stopped being employed has not lost an entitlement. She has lost a reminder — the letter from personnel, the booked morning, the colleague going at the same time — and the entitlement was always somewhere else, held by her insurer and her city, waiting for an application nobody told her to make.

The additional tests are almost all orderable — through your own doctor, through the optional menu attached to a comprehensive check, or through a clinic you go to on your own. What stops women is not availability and not money. It is not knowing that asking is permitted, and not having a sentence ready.

So here is the sentence, and it works because it names a symptom and a test rather than making a request that can be declined as unnecessary: I have been tired for months and my annual check was normal — can we check ferritin as well as haemoglobin, and thyroid function. That is one sentence, it is specific, it is cheap, and it is the single most useful thing on this page for a woman who has been told for years that nothing is wrong.

Two notes on the surrounding mechanics. The comprehensive check that many employers subsidise on top of the statutory one usually has an optional menu, and the women’s items on it are frequently an extra a few thousand yen rather than a separate appointment — worth reading the form rather than ticking the default. And your results are medical information about you: you are entitled to them, in detail, with the numbers rather than a verdict, and a result sheet that only says 異常なし is not the full document.

One more thing about the word 異常なし, because it hides a second and subtler problem underneath the first. A reference range is a statement about a population, not about you. It is the band most people fall inside, and a value can sit within it while being unusual for the particular body it came out of.

The place this bites hardest is the trend. A result that moved a long way in one direction over four years, and is still just inside the band, is a different thing from a result that has sat in the same place for four years — and the annual sheet cannot tell you which you are, because it shows one year and delivers a verdict. The system is not built to notice a slope. It is built to notice a threshold, and it notices it accurately on the day you cross it, which may be several years after the useful moment.

Which makes the cheapest useful habit in this whole area one that costs nothing and almost nobody has: keep your own sheets. Photograph the result each year and put it in one place with the others. Five years of your own numbers is a better instrument than any single year of anybody’s, it belongs to you rather than to an employer you may leave or an insurer you may change, and the first doctor you ever bring it to will be visibly pleased, because it is the thing they almost never get.

This library has now told readers to get things checked on a great many pages. The essay on sensitivity ends by saying that if the tiredness is not load-dependent, the address is a doctor. The one on the menopausal decade, the one on pain during sex, the one on the appointment you have been putting off — all of them assume a reader who can distinguish between having been examined and having been examined for the thing in question. This page exists because that assumption was unearned.

And it matters in the other direction too, which is the part that should be said gently. A woman who has been tired for two years and has an annual certificate saying she is fine will usually conclude the tiredness is psychological, or character, or the price of her life — and everything this library has written about women defaulting to a verdict about themselves applies with full force here. The certificate did not say the tiredness had no cause. It said eleven specific things looked normal, and her cause was never among the eleven.

So, three things, and none of them costs much. Read the list once, so that 異常なし becomes a sentence about eleven items rather than a sentence about you. Find out what your own city offers and when you are next eligible, because that is where the cervical and breast programmes live and nobody at work will ever mention them. And if you are tired, ask for ferritin and thyroid by name, because the annual test does not include them and will not find them.

Nobody in this system has behaved badly. The regulation does what it was written to do, the clinic follows it, and the city runs its programme faithfully for anybody who turns up. The only thing missing was somebody putting the two documents side by side and telling you which one is which — and that is all this page has done.