Fukushima Thyroid Examination: 112 Children Suspected (28 Cases) or Confirmed (84 Cases) with Thyroid Cancer--108 from Initial Screening and 4 from Full-Scale Screening

The Seventeenth Prefectural Oversight Committee convened in Fukushima City, Fukushima Prefecture, on December 25, 2014, releasing the latest results of thyroid examination, consisting of Initial Screening or the first-round (originally scheduled to be conducted from October 2011 to March 2014, but actually still ongoing) and Full-Scale Screening or the second-round (beginning April 2014).

An official English translation of the results is available here.

Initial Screening targeted about 368,000 individuals who were age 18 and younger, residing in Fukushima Prefecture at the time of the Tokyo Electric Fukushima Daiichi nuclear power plant accident on March 11, 2011. About 80% of those eligible have undergone the primary ultrasound examination, either in Fukushima Prefecture or in other prefectures where they have relocated to. Full-Scale Screening, to be conducted every 2 years until age 20 and every 5 years after age 20, additionally targets those who were born in the first year after the accident, aiming to examine approximately 385,000 individuals in a 2-year period. 

Notably, there was a leak of information the day before the committee met, pertaining to four cases from Full-Scale Screening discovered to be suspicious of malignancy, as described in this post. These four cases caused quite a shock as Initial Screening, considered to provide a baseline incidence rate from the prevalence rate obtained as a result of the wide-scale screening, supposedly would have detected all the cases with "pre-existing" tumors. These "pre-existing" or "latent" cancers would have been discovered before becoming symptomatic due to screening. (It is important to note that Shinichi Suzuki, a Fukushima Medical University thyroid surgeon in charge of the thyroid examination, has steadfastly declined to provide the number of children--some are now adults, over 3 years after the accident--who might have had subjective symptoms). In other words, the incidence rate from the second-round of screening would be expected to be lower.

The four cases, 3 males (ages 6, 10, and 17 at the time of the accident) and 1 female (age 15 at the time of the accident), were either A1 (2 cases) or A2 (2 cases) in Initial Screening. Suzuki was grilled about whether these might have been missed diagnoses in Initial Screening, both during the committee meeting and the press conference, and he flatly denied such possibilities stating the retrospective review of the ultrasound images did not reveal any missed lesions. This, however, means the tumors newly arose since Initial Screening in at least 2 of the cases previously classified as A1, which by definition had no nodules or cysts. Suzuki refused to provide the tumor diameter and the speed of tumor growth for each of the four individuals, citing that they were no longer considered part of the screening and thus patient privacy overruled any other obligation for information release. 

The male to female ratio of 3:1 is also unexpectedly high, as thyroid cancers are usually more common in females, except as discovered after the Chernobyl accident. However, Suzuki stated that nothing conclusive can be drawn from merely 4 cases, and they would have to keep an eye on the future development. Eventually Suzuki used these 4 cases to emphasized the importance of participating in Full-Scale Screening even though the Initial Screening result was normal, as in A1. 

If Suzuki was at all puzzled by the contradiction presented by the situation, he did not show it. An unexpectedly high prevalence rate of thyroid nodules and cancer detected in Initial Screening has been attributed to the highly sensitive ultrasound equipment picking up very small tumors. Today Suzuki emphasized the limitation of ultrasound as it might not always detect what's there. Also, Suzuki has repeatedly mentioned how slowly thyroid cancers grow. Then why did these 4 cases become detectable in two and a half years or less? It seems as if he is hiding behind "patient privacy" so as not to reveal some inconvenient truths. 

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A summary of results are provided for Initial Screening and Full-Scale Screening.

Initial Screening (October 2011 - ongoing)

Total number targeted: 367,686
Number of participants in primary examination as of October 31, 2014: 296,586
Number with confirmed results as of October 31, 2014: 296, 253

• A1   152,633 (51.5%) (no nodules or cysts found)
• A2   141,379 (47.7%) (nodules ≦ 5.0 mm or cysts ≦ 20.0 mm)
• B         2,240   (0.8%) (nodules ≧ 5.1 mm or cysts ≧ 20.1 mm)
• C                1   (0.0%) (requiring immediate secondary examination)

(Note: Cysts with solid components are treated as nodules).

Number eligible for secondary examination: 2,241

Number of participants in secondary examination as of October 31, 2014: 2,051

Number with confirmed results as of October 31, 2014: 1,985

Number of fine-needle aspiration biopsy (FNAB) as of October 31, 2014: 519

Number suspicious or confirmed of malignancy: 109 (often referred to as 108, excluding the case of benign nodule)

Number undergoing surgery as of October 31, 2014: 85

• 1 benign nodule
• 81 papillary thyroid cancer
• 3 poorly differentiated cancer

Full-Scale Screening (April 2014 - March 2016)

Total number targeted: 220,000 in FY2014 (about 385,000 total)

Number of participants in primary examination as of October 31, 2014: 82,101

Number with confirmed results as of October 31, 2014: 60,505

• A1   25,563 (42.2%) (no nodules or cysts found)
• A2   34,485 (57.0%) (nodules ≦ 5.0 mm or cysts ≦ 20.0 mm)
• B          457   (0.8%) (nodules ≧ 5.1 mm or cysts ≧ 20.1 mm)
• C              0   (0.0%) (requiring immediate secondary examination)

(Note: Cysts with solid components are treated as nodules).

Number eligible for secondary examination: 457

Number of participants in secondary examination as of October 31, 2014: 248

Number with confirmed results as of October 31, 2014: 155

Number of FNAB as of October 31, 2014: 11

Number suspicious or confirmed of malignancy: 4

Number undergoing surgery as of October 31, 2014: 0

Overall, the number of suspicious or confirmed of malignancy is 113, including a case of post-surgically diagnosed benign nodule. (This number might be referred to as 112, excluding the benign nodule case). Of these, 84 are surgically confirmed as thyroid cancer (81 papillary thyroid cancer and 3 poorly differentiated cancer) and 29 are suspicious of malignancy awaiting surgery, including 5 new cases from Initial Screening and 4 from Full-Scale Screening.

In regards to detailed characteristics of some of the malignant cases, such as metastases, staging, surgical methods, and genetic analysis, refer to this post describing information gathered from various sources. (Such information is not readily provided, as biopsy as well as surgical cases are technically no longer part of the screening and personal data is guarded, almost over-rigorously). 

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Below are translations of some of the tables in the results.

Initial Screening

Table 1. Primary examination results as of October 31, 2014

Table 2. Number and proportion of participants with nodules/cysts as of October 31, 2014

Table 3. Secondary examination: progress and results as of October 31, 2014

Table 4. Results of FNAB

Table 9: Regional comparison of suspicious/malignant cases

Note 10: Excluding duplicate data and unconfirmed results.

Note 11: Excluding unconfirmed results. 

Note 12: The number of FNAB, out of (c), including those who were reclassified as A1 or A2.

Note 13: Excluding one case that was suspected of malignancy but turned out to be benign after surgery.

Note 14: Tamura City, Minamisoma City, Date City, Kawamata Town, Hirono Town, Naraha Town, Tomioka Town, Kawauchi Village, Okuma Town, Futaba Town, Namie Town, Katsurao Village and Iitate Village

Note 15: Fukushima City, Koriyama city, Shirakawa City, Sukagawa City, Nihonmatsu City, Motomiya City, Koori Town, Kunimi Town, Otamamura Village, Kagamiishi Town, Tenei Village, Nishigou Village, Izumizaki Village, Nakajima Village, Yabuki Town, Tanagura Town, Yamatsuri Town, Hanawa Town, Samegawa Village, Ishikawa Town, Tamakawa Village, Hirata Village, Asakawa Town, Furudono Town, Miharu Town, and Ono Town

Note 16: Iwaki City, Soma City, Shinchi Town

Note 17: Aizuwakamatsu City, Kitakata City, Shimogo Town, Hinoemata Village, Tadami Town, Minamiaizu Town, Kitashiobara Village, Nishiaizu Town, Bandai Town, Inawashiro Town, Aizubange Town, Yugawa Village, Yanaizu Town, Mishima Town, Showa Village, and Aizumisato Town

〈Discussion of regional comparison results〉

• Analysis of 296,253 primary examination participants, excluding duplicates and unconfirmed results, by regions revealed that proportions of B&C tended to increase in the order of "13 municipalities including the evacuation zone," "Nakadori," "Hamadori," and "Aizu region."
• On the other hand, proportions of suspicious or malignant cases was about the same in "13 municipalities including the evacuation zone," "Nakadori," and "Hamadori," but a little lower in "Aizu region." This is probably because the proportion of those who completed the secondary examination is lower in Aizu region compared to the other areas. 

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Full-Scale Screening

Table 1. Primary examination progress as of October 31, 2014

Table 2. Number and proportion of participants with nodules/cysts as of October 31, 2014

Table 3. Transition from Initial Screening to Full-Scale Screening

Note 1: The upper row shows the number whose Full-Scale Screening results were confirmed, and the lower row the proportion (%).

Note 2: The upper row shows the Initial Screening result in the corresponding diagnostic category in Full-Scale Screening, and the lower row the proportion (%).

Of 60,048 who were classified as A1 (25,563) or A2 (34,485) categories in Full-Scale Screening, 56,204 were also classified as A1 or A2 in Initial Screening. Also, of 457 who were classified as diagnostic category B, 333 were A1 or A2 in Initial Screening.

Also notable is the fact that, of the 3,776 previously unexamined individuals who participated in Full-Scale Screening, 16 were classified in the diagnostic category of B.

Table 4. Secondary examination progress and results as of October 31, 2014

Table 5. Results of FNAB

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Fukushima Thyroid Examination: Four Suspected of Cancer in Second Screening--These Children Had Normal Exam Results in First Screening

As with some of the previous committee meetings, thyroid cancer information was apparently leaked to the media the day before the 17th Prefectural Oversight Committee Meeting for Fukushima Health Management Survey, scheduled for December 25, 2014. Since the English edition of the Kyodo news article contained very little information, just as the online Japanese news articles, all based on the same Kyodo post, the paper edition of the Fukushima Minyu post was transcribed and translated as below. (See below the translation for the actual images of the post in the paper edition).

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From the December 24, 2014 article in the paper edition of Fukushima Minyu. (The online edition only includes the first three paragraphs and the first sentence of the fourth paragraph).

Thyroid Examination: Four Suspected of Cancer in Second Screening--These Children Had Normal Exam Results in First Screening

In the thyroid examination conducted in all children in Fukushima Prefecture in order to investigate the effects of radiation as a result of the Tokyo Electric Fukushima Daiichi nuclear power plant (NPP) accident, officials revealed on December 23rd that 4 children whose first screening was “normal” were diagnosed with suspect thyroid cancer in the second screening. It is to be reported at the Prefecture Oversight Committee to be held in Fukushima City on December 25th.

If these cases are confirmed to be thyroid cancer, they will become the first cases where the increase in cancer is confirmed after the NPP accident.

Fukushima Medical University (FMU), in charge of the screening examination, will hurry to confirm the diagnoses and carefully ascertain whether these cases were caused by the effects of radiation exposure.

Occurrence of pediatric thyroid cancer cases skyrocketed 4-5 years after the Chernobyl NPP accident in 1986. Because of this, FMU considers the results of the first screening, during the three years after the accident, as baseline data with no radiation effects. FMU plans on investigating the effects of radiation by comparing any increase of cancer cases from the second screening onward.

The first screening targeted approximately 370,000 residents who were 18 and younger at the time of the accident. The second screening targets approximately 385,000 residents, including children born in the first year after the accident. In each screening, ultrasound is used to examine the size and shape of thyroid mass, which is classified as “A1,” “A2,” “B” and “C” assessment categories, in the ascending order of severity. “B” and “C” assessment categories go onto secondary examination with a detailed blood test as well as a cytological biopsy.

According to officials, 4 people who were diagnosed with suspect cancer are men and women whose ages were in the 6-17 range at the time of the accident. In the first screening, they had “normal” test results, with 2 in “A1” and the other 2 in “A2” assessment categories. The four participated in the second screening, which began in April 2014, where they were classified in the “B” category and diagnosed with “suspect cancer” during the secondary examination. The tumor size varies from 7 to 17.3 mm.

External exposure dose estimation for the first four months after March 11, 2011 was available for the three of the four, with the maximum being 2.1 mSv. The places of residence for the four [at the time of the accident] included Okuma Town, Fukushima City, Date City and Tamura City.

In addition, it was newly revealed that the number of children who were confirmed with cancer during the first screening went from 57, as of August 2014, to 84, increasing by 27. The number of children with suspect cancer is now 24 (46 as of August).


Images of the article in the paper edition courtesy of @fukushima_info.
The original Japanese transcript can be found here.

Details of Fukushima Thyroid Cancer Surgical Cases

This is a compilation of the most current information on Fukushima thyroid cancer surgical cases from 3 different sources (screenshots of the abstracts for 2 & 3 can be seen in this post): 

1. November 11, 2014 Thyroid Examination Evaluation Subcommittee meeting
2. November 14, 2014 Japan Thyroid Association meeting
3. August 28, 2014 Japan Society of Clinical Oncology meeting

Due to the span of the time amongst these 3 sources, they have different numbers for the cases of thyroid cancer. For clarification, the most updated summary of the thyroid cancer cases is presented first. 

Summary of Fukushima Thyroid Cancer Cases as of November 29 by Yuri Hiranuma

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Summary of Fukushima thyroid cancer cases as of November 2014

Number of cases suspected or confirmed of thyroid cancer = 104

Cases that had surgery = 58

Cases confirmed of thyroid cancer = 57 (1 of 58 turned out to be benign nodules)

55 of 58 cases were operated on at Fukushima Medical University (FMU)

• 1 case turned out to be benign nodules
• 52 cases of papillary thyroid cancer
• 2 cases of poorly differentiated thyroid cancer 

Pre-operative diagnosis: 

42 cases (78%) had pre-surgical tumor diameter > 10 mm

12 cases (22%) had pre-surgical tumor diameter ≤ 10 mm:

• 3 cases were suspected to have lymph node or distant metastasis.
• 7 cases with proximity to trachea or recurrent laryngeal nerve, or extrathyroidal extension 
• 2 cases of voluntary surgery despite recommendation of non-surgical follow-up

Overall, 17 cases (31%) had lymph node metastasis and 2 cases (4%) had distant metastasis to the lungs

Operative methods:

5 cases (8%) had total thyroidectomy

49 cases (91%) had hemithyroidectomy

All 54 cases had lymph node dissection

Post-operative pathological diagnosis:

15 cases (28%) had tumor diameter ≤ 10 mm, and 3 (6%) of them had no lymph node metastasis or distant metastasis (pT1a pN0 M0)          

37% (?20 cases?) had extrathyroidal extension

74% (?40 cases?) were positive for lymph node metastasis

No post-operative complications (post-surgical hemorrhage, permanent paralysis of recurrent laryngeal nerve, hypoparathyroidism, or hypothyroidism after hemithyoidectomy) observed.

Note: 2 cases of lung metastasis were papillary thyroid cancer cases.

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Thyroid Examination Evaluation Subcommittee

Information that was released by Shinichi Suzuki at the Thyroid Examination Evaluation Subcommittee meeting held on November 11, 2014

https://www.pref.fukushima.lg.jp/uploaded/attachment/90997.pdf

Regarding Surgically Indicated Cases

Three years have passed since the disaster struck. Of 1,848 subjects that underwent the secondary examination up to June 30, 2014, 485 had cytological examinations. Suspicious or malignant cases totaled 104, and 58 of them were already operated on.

Surgeries on 55 of 58 cases were conducted at the Division of Thyroid and Endocrine Surgery, Fukushima Medical University. 3 cases were operated on at other facilities. As 1 of 55 cases turned out to be benign nodule post-operatively, only the 54 thyroid cancer cases were considered there.

According to the pathological evaluation, 52 cases were papillary cancer, and 2 were poorly differentiated thyroid cancer.

In pre-operative diagnosis, 42 cases (78%) had tumor diameter > 10 mm. and 12 (22%) were ≤ 10 mm in diameter. Also, of the 12 cases with tumor diameter of ≤10 mm, 3 (5%) were suspected to have lymph node metastasis and/or distant metastasis. 9 (17%) cases were not suspected to have lymph node or distant metastasis (cT1acN0cM0).

Of these 9 cases, 7 were suspected to be close to the trachea or the recurrent laryngeal nerve, or have extrathyroidal extension. The remaining 2 cases were operated on based on patients’ wishes, despite the recommendation of non-surgical follow-up.

Furthermore, 17 cases (31%) were positive for lymph node metastasis, and 2 cases (4%) were suspected of multiple lung metastasis.

Surgical methods included total thyroidectomy in 5 cases (9%), and hemithyroidectomy in 49 cases (91%). Lymph node dissection was conducted in all cases, with 67% limited to the central compartment and 33% including lateral compartment. As much as possible, small-size incisions of 3 cm were used.

Post-surgical pathological diagnosis revealed 15 cases (28%) with tumor diameter ≤ 10 mm, and 3 (6%) of them had no lymph node or distant metastasis (pT1a pN0 M0). Extrathyroidal extension, pEX1, was seen in 37%, and 74% was positive for lymph node metastasis. No post-operative complications (post-surgical hemorrhage, permanent paralysis of recurrent laryngeal nerve, hypoparathyroidism, or hypothyroidism after hemithyoidectomy) were observed.

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The 57^th Annual Meeting of the Japan Thyroid Association

November 14, 2014

Identification of  gene clusters related to initiation of thyroid cancer and elucidation of pathogenesis in children and young adults

Shinichi Suzuki^１, Toshihiko Fukushima^１, Michiko Matsuse^３, Yudai Hirata^１, Hirokazu Okayama ¹, Chiyo Okouchi ¹, Toshiyuki Monma ², Hiroshi Mizunuma ¹, Satoshi Suzuki^１, Norisato Mitsutake ³, Shunichi Yamashita ³

^１Department of Thyroid and Endocrinology, School of Medicine, Fukushima Medical University, ^２Department of Organ Regulatory Surgery, Fukushima Medical University, ^３Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University

There has been an increase in the number of pediatric and young adult patients diagnosed with thyroid cancer due to the advance in diagnostic ultrasound technology and implementation of pediatric thyroid ultrasound screening. However, pathogenesis relating to initiation and development of these cancers is yet to be fully understood. As  it is anticipated the number of cases will increase in the future, we will identify gene clusters related to cancer initiation and elucidate the mechanism of pathogenesis in order to reveal biological features of these cancers. In this study, we investigated the gene clusters known to be related to thyroid cancer initiation.

Study subjects: 24 surgical cases (male:female = 1:2, average age 17.9 years (9-22 years)) in children and young adults. 23 cases were papillary thyroid cancer and 1 was follicular cancer. (Note: The actual presentation referred to 23 cases of papillary thyroid cancer and 1 case of poorly differentiated thyroid cancer).

Method: DNA and RNA were extracted from excised tumor tissues and analyzed with direct sequencing and PT-PCR. Mutation in BRAF, K-, N-, and H-RAS and rearrangement in RET/PTC1 and RET/PTC3 were investigated.

Results: 67% was positive for BRAF mutation. Also, 12.5 % had rearrangement of RET/PTC1, but no mutation was found in RET/PTC3, K-, N-, and H-RAS.

Information from the transcript of the presentation by Shinichi Suzuki

23 cases were papillary thyroid cancer (19 cases of classical type, 1 case of follicular variant, and 3 cases of cribriform-morular variant or CMVPTC), and 1 case was poorly-differentiated thyroid cancer.

23 patients were from the Fukushima Health Management Survey Thyroid Examination, and 1 case of a 22-year-old female was unrelated to the survey.

Genetic analysis results:

RET/PTC1: positive in 3 cases or 12.5%（average age 17.8 years)

ETV6/NTRK3: positive in 1 case or 4.2％ (16-year-old female）

BRAF (known to be common in adults): positive in 18 cases or 67%（average age 18 years）

No RET/PTC3, K-, N-, H-RAS, or TRK detected.

5 cases (all females, average age 16.7 years) were negative for RET/PTC1, BRAF, or ETV6/NTRK3.

The patient unrelated to Fukushima Health Management Survey, a 21-year-old female, was RET/PTC1 positive.

BRAF, RET/PTC1 and ETV6/NTRK3 cases were all classical type papillary thyroid cancer.

Five all-negative cases included 1 case of follicular variant papillary thyroid cancer, 1 case of poorly-differentiated cancer, and 3 cases of cribriform-morular variant papillary thyroid cancer (CMVPTC). CMVPTC cases are under investigation for APC genetic mutations which are known to be causative. All 3 CMVPTC cases have family history.

Five all-negative cases had slightly larger tumor diameter than others. These 5 cases were the only cases undergoing total thyroidectomy.

BRAF positive cases are said to be aggressive. RET/PTC1 tends to be seen in older children and associated with cases unrelated to radiation exposure. RET/PTC3 is seen in younger children, and seen frequently in Chernobyl, although it is not considered to be the definitive oncogene for radiation-induced PTC. It is commonly thought gene rearrangements are more frequently seen in children, whereas point mutations are seen more in adults.

As a conclusion, BRAF, the genetic mutation detected most frequently, is what is usually seen in typical adult PTC. It is highly possible that cases which may not have been detected if it weren’t for the thyroid ultrasound screening are being discovered in children and young adults as a result of the screening.

Note 1: Three cases of cribriform-morular variant papillary thyroid cancer are not consistent with the information from the August 2014 meeting of Japan Society of Clinical Oncology below, showing 3 cases of diffuse sclerosing variant papillary thyroid cancer. It is likely the pathological diagnosis was updated after an outside review.

Note 2: Suzuki’s presentation of these details outside the Thyroid Examination Evaluation Subcommittee, especially before the information was shared with the Subcommittee and the public, created controversy as to the handling of data. Suzuki claims the study was accepted by the ethics committee at Fukushima Medical University, but the thyroid examination itself is conducted with the money provided by the central government to Fukushima Prefecture, and the data belongs to the prefecture and the residents. Suzuki has a track record of not revealing the data to the Thyroid Examination Evaluation Subcommittee or the Prefectural Oversight Committee for Fukushima Health Management Survey before presenting it at an academic meeting in August 2014, as described below.

Note 3: This meeting was closed to media due to the decision of the conference chair, based on the wishes of some of the presenters.

Note 4: Shigenobu Nagataki, a mentor to Shinichi Yamashita, revealed the following information during the questions and answers session:

Shigenobu Nagataki was invited to do a presentation called “Fukushima Daiichi Accident and Thyroid Cancer” at “Meet-the-Professor Workshop” on October 30, 2014 at the 84th Annual Meeting of the American Thyroid Association.  

He was asked by thyroid specialists attending the meeting if nodule sizes were the only thing determined in this unprecedented, large-scale screening. Participants wanted to know how many had Graves’ disease, autoimmune thyroiditis, goiter, etc. [Note: Fukushima Health Management Survey has not released hardly any data regarding non-cancer thyroid diseases]. Nagataki referred to patient privacy in disclosing such information, but he was told patient privacy meant such things as patients’ names and had nothing to do with how many patients had Graves’ disease. [Note: Fukushima Medical University cites patient privacy when refusing to disclose details of their findings]. They asked him there must be a rough estimate of non-cancer thyroid diseases made by thyroid specialists conducting ultrasound screening. Nagataki told them he would get back to them in writing as he didn’t know what to say.

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The 52^nd Annual Meeting of Japan Society of Clinical Oncology

August 28-30, 2014

Organ Specific Symposium 03, August 28, 2014  10:00-12:00

OS3-5 “Treatment of Pediatric Thyroid Cancer in Fukushima”

Shinichi Suzuki

Division of Thyroid and Endocrinology, School of Medicine, Fukushima Medical University

Pediatric thyroid cancer has been considered rare, consisting approximately 1-2% of all thyroid cancer. They might appear to be advanced at first sight, with lung metastasis or widespread lymph node metastasis discovered at the time of diagnosis, but long-term survive is known to be extremely good.

After the Fukushima Daiichi nuclear power plant accident following the Great East Japan earthquake and tsunami on March 11, 2011, Fukushima Prefecture was burdened with the prospect of faces long-term radiation health effects. Fukushima Health Management Survey was launched in Fukushima Prefecture, with one of the surveys being thyroid ultrasound examination of residents who were children at the time of the accident. Initial Screening has already completed, and thyroid cancer cases have been discovered. We report our experience in treating these asymptomatic pediatric thyroid cancers detected through ultrasound screening, unlike the usual symptomatic thyroid cancer.

Study subjects are 269,354 children (participation rate 80.8%) who underwent primary examination from October 2011 to December 31, 2013. Of these, 1796 required secondary examination, and 75 of them were diagnosed with malignant or suspicious tumor as a result of fine-needle aspirational biopsy. 34 already had surgery, and 33 were confirmed to have thyroid cancer. We are reporting here on the 31 cases operated on in our department.

Average age at the time of surgery is 16.4 (9-20) years,  the male to female ratio is 14:17, and 9 cases were from Fiscal Year 2011 (from 13 municipalities designated by the government to be evacuation zone), and 22 cases were from Fiscal Year 2012.

Average tumor diameter at the time of surgery was 14.9 mm (6-13 mm). Pre-operative diagnosis revealed 22 cases of T1 (7 T1a and 15 T1b), 7 cases of T2, and 2 cases of T3. 19 cases were N0, 12 cases were N1 (4 N1a and 8 N1b), 29 cases of M0 and 2 cases of M1 (lungs). Surgical method was 28 cases of hemithyroidectomy and 3 cases of total thyroidectomy, and lymph node dissection included 19 cases of central compartment dissection, and12 cases of lateral compartment dissection. Post-operative diagnosis revealed 24 cases of papillary thyroid cancer (usual type), 3 cases of follicular-type papillary thyroid cancer, 3 cases of diffuse sclerosing papillary thyroid cancer, and 1 case was suspicious of poorly differentiated thyroid cancer.  21 cases of pT1 (9 cases of pT1a, 12 cases of pT1b), 3 cases of pT2, 7 cases of pT3 (EX1), 7 cases of pN0, and 24 cases of pN1 (12 pN1a and 12 pN1b). Two cases with pre-operative suspicion of  M1 (lungs), which had the Tg level in the blood dropping below detection range after total thyroidectomy, will be scheduled for either CT scan of lungs or I131 scintigraphy.

In all cases, intraoperative monitoring of the recurrent laryngeal nerve was conducted using NIM. Surgical incision for neck dissection was limited to small skin incisions of 3 cm in the central compartment dissection and 3-5 cm in the lateral compartment dissection. No paralysis of the recurrent laryngeal nerve or hypoparathyroidism was observed.

A Letter Hand-delivered to the UN and UNSCEAR, Requesting Revision of UNSCEAR Report And a New UN Mandate for UNSCEAR

On October 24, 2014, at the Fourth Committee of the UN General Assembly being held in New York City, representatives from Physicians for Social Responsibility (USA) and Human Rights Now (Tokyo, Japan) hand-delivered a letter to the chairperson of the 4th Committee and the Secretary of UNSCEAR.  The letter, co-signed by 43 civil society groups from 9 countries, including 21 Japanese groups, requested revision of the 2014 UNSCEAR report on Fukushima accident as well as a new UN mandate for UNSCEAR.

Date: 24 October 2014

To:       Members of the Fourth Committee of the UN General Assembly 69th Session,

Members of UNSCEAR, and

Members of the UN General Assembly:

Re:       Civil Society groups request revision of the recent United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) Report: “Levels and effects of radiation exposure due to the nuclear accident after the 2011 Great East-Japan Earthquake and tsunami.”

      The 2011 Fukushima disaster made UN oversight of the adverse effects of ionizing radiation an issue of utmost global importance.  The goals and criteria of oversight should be the protection and promotion of the human right to health and well-being, which encompasses an environment as free from exposure to man-made ionizing radiation as possible.  We, the undersigned, urge the 4^th Committee to examine critically both the scientific conclusions in the UNSCEAR report[i] and the scientific evidence omitted from the report.

     Physicians from 19 national affiliates of the International Physicians for the Prevention of Nuclear War (IPPNW), including Physicians for Social Responsibility (USA) and IPPNW Germany, have authored/issued/published a Critique of the UNSCEAR report[ii] which calls into question the presumptions and data used by UNSCEAR, and the consequent interpretations and conclusions.  This Critique demonstrates how UNSCEAR systematically underestimates and downplays the health effects of the Fukushima disaster.

     We appreciate the significant efforts made by UNSCEAR committee members to evaluate the extensive and complex data concerning the Fukushima nuclear catastrophe.  However, their conclusion that there is “no discernable effect”, now or in the future, defies common sense and undermines the credibility of UNSCEAR.  The Critique notes that based on the UNSCEAR report itself, it can be expected that about 1,000 excess cases of thyroid cancer and between 4,300 and 16,800 other excess cancer cases would occur in Japan due to Fukushima radioactive fallout.  We believe that these are very discernable effects for the individuals, families and communities experiencing these cancers, as well as those individuals who will experience other form(s) of radiation induced illness.

     Furthermore, the conclusion by UNSCEAR of ‘no discernible health effect’ is misleading the Japanese government to not implement countermeasures for individuals to avoid additional exposure and to have thorough monitoring of health effects, thereby causing serious human rights violations. 

     This catastrophe was not a singular event that has come to an end, but rather it is an unfolding event with an unknown endpoint.  Radioactive elements continue to leak into the biosphere and individuals continue to be exposed to ionizing radiation because they live in contaminated areas, consume contaminated food and water and inhale contaminated air.  Additionally, most of the health effects from Fukushima will take decades or generations to be expressed.  Thus the UNSCEAR report at hand should be considered a preliminary or initial assessment of the health effects of Fukushima. Ongoing and improved monitoring and updating of the assessment is required for a long time to come.  The 2014 UNSCEAR report is a beginning, not an end.

     We ask that the Fourth Committee take two actions regarding the UNSCEAR report:

     1)  Return the report to UNSCEAR for revision based on the Critique, taking into consideration the points of concern raised in the Critique, and that UNSCEAR broaden the composition of the committee to include as full-fledged members scientists who are critical of nuclear activities.

     2) We also ask that the Fourth Committee urge the General Assembly to pass a new resolution reframing the 1955 UNSCEAR founding mandate to ensure that the UNSCEAR’s primary scientific mission is to promote and protect public health and the right to health of the most vulnerable individuals.  The Precautionary Principle should be employed to address the short-term and long-term effects of ionizing radiation upon present and future generations as well as the environment.  Likewise, the Precautionary Principle should be employed when determining exposure, cleanup and decontamination regulations and activities after a nuclear disaster, educational measures to minimize and mitigate the risk of individual exposure, and the long-term monitoring of contaminated sites.  A new UN mandate is critical for UNSCEAR Committee members to be able to fully utilize their expertise for the purpose of protecting the lives and health of the global community.

This request is supported by the following organizations:

Physicians for Social Responsibility, USA

International Physicians for the Prevention of Nuclear War – Germany, Germany

Human Rights Now, Tokyo, Japan

Peace Boat – US, USA

Niji to midori no kai, Japan

Greens Fukushima, Japan

Workers’ Executive Committee For Anti-nuclear Power Movements, Japan

Kai Fukushima Downwind, Japan

The Nature Conservation of Fukushima, Japan

Friends of the Earth Japan, Japan

Showa Shell Labour Union, Japan

Chernobyl Health Survey and Health-care Support for the Victims - Japan Women's Network, Japan

Nuclear Disaster Information Center, Japan

Japan International Volunteer Center, Japan

Campaign for Nuclear-free Japan, Japan

Fukushima Network for Denuclearization, Japan

Hairo Action Fukushima, Japan

Hairo Fukushima Women Against Nukes, Japan

People in Fukushima-NPP 30km area, Japan

Refugee Living with Fukushima in Niigata Prefecture, Japan

Shinshu 3.11 Network, Japan

National Network of Parents to Protect Children from Radiation, Japa

The Civil Forum on Nuclear Radiation Damages (CFNRD), Japan

Takagi School, Japan

Association de l'Education Environnementale pour les Futures Generations, Tunisia

NGO of “Ecolife”, Azerbaijan

Women in Europe for a Common Future International, Netherlands

Women in Europe for a Common Future, Germany

Women in Europe for a Common Future, France

Irish Doctors' Environmental Association (IDEA), Ireland

Nuclear Information and Resource Service, USA

Nuclear Age Peace Foundation, USA

Nuclear Age Peace Foundation, New York, USA

Nukewatch/The Progressive Foundation, USA

Nuclear Watch New Mexico, USA

Georgia WAND - Women's Actions for New Directions, USA

Physicians for Social Responsibility – Kansas City, USA

Gray Panthers, USA

Center for Safe Energy, USA

Nuclear Energy Information Service, USA

Shut Down Indian Point Now, USA

International Society of Doctors for the Environment, Switzerland

Beyond Nuclear, USA

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^[i]  UNSCEAR report “Levels and effects of radiation exposure due to the nuclear accident after the 2011 Great East-Japan Earthquake and tsunami” at:  http://www.unscear.org/docs/reports/2013/13-85418_Report_2013_Annex_A.pdf

^[ii]  Critical Analysis of the UNSCEAR Report “Levels and effects of radiation exposure due to the nuclear accident after the 2011 Great East-Japan Earthquake and tsunami: www.fukushima-disaster.de/information-in-english/maximum-credible-accident.html