Fukushima Thyroid Examination September 2018: 164 Surgically Confirmed as Thyroid Cancer Among 201 Cytology Suspected Cases


For more detailed information on the Fukushima Thyroid Examination itself, see the September 2017 fact sheet (long version, or e-published PDF)

Highlights: 
  • The third round: 3 cases newly diagnosed as suspicious or malignant, and 2 new  cases surgically confirmed.
  • The fourth round began on April 1, 2018.
  • Total number of suspected/confirmed thyroid cancer is now 201 (excluding a single case of benign tumor; 115 in the first round, 71 in the second round, and 15 in the third round).
  • Total number of surgically confirmed thyroid cancer cases has increased by 2 to 164 (101 in the first round, 52 in the second round, and 11 in the third round)
The latest overall results:
(Scroll down for the latest results including the "unreported" cases explained in this post.)

On September 5, 2018, the 32nd Oversight Committee for Fukushima Health Management Survey (FHMS) convened in Fukushima City, Fukushima Prefecture. Among other information, the Oversight Committee released the latest results (as of June 30, 2018) of the third and fourth rounds of the Thyroid Ultrasound Examination (TUE). 

A four-page summary of the first through third rounds, "The Status of the Thyroid Ultrasound Examination," was also released, listing key findings from the primary and confirmatory examinations as well as the surgical information. In particular, any update to the number of surgical cases is reflected in this summary before such information is compiled in the fiscal year update as of March 31. This summary is not translated into English officially, but here's an unofficial translation. 



Key points from the Oversight Committee:

Target population shrinks
For the fourth round to be conducted during FY2018-2019, the target population excludes about 44,000 individuals total (22,000 each from FY2018 and FY2019) as those born in FY1993 and FY1994 will shift to the Age 25 Milestone Screening in FY2018 and FY2019, respectively).

The first Age 25 Milestone Screening results for those born in FY1992 were released at the last Oversight Committee meeting on June 18, 2018. Only 1,902 out of 22,653 participated at a strikingly low participation rate of 8.4%. It should be noted that with each successive round of screening, more and more individuals reaching age 25 will be removed from the main dataset. So far no thyroid cancer has been diagnosed in the Milestone Screening cohort, but any cancer case from this cohort will not be reflected in the age distribution graphs of the main dataset. 

For each round, there are two such graphs: one for age-at-exposure as of March 11, 2011 and the other for age-at-examination. Because thyroid cancer incidence naturally increases with age, one would expect a growing trend towards the right in the age distribution graph. The second round age-at-exposure graph, before the Age 25 Milestone Screening began, lacks this trend and falls to the right, most likely due to a lower participating rate beyond the high school age. The third round age-at-exposure graph completely deviates from an expected pattern, mostly blank in higher ages saving 2 cases at age-at-exposure of 16 years. This likely reflects even a lower participation rate after high school graduation, in addition to the exclusion of those eligible for the Age 25 Milestone Screening. An appearance of no cancer cases for higher ages might simply be an artifact due to exclusion of individuals reaching age 25.

Participation rates
The primary examination participation rates have been declining with each successive round of the TUE: 81.7% for the first round, 71.0% for the second round, and 64.3% for the third round. In particular, a participation rate for age 18 or older (age at examination) has gone from already low 25.7% in the second round to even lower 15.9% in the third round.  

Participation rates for the confirmatory examination have also been declining from 92.9% in the first round, 84.1% in the second round, and 58.7% in the third round which is still ongoing.

Correction of the number of surgeries conducted outside FMU
At this committee meeting, a discrepancy in the number of surgical cases at medical facilities other than FMU (refereed to as "non-FMU surgical cases" herein) was resolved.

So far clinicopathological information on surgical cases have been released three times: as a document called "Regarding Surgical Indicated Cases" in November 2014 (at the 4th Thyroid Examination Assessment Subcommittee) and August 2015 (at the 20th Oversight Committee); and presented at an international symposium in September 2016. (Note
the 2016 information was later reported as "Regarding Surgical Indicated Cases" at the 8th Thyroid Examination Assessment Subcommittee in November 2017. This means and no new clinical information has been reported to the Oversight Committee since 2016.) 

Information released so far shows the number of surgeries conducted at non-FMU facilities as 3, 7, and 6 in 2014, 2015, and 2016, respectively. It is easy to see the number increased from 3 to 7 from 2014 to 2015 as the number of surgical cases increased. However a drop from 7 to 6 has been a mystery. 

A closer look at the 2016 number shows that there were 132 surgical cases between August 2012 and March 2016 (see Slide 1 in this post). Of 132, 126 surgeries were conducted at FMU, and one was diagnosed benign and 125 malignant. Non-FMU surgical cases are shown as 6. However, it turns out that 126 surgical cases included one case operated on in April 2016. The TUE data is compiled fiscally, with the end of a fiscal year being March 31 of the following calendar year. Thus, strictly speaking, 125 of 132 surgeries as of March 31, 2016 were conducted at FMU resulting in one benign and 124 malignant cases, leaving non-FMU surgical cases at 7, not 6 as previously reported. 

However, this creates another discrepancy because Slide 2 of this post discusses "Characteristics of 125 thyroid cancers at Fukushima Medical University", not 124. This was resolved in the correction report (only in Japanese) which explained that the clinicopathological details given on 125 FMU surgical cases includes the April 2016 case.
   
Non-FMU surgical cases have not been kept track of
In relation to the above corrections, Hiroki Shimura, head of the TUE program, revealed that FMU has not kept track of non-FMU surgical cases beyond the 7 cases already reported. Shimura explained that the surgical information as clinical information is outside the scope of the TUE, but it has been reported out of courtesy. However, FMU began to report the number of surgical cases on the last page of the report, separately from the rest of the results such as cytology results at the 19th Oversight Committee in May 2015. Up to this point, surgical information was included in the cytology results section. Their intention appears to be to clarify what belongs to the TUE itself. 

Shimura further explained that during the first round and part of the second round (probably through March 2016), non-FMU surgical cases were included in the number of surgeries reported to the Oversight Committee. However, beyond 7 non-FMU surgical cases already reported, FMU has not attempted or does not intend to kept track of non-surgical cases. 

The reason given by Shimura has to do with FMU's decision to tighten how clinical information is obtained and released, reflecting "changes in how the society views research ethics and patient privacy protection." Shimura elaborated that FMU has been careful about whether or not to obtain clinical information from other medical facilities, giving a special consideration to release of information that might reveal patient identity and to appropriate ethics review. In regard to obtaining non-FMU surgical data, Shimura cites a potential difficulty in  confirming authenticity of such data as well as a lack of actual mechanism to  follow patients outside the FMU system.

This revelation was a surprise. FMU has no idea if and how many surgeries might be conducted outside FMU including medical facilities contracted to participate in the TUE. Not all medical facilities contracted to conduct the primary and confirmatory examinations may offer surgeries, but they already have a line of communication established with FMU in order to send the raw data. Rather than trying everything possible to gather all the data available, FMU appears to be making excuses not to add to their dataset.

This revelation also brings a doubt on accuracy of the number of cases suspected of thyroid cancer which have not undergone surgery. There are 37 such cases as of June 30, 2018: 14 from the first round, 19 from the second round, and 4 from the third round. It is possible that these 37 cases are simply being followed up regularly without needing any surgery, but it is also plausible that some, especially from the first and second rounds which have been followed up quite some time, might have already undergone surgery outside FMU.


Reluctance on releasing detailed data
There have been repeated requests to FMU from multiple committee members to release more detailed data. Fumiko Kasuga, a committee member from the National Institute of Health Sciences, again asked for a more detailed breakdown of tumor sizes in cancer patients and reiterated that information gained from the TUE belongs to Fukushima residents and that any data should be shared with the residents in an easy-to-understand manner. 

However, detailed data are often presented at academic meetings or released in academic publications first, without ever being reported to the Oversight Committee. Clinical details of surgical cases are one such example: no new data beyond the 132 surgical cases as of March 2016 has been reported to the Oversight Committee or the Subcommittee, while more recent data on 153 surgical cases (including 145 FMU cases) as of March 2017 were presented at the Japan Thyroid Association meeting in October 2017. As shown in the abstract below, it appears that the same data are to be presented at the poster session during the 88th Annual Meeting of the American Thyroid Association in October 3-7, 2018. (Abstracts can be seen here.)


  
Furthermore, FMU's partial analysis of some of the first and second round data (available only in Japanese here) released at the 10th Thyroid Examination Assessment Subcommittee meeting on July 8, 2018 met a near unanimous request from the subcommittee members to make data available in actual numbers rather than just percentages (the minutes of the proceedings are available here in Japanese). At the time, FMU officials asserted as before that detailed information were not to be released for the protection of patient privacy. 

Shimura also explained that a more detailed analysis considering various biases could breakdown the data into very small sample sizes, such as one or two cases, potentially revealing their identity. Some subcommittee members emphasized the need for seeing actual data in order to begin some type of analysis. FMU officials expressed their willingness to share actual data with subcommittee members in a closed meeting, especially with those specializing in epidemiology.

During this Oversight Committee meeting, Tamami Umeda, a committee member representing the Ministry of the Environment stressed an importance of sharing data with transparency. Umeda also repeated her previous request to integrate all the data available, including data from the TUE support program and the unreported cases clinically and surgically managed at FMU (see the post on the previous Oversight Committee meeting here). Kasuga also made a similar request.

The latest overall results including "unreported" cases
Here's the latest results including unreported cases. It should be kept in mind that even this table is far from being comprehensive: the TUE support program data isn't detailed enough to be included in this format, and there are surgical cases from other medical facilities completely outside the framework of the TUE. (The italicized part was added on October 2, 2018)



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The first round results (no change from the previous report)
From the FY 2016 supplemental report with data as of March 31, 2017. (Summary report with data as of March 31, 2018, only shows the total results, not by fiscal year cohorts. However, for the content shown below, information remained the same between 2017 and 2018.)


The second round results 
No change since the March 5, 2018 Oversight Committee meeting.


The third round results
Three new suspicious/malignant cases were diagnosed, all from the FY 2017 cohort: two females (ages 10 and 11 in March 2011) and 1 male (age 9 in March 2011). One resides in a Hama-dori municipality, and the other two in the Aizu region. All three were assessed "B" in the second round.



"Unreported" Cases: Results of Survey on Fukushima Thyroid Cancer Cases Excluded from the Official Report


The following is an unofficial English translation of a handout regarding previously unreported thyroid cancer cases which was distributed at the Tenth Thyroid Examination Assessment Subcommittee held in Fukushima City, Fukushima on July 8, 2018. A PDF version on Scribd is shown first, followed by actual text and some pertinent notes to put the information in perspective. 
July 16, 2018 Update: Corrections were made regarding the total number of cytologically suspected thyroid cancer (corrected from 201 to 211) and the total number of surgical confirmed thyroid cancer (corrected from 174 to 173) in the Notes section. A table of the latest results was also added.






Handout 3

Survey Results Regarding Thyroid Cancer Cases Excluded from the Official Report of the Thyroid Ultrasound Examination 

Susumu Yokoya
Director of Thyroid and Endocrine Center
Fukushima Medical University

【Background】
Media coverage of a thyroid cancer case not previously reported to the Fukushima Health Management Survey (FHMS) Oversight Committee prompted a question regarding a  possibly numerous existence of similarly unreported cases diagnosed outside the framework of the Thyroid Ultrasound Examination (TUE).

【Objectives】
Conducting a complete survey of thyroid cancer cases diagnosed and treated at the Fukushima Medical University  (FMU) Hospital which have not been included in the official TUE report, in order to examine the grasp of thyroid cancer cases in the current TUE.

【Methods】
1. Obtained an approval by the FMU Ethics Committee.
2. From the target population* for the TUE, a complete list was created of patients who underwent thyroid cancer surgery between October 19, 2011 and June 30, 2017.
   *Individuals who were in Fukushima at the time of the accident who were born between April 2, 1992 and April 1, 2012.
3. For each patient, an inquiry was made with the Division of the TUE, the Department of the FHMS, Radiation Health Science Center, to determine if the patient participated in the TUE.
4. For each patient in the complete list created in Method 2, confirmation was made whether the case was included in or excluded from the official report of the TUE, as determined in Method 3.

【Results】
1. Patients who underwent surgery at the FMU Hospital: 160 (including 2 benign cases)
2. Report status as "malignant or suspicious" in the FHMS TUE report during the same time period :
    Reported:      148 (including 1 benign case)
    Unreported:    12 (including 1 benign case)
3. Regarding 11 malignant cases among 12 cases excluded from the official report
   (1) Breakdown in relation to participation in the TUE
   (2) Breakdown by sex     4 males and 7 females
   (3) Breakdown by age
        ① Age at the time of the accident: 13.8 ± 4.0 years
             (1 in ages 0-4, 1 in ages 5-9: 1, 4 in ages 10-14, and 5 in ages 15-19) 
        ② Age at the time of the confirmatory examination (if no confirmatory examination, age at the initial visit at the FMU Hospital): 16.8 ± 4.8 years   
             (1 in ages 5-9, 3 in ages 10-14, 3 in ages 15-19, and 4 in ages 20-24)
   (4) Breakdown of residential addresses at the time of the accident by 4 regions
        4 in 13 municipalities including the evacuation zone, 4 in Naka-dori, 3 in Hama-dori, and 0 in Aizu

【Summary】
1. A complete survey was conducted on thyroid cancer cases diagnosed and treated at the FMU Hospital as of June 30, 2017, which were not included in the official report.
2. As of June 30, 2017, 193 (excluding one benign case) were diagnosed with "suspicious or malignant" lesions by FNAC as part of the TUE, while 158 patients (147 reported and 11 unreported) were diagnosed and treated at the FMU Hospital.

**************
Notes:
These 12 previously unreported cases that underwent medical treatment at the FMU hospital make the current total count of cytologically suspected thyroid cancer cases 211, including 2 benign cases. The number of surgically confirmed thyroid cancer cases now is 173. It should be noted that the 12 additional cases only include thyroid cancer cases diagnosed and treated at the FMU Hospital. There is no grasp of thyroid cancer cases, partially or completely outside the TUE system, which were treated at medical facilities not in cooperation with FMU for the purpose of the FHMS. 



In general, the official report includes cases that undergo the primary and confirmatory examinations as well as surgery at the FMU Hospital or non-FMU medical facilities cooperating with the FHMS.

This survey revealed that 3 of 11 cases never participated in the TUE. It was not clear if these 3 individuals sought medical care because they had some symptoms or if they were simply concerned about the potential risk of thyroid cancer.

The thyroid cancer case in a then 4-year-old that originally shone a light on unreported cases through the March 2017 media coverage appears to be included in 11 unreported cancer cases.

As of June 30, 2017, the number of surgically confirmed cases was officially reported to be 154 (101 in the first round, 50 in the second round, and 3 in the third round), excluding one benign case. Of 158 surgeries that were conducted at the FMU Hospital as of June 30, 2017, 147 are included in the official report. This means 7 of 154 cases underwent surgery at medical facilities not affiliated with FMU. The FMU thyroid surgeon Shinichi Suzuki previously reported at the September 2016 conference that 132 surgical cases as of March 31, 2016 (102 from the first round and 30 from the second round) included 126 undergoing surgery at the FMU Hospital (including one benign case) and 6 at other facilities. This means that between March 31, 2016 and June 30, 2017, only one additional surgery was conducted at other facilities.

Recently the fiscal report of the TUE Support Program, as reported at the 31st Oversight Committee held on June 18, 2018, revealed information on 77 thyroid cancer cases that received financial assistance as of March 30, 2018. Five of 77 cases were not diagnosed directly during the confirmatory examination: 3 cases were diagnosed with thyroid cancer during a clinical follow-up for non-cancer condition after the confirmatory examination, and 2 were diagnosed with thyroid cancer at other medical facilities without participating in the confirmatory examination. Regarding 3 cases that were diagnosed during a clinical follow-up, officials had no information whether they were included in the 11 previously unreported cases. 


Fukushima Thyroid Examination June 2018: 162 Surgically Confirmed as Thyroid Cancer Among 198 Cytology Suspected Cases


For more detailed information on the Fukushima Thyroid Examination itself, see the September 2017 fact sheet (long version, or e-published PDF)

Highlights: 
  • The third round: 2 cases newly diagnosed as suspicious or malignant, and 2 new  cases surgically confirmed.
  • Total number of suspected/confirmed thyroid cancer is now 198 (excluding a single case of benign tumor; 115 in the first round, 71 in the second round, and 12 in the third round).
  • Total number of surgically confirmed thyroid cancer cases has increased by 2 to 162 (101 in the first round, 52 in the second round, and 9 in the third round)
  • Hiroki Shimura replaces Akira Ohtsuru as the new Director of the Thyroid Ultrasound Examination.
  • "Age 25 Milestone Screening" results released for those born in FY1992. (Shown in the bottom part of this post.)
The latest overall results:

On June 18, 2018, the 31st Oversight Committee for Fukushima Health Management Survey (FHMS) convened in Fukushima City, Fukushima Prefecture. Among other information, the Oversight Committee released the latest results (as of March 31, 2018) of the third round of the Thyroid Ultrasound Examination (TUE). For the first round, a 3-page summary of the final results was released. For the second round, the final results were previously released at the Eighth Thyroid Examination Assessment Subcommittee held on November 30, 2017, but it hasn't been translated into English. Also, a FY2017 update to the final results of the second round was released. (Final results for the first round have been updated at the end of each fiscal year, March 31.Official English translation of the results is posted here. (As of July 20, 2018, only the third round results have been translated into English.)

Since the 29th Oversight Committee held on December 25, 2017, Fukushima Medical University (FMU) has released a 4-page summary of all 3 rounds conducted so far, "The Status of the Thyroid Ultrasound Examination." This summary has proven quite useful, listing key findings from the primary and confirmatory examinations as well as the surgical information. In particular, any update to the number of surgical cases is reflected in this summary before the information is compiled in the fiscal year update. There is no official English translation of this summary, but here's an unofficial translation. 



Key points from the Oversight Committee:
New Director of the TUE
It was a surprise not to see Akira Ohtsuru at the Oversight Committee session. Ohtsuru began to report the results of the TUE at the 19th Oversight Committee on May 18, 2015, replacing Shinichi Suzuki, a thyroid surgeon at FMU. It was explained at the time that Suzuki was to concentrate on the clinical (surgical) aspect of the TUE, but it definitely led to a loss of access to a first-hand account from the surgeon directly involved with medical care of the thyroid cancer patients. Unlike Suzuki, Ohtsuru would not slip out heavily guarded clinical information. Actually, unlike Suzuki's smooth talking, it was apparently difficult to hear Ohtsuru even in the room even though he used a microphone. Now, a baton has been passed to Hiroki Shimura, Chairman of Department of Laboratory Medicine at FMU. This time there was no problem making out what was being said.

Participation rates
The primary examination participation rates have been declining with each successive round of the TUE: 81.7% for the first round, 71.0% for the second round, and 64.3% for the third round. In particular, a participation rate for age 18 or older (age at screening) has gone from already low 25.7% in the second round to even lower 15.9% in the third round. Participation rates for the confirmatory examination have also been declining from 92.9% in the first round, 84.1% in the second round, and 58.7% in the third round which is still ongoing.

Cytology rates
There have been repeated questions regarding declining rates of cytology among participants of the confirmatory examination: 39.6% in the first round (63.9% in FY2011, 44.3% in FY2012, and 29.8% in FY2013), 14.8% in the second round (19.1% in FY2014 and 9.2% in FY2015), and 5.6% in the third round (6.2% in FY2016 and 3.8% in FY2017). Note that the confirmatory examination for FY2016 and FY2017 is still ongoing.

The decline in successive rounds (39.6% to 14.8% to 5.6%) was previously explained to reflect some participants repeating the confirmatory examination and not necessarily requiring repeat cytology. A big drop during the first round from FY2011 to FY2013 has been attributed to a more chaotic situation in the first year of the first round leading to cytology performed with abundance of caution. This time Shimura supplemented the explanation by stating that as examiners gained more experience, they were more comfortable with determining the need for cytology for each case. This statement drew multiple questions especially from members of the press regarding if the examiners were strictly adhering to the diagnostic guidelines. 

The TUE support program
fiscal report on the TUE support program sheds some light on the existence of several thyroid cancer cases not included in the official tally. (See the section below for background information.) This program offsets out-of-pocket medical expenses (30% copay) incurred due to participation in the TUE, if all 3 eligibility criteria are met: 1) participation in the TUE, 2) requiring a follow-up observation or medical treatment for conditions such as thyroid nodular lesions if they were detected during the TUE confirmatory examination, and 3) receiving or having received outpatient and/or inpatient medical care at medical facilities authorized to conduct the TUE confirmatory examination or other medical facilities referred by such authorized facilities. The TUE support program excludes those receiving full medical assistance such as those ages 18 and under living in Fukushima Prefecture or those on welfare.

The TUE support program began on July 10, 2015. Between FY2015 and FY2017, 313 payments were made to 233 individuals (ages 18-25), including 82 surgical cases (ages 18-23). Post-operative pathological diagnoses included 77 cases of thyroid cancer (76 cases of papillary thyroid cancer and 1 case of poorly differentiated thyroid cancer) and 5 cases of thyroid conditions other than cancer, such as follicular adenoma. Of 77 cases of thyroid cancer, 72 were diagnosed directly during the confirmatory examination, 3 were diagnosed during a clinical follow-up for a non-cancer thyroid condition after the confirmatory examination, and 2 were diagnosed totally outside the TUE system without participating in the confirmatory examination. 

Thyroid cancer cases diagnosed outside the framework of the TUE
It has been known that the official tally of thyroid cancer cases is far from complete partially due to a loophole in the study design that is not conducive to a compilation or release of "clinical" information once the suspicious cases move from the specially-funded TUE to regular medical care during the confirmatory examination. That is, if a suspected cancer is diagnosed directly during the confirmatory examination, it is included in the official report. However, cases might not need cytology urgently but warrant closer follow-ups such as every 6 months to 1 year rather than the next screening cycle 2 years later. Such cases are moved to a "clinical follow-up track" under the national health insurance, and FMU has been extremely reluctant to release detailed clinical information citing privacy protection. (This is explained in the Transparency and Integrity of Data section of the September 2017 fact sheet.)

In some cases, participants might voluntarily go outside the framework of TUE either from the beginning or the middle of the screening. This happens when they decide to undergo the primary and/or confirmatory examination at non-FMU medical facilities for various reasons—for instance, physical (evacuation or relocation due to schooling/jobs) and/or psychological (distrust). One such case, discussed in this post, revealed an existence of a cancer case in a 4-year-old boy (age at the accident time).

Due to repeated requests from the press as well as the committee members to gather cancer cases diagnosed outside the TUE framework, FMU has been conducting a study since late 2017, investigating how many of the surgical cases at FMU are actually from the "clinical follow-up track." No report was made on this matter at this Oversight Committee session. This "study" is being conducted by Thyroid and Endocrine Center in Fukushima Global Medical Science Center at FMU. It should be noted this study will not collect any information on surgical cases at non-FMU facilities.

As described in the section above, the TUE support program fiscal report reveals 3 thyroid cancer cases diagnosed in the clinical follow-up track as well as 2 cases diagnosed totally outside the TUE system. Because the TUE support program is only offered to those aged 18 and above, it gives no information on any clinical follow-up or non-TUE cancer cases in children younger than age 18. We know at least one such case as in the then 4-year-old mentioned earlier. 

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The first round results
From the FY 2016 supplemental report with data as of March 31, 2017. (Summary report with data as of March 31, 2018, only shows the total results, not by fiscal year cohorts. However, for the content shown below, information remained the same between 2017 and 2018.)


The second round results
No change since the last Oversight Committee meeting on March 5, 2018.


The third round results
Two new suspicious/malignant cases were diagnosed from the FY 2016 cohort: one female (age 11 in March 2011) and 1 male (age 16 in March 2011). They both reside in Naka-dori municipalities. One had an A1 assessment in the second round, and the other never participated in the second round.


Age 25 Milestone Screening results
After reaching age 20, the TUE transitions to screening every 5 years at a "milestone" of ages 25, 30, 35, 40, etc. The third round results this time included a separate report on the first group of "Age 25 Milestone Screening," 22,653 individuals born in FY 1992 (April 1, 1992 through March 31, 1993).

Table 1 shows that the participation rate of the primary examination is extremely low at 8.4%. Nearly one-third of 1,846 whose primary examination results are complete had not participated in previous TUE, shown as 577 "non-participants" in Table 3. It should be noted that nearly one-third of 80 subjects with "B" assessment requiring confirmatory testing came from these 577 subjects who never participated in the TUE.

Table 4 indicates that 41 or only half of 80 underwent required confirmatory examination. In 31 subjects with completed confirmatory examination, none underwent FNAC or reclassified as A1 or A2. This suggests that they likely have some type of thyroid conditions that are not cancerous but require clinical follow-ups. 

According to Shimura, those missing the Age 25 Milestone Screening can be screened before the Age 30 Milestone Screening.


Table 1. Screening test (primary examination) coverage as of March 31, 2018

Table 2. Number and proportion of children with nodules/cysts as of March 31, 2018

Table 3. Comparison with the prior examination, as of March 31, 2018

Note 1: Top line refers to the results of the prior examination for confirmed results of the Age 25 Milestone Screening.
Note 2: Top line refers to the breakdown of the Age 25 Milestone Screening results in a given category of the prior examination results. Bottom line shows the proportion in %.

Table 4. Confirmatory examination coverage and results as of March 31, 2018






Fukushima Thyroid Examination February 2020: 186 Surgically Confirmed as Thyroid Cancer Among 237 Cytology Suspected Cases

Highlights   The third round: 1 case newly diagnosed as suspicious or malignant, and 5 new cases surgically confirmed.  The fourth ...