Where to Find Fukushima Radiation Health Survey Information: : Fukushima Medical University's Radiation Medical Science Center Website

Where to Find Fukushima Radiation Health Survey Information: Fukushima Medical University's Radiation Medical Science Center Website 

Fukushima Medical University's Radiation Medical Science Center opened a new website on January 10, 2019. The original English website, "Office of International Cooperation," is still active, although it seems to be updated at a lot slower pace nowadays. (It took 2 months for them to post English translation of the reports from the September 2018 Oversight Committee meeting, which used to come out in 3-4 weeks.)

The top page looks like this:

When you scroll down, 4 blue rectangles appear: 

1. Radiation Medical Science Center: scrolls down the screen to show a greeting and organizational information. 
2. Fukushima Health Management Survey: shows the report of the Fukushima Health Management Survey, with the current version being the "revised version" as of December 5, 2018. (The "original" version appears to have been deleted. For record, the current version is stored here.)
3. Research/Publication: jumps to the Publications page of the Office of the International Cooperation
4. Office of International Cooperation: jumps to the original website where official English translation of selected reports presented at the Oversight Committee meetings (here) and links to past conference and workshops (here) can be accessed.

If you are interested in information available in Japanese, click "Japanese Website" in the right upper corner of the top page. There are 3 blue rectangles with Japanese/English labels. 

Radiation Medical Science Center: scrolls down to the greeting and organizational information. 
Fukushima Health Management Survey: jumps to the top page of the Japanese website for the Radiation Medical Science Center's Fukushima Health Management Survey, which functions as an information hub for the Fukushima residents and includes all the basic information about each survey.
Research/Publications: jumps to the publications page of the above Japanese website.

＊If you are specifically looking for information on the Oversight Committee for the Fukushima Health Management Survey where the results of the Thyroid Ultrasound Examination (TUE) are reported, the Fukushima Prefecture website offers an easier access here (in Japanese). 

Here's the screenshot of the partial list of the Oversight Committee meetings: 

Dates for each Oversight Committee meeting (First through thirty-third at this time) are shown, and the right column has links to the details of each meeting including links to all the handout materials as well as the meeting minutes. 

For instance, the 32nd Oversight Committee meeting details look like this:

The first section has a link to the meeting notice. The big middle section shows a list of the materials handed out at the meeting, not all of which are officially translated into English. The bottom section has a link to the meeting minutes.

Information on the Thyroid Examination Assessment Subcommittee can be similarly accessed here (in Japanese).

Shin-ichi Kurokawa Sets Straight Dishonesty and Misrepresentation in the Hayano Statement Regarding the Radiation Dose Study with Alleged Misconduct

This is an unofficial English translation of the article that originally appeared on the HARBOR BUSINESS Online (HBOL) website on February 11, 2019, posted here with permission from the HBOL. The English translation is supplemented with additional information as needed, enclosed in square brackets.

＊February 20, 2019 update: PDF link for translation of the article co-authored by Kurokawa and published in the February 2019 issue of Kagaku is inserted in appropriate places. This translation is available in Kagaku's e-publication page and citable in AMA style as: Kurokawa S, Shima A. A Glass Badge Study That Failed and Betrayed Residents —A Study with Seven Violations of Ethical Guidelines Can Be No Ground for Government Policies. Kagaku. 2019;89(2):e0017-e0024.

Urgent Report: Professor Emeritus Kurokawa sets straight dishonesty and misrepresentation in the "statement" by Ryugo Hayano, the author of the radiation dose study with alleged misconduct

Written by Shin-ichi Kurokawa

　
   On January 8, 2019, Ryugo Hayano posted "A position statement regarding the external dose study in Date City residents" (herein, "statement") at the Ministry of Education, Culture, Sports, Science and Technology press club. He also tweeted it as below.

本日1/8，文科省記者クラブに「伊達市⺠の外部被ばく線量に関する論⽂についての⾒解」を貼出いたしました．70年間の累積線量計算を1/3に評価していたという重大な誤りがあったことと，その原因，意図的ではなかったこと，今後の対応，伊達市の方々への陳謝などを記したものです→ pic.twitter.com/OuHJKXZmY2

— ryugo hayano (@hayano) January 8, 2019

(Translation of Hayano’s tweet itself: Today, on January 8, I posted a “position statement regarding the external dose study in Date City residents” at the MEXT press club. It describes: the serious error which undercalculated the 70-year cumulative doses by a factor of 3; the reason for the error; unintentionality of the error; and apology to the Date City people.)

   This "statement" describes the "facts" surrounding the allegation made to the University of Tokyo for research misconduct as well as falsification regarding two studies (herein, Hayano-Miyazaki Papers I & II) co-authored by Makoto Miyazaki (Fukushima Medical University) and Ryugo Hayano (Professor Emeritus, University of Tokyo) and published in a British journal, Journal of Radiological Protection (herein, JRP), which is a journal for the Society for Radiological Protection (SRP):“

Paper I: Individual external dose monitoring of all citizens of Date City by passive dosimeter 5 to 51 months after the Fukushima NPP accident (series): 1. Comparison of individual dose with ambient dose rate monitored by aircraft surveys  

Paper II: Individual external dose monitoring of all citizens of Date City by passive dosimeter 5 to 51 months after the Fukushima NPP accident (series): II. Prediction of lifetime additional effective dose and evaluating the effect of decontamination on individual dose 

The "statement" is also said to describe Hayano's views as the person mostly in charge of the data analysis. Incidentally, the "statement" shows an incorrect title for Paper II, but the correct title is shown above. The "statement" consists of two pages: the first page includes four items of explanation and a closing remark, and the second page is an attachment that explains the calculation error allegedly discovered by the authors (Hayano and Miyazaki).

English translation of the first page of the "statement" by Hayano from Hayano's tweet

The second page of the "statement" by Hayano from Hayano's tweet
(Numbers added in reference to Japanese translation of text shown below.)

A Figure 6 shows “measurements over a 3-month period represented by a single data in the central month.” However, in our data analysis program to calculate the cumulative dose, we failed to recognize that each period is “3-month long”. As a result, the cumulative doses were underestimated by a factor of 3.

B Figure 6, Paper II (excerpted for explanation), Distribution of individual doses by the glass badge measurement period (µSv/h)

C Figure 7, Paper II (excerpted for explanation), Cumulative doses (mSv)

D Glass badges were worn for 3 months. Figure 6 shows the 3-month average (dose rate) represented by the central month.

E In (this portion of) Figure 6, the data are shown only for the 7th and 10th months after the accident. However, the first measurements are for the 6th, 7th and 8th months, and the second ones for the 9th, 10th, and 11th months. The figure below exhibits these situations.

F Added up to calculate the cumulative doses

G Error: Data in Figure 6 were simply added.

H To be correct, the data should have been tripled as above. There is a similar error in the integrated theoretical curve, which should also have been tripled. Figure 5 also includes a similar error.

   Item 1 on the first page of the "statement" mentions "S. Kurokawa," which is me. It was my submission of a Letter to the Editor to JRP criticizing Paper II that triggered the sequence of events leading to this incident [of the allegation of research misconduct and falsification]. Not only does Hayano's explanation in the "statement" use vague and arbitrary expressions, but it also includes multiple falsehoods. I am greatly concerned that many people who read this "statement" might believe Hayano's words and gain a false notion of the circumstance. It is because of this concern that I decided to write this critique.

   

Timeline of how the Letter criticizing the Hayano-Miyazaki Paper was accepted

   A critique of a paper published in an academic journal usually takes a form of a paper called a Letter to the Editor. It is a rule in the world of science to criticize an academic paper with another academic paper, and it is also a rule to reply to the criticism with an academic paper.

　

   The status of My Letter to the Editor,

ʻComment on ʻIndividual external dose monitoring of all citizens of Date City by passive dosimeter 5 to 51 months after the Fukushima NPP accident (series): II. Prediction of lifetime additional effective dose and evaluating the effect of decontamination on individual doseʼ（shown in the arXiv site）

follows the timeline shown below:

        August 17, 2018: The Letter is received by JRP.
        September 13, 2018: First revision submitted.
        November 5, 2018: Second revision submitted.
        November 16, 2018: The Letter "is ready to accept," and it was sent to the authors.

   The expression, the Letter "Is ready to accept" means that my Letter will be accepted when the original authors write and submit their reply: Both my Letter and their reply will then be published in the same issue. The November 16, 2018 email I received from the Editorial Office informing me that the Letter "is ready to accept" explained that the process of receiving the authors' reply usually takes about a month.

   My Letter to the Editor points out about 10 simple errors or inconsistencies between the numbers and graphs. The Letter was also peer-reviewed by two referees before attaining the "is ready to accept" status.

"Deceptions" seen in the Hayano "statement"

   
    Now, I am going to examine the content of the "statement."

   First, Item 1 states, "I was contacted by JRP to 'comment on Letter by S. Kurokawa with academic inquiries regarding the contents of Paper II.'" To those who might not be familiar with rules of academic journals, the expression, "Letter with academic inquiries," might be misunderstood as if I sent a letter of inquiries to JRP. What I did was not conducting academic inquiries nor sending a letter. Rather, what I did was submitting a form of academic paper called a Letter to the Editor. When the Letter became "ready to accept" on November 16, the authors were asked by the Editorial Office to reply. In explaining such a simple fact, Hayano's uses inappropriate and vague expressions.

   Next, I am going to examine the part, "When the main author and I reviewed the data analysis program made by myself for the study, we realized for the first time that we made a serious error in miscalculating the 70-year cumulative doses, underestimating the doses by a factor of 3."

   My Letter points out that even though Figure 7 should correspond to Figure 6 in Paper II, the  actual values [cumulative doses] in Figure 7 are only half of the values expected from calculation of the values [dose rates] shown in Figure 6. It also points out that this discrepancy between Figures 6 and 7 is due to the fact that Figure 7 is shrunk by half while Figure 6 is correct. 
　The miscalculation discovered by Hayano does not explain the discrepancy raised in my Letter. Thus, the phrase, "I would like to express a deep gratitude to S. Kurokawa who gave me an opportunity to find the error," only leaves me perplexed.
　

   Next, Item 2 says, "Regarding the error, I contacted JRP on November 28, 2018 stating, 'It is necessary to comment on the Letter and make corrections in the paper due to a serious error that has been discovered.' JRP responded on December 13, 2018 and told us to 'submit a corrected version.'" This phrase has two major problems. First, the part, "It is necessary to comment on the Letter and make corrections in the paper" is a false statement.

   In mid-December 2018, I received an email from the JRP Editorial Office including the authors' response.
   The authors' response stated, "We believe it is appropriate to publish a corrigendum rather than point-by-point replies." Here "We" refers to the authors, Hayano and Miyazaki. The authors "believe it is appropriate to publish a corrigendum rather than point-by-point replies" to my Letter. In other words, the authors are essentially saying they have no intention to "comment on the Letter." It is quite obvious that the Hayano "statement" contains a falsehood. 　

   It should be noted that Corrigendum is equivalent of "seigo-hyo" (which means "erratum") in Japanese. In fact, the authors have issued the corrigendum regarding Paper I. (See Corrigendum: Individual external dose monitoring of all citizens of Date City by passive dosimeter 5–51 months after the Fukushima NPP Accident (series): I. Comparison of individual dose with ambient dose rate monitored by aircraft surveys.)

Corrigendum: Individual external dose monitoring of
all citizens of Date City by passive dosimeter 5–51 months after
the Fukushima NPP Accident (series): I. Comparison of
individual dose with ambient dose rate monitored by aircraft
surveys (2016 J. Radiat. Prot. 37 1)
(Excerpted from the IOP Science website.)

   This shows what a corrigendum looks like. In this corrigendum, the year "2011" is corrected to be "2012." The serious error of miscalculation underestimating the 70-year cumulative doses by a factor of 3 is not something that can be corrected with a corrigendum in the first place.

   Also, please pay particular attention to the fact that the "statement" uses the term "revision" rather than "erratum" or "correction" in place of corrigendum. "Correction" means fixing a sentence and can be equivalent of a corrigendum, but "revision" has a broader meaning, as in the case of "revising a plan." Hayano's use of the word "revision" could be construed as a way to manipulate people's perception with an arbitrary use of the broad meaning of the word.

　

Slickly replacing JRP's request for a corrigendum with a rewrite

   Also, as will be described later, it is clear what JRP requested from the authors is not a rewrite but a corrigendum. However, the "statement" says, "JRP responded (...) and told us to 'submit a revised version.'" This "revised version" is supposed to be a corrigendum, but Item 4 suggests otherwise.

   Item 4 states, "We believe that, in order for us to submit a revised version, it will be necessary for Date City to re-supply us with only data with appropriate consent so we can re-conduct the analysis. However, whether or when this is possible is to be discussed in the near future between Date City as the contractee and Fukushima Medical University as the contractor. When the decision is made, we will do our best to follow it."

　
   It was originally supposed to be a corrigendum, but somehow "a revised version" has morphed into re-writing the paper after the data is re-supplied by Date City. All that JRP requested is submission of a corrigendum. Replacing that request with rewriting the paper would have to be considered a fraud. 

　

   Item 4 also states, "The data used in the two papers have been deleted, in accordance with the research protocol approved by the Ethics Committee at Fukushima Medical University."

　

   Deletion (more appropriately called "destruction") of data is a violation of the Ethical Guidelines which would be considered research misconduct, as pointed out in the article that I co-authored with another person in the February issue of Kagaku [Note: English translation of an abridged version of the article will be is now available on the Kagaku website soon. PDF download link.] I will not go into the details of the article here, but "data deletion" in the "statement" refers to destruction of all the data as reported in the Status Report on the Maintenance of Materials and Data which is attached to the Research Completion Report that was submitted to Fukushima Medical University (FMU).

   The "statement" only refers to destruction of the data, but actually the research itself was completed as of October 31, 2018. There is no way to rewrite a paper when the research has already completed and all the data have been destroyed. Even if Date City were to re-supply the data to FMU, it would be considered new research and a new research proposal would have to be submitted to the Ethics Review Committee at FMU. A resulting paper would no longer be a revised version, but an entirely different paper based on new research. A scientist should never conceal such information, let alone pretend as if what was requested by JRP was a rewritten paper when it was a corrigendum that was actually requested.

  Item 3 states that the authors "discovered for the first time through a media report" that the data used included data without appropriate consent of Date City residents, but the previously mentioned article in the February issue of Kagaku clarifies that is not true. The Kagaku article also shows the authors committed six more violations of the Ethical Guidelines in addition to the data destruction. If you are interested in more details, please refer to the Kagaku article.

Hayano avoiding discussions in an academic setting

   Lastly, I would like to express my opinion regarding the part, "As described above, the serious error in the study is advancing to be addressed in discussions in an academic setting of JRP." that appears on the first page of the "statement."

   Academic discussions mean nothing other than advancing the cycle of criticisms  of papers and replies by authors. Yet Hayano is refusing to take the initial step, that is, replying in a point-by-point manner to the Letter criticizing his paper. Then, how can he say, the situation is "advancing to be addressed in discussions in an academic setting"? Regarding this, Hayano owes a clear explanation.

　

*****

Note: In the Retraction Watch article that reported that JRP issued Expressions of Concern (EOCs) to both Paper I and Paper II, a spokesperson from Institute of Physics (IOP) that publishes JRP is quoted to have said, 

"(...) due to the nature of the investigation(s) the authors would need to await the outcome prior to re-analysing the data to correct the mistake by way of a potential corrigendum."

As described in the main body of this article, a corrigendum is a simple erratum, not a rewrite of the paper. (An EOC is issued when an editorial office of a journal alerts readers regarding a potential issue in credibility of a paper.)

*****

Supplementary information regarding the reference to Paper I in the "statement":

   Item 1 in the "statement" says, "It should be noted that this error is limited to the calculation of the cumulative doses in Paper II, and no analytical error has been found in Paper I." This phrase strikes as bizarre.
   It was in Paper II that the cumulative doses were calculated, and Paper I says nothing about the cumulative doses. Of course there is no analytical error in Paper I as in Paper II. 
   Researchers submitting papers to journals do so because they believe their papers contain no errors. After a paper is published, it is not the author(s) but a community of scientists that determines whether or not the contents of the paper are correct. An Inclusion of such an uncalled-for phrase in the "statement" could be considered a message directed towards those outside the scientific community.
   Sure enough, the "statement" was read aloud during the January 25, 2019 session of the Radiation Council of the Japanese government. The secretariat of the Radiation Council went on to explain that Paper I "is not something to be completely disapproved in terms of its academic significance." For more details on this matter, please refer to the HBOL article by Junichiro Makino (available here only in Japanese).



Shin-ichi Kurokawa is Professor Emeritus at the High Energy Accelerator Research Organization. Born in 1945. Graduated with a major in physics from the University of Tokyo in 1968. Withdrew from Department of Physics, Graduate School of Science, the University of Tokyo in 1973. Doctor of Science. After joining the High Energy Physics Research Institute (currently the High Energy Accelerator Research Organization) as a research assistant, Kurokawa advanced to positions of assistant professor and professor, retiring in 2009. Awarded the Rolf Widerøe Prize by the European Physical Society in 2011 and the People's Republic of China International Science and Technology Cooperation Award in 2013. Specializes in accelerator physics.

(Translation by Yuri Hiranuma)

Citation in AMA style for the article co-authored by Kurokawa and published in the February 2019 issue of Kagaku: 

Kurokawa S, Shima A. A Glass Badge Study That Failed and Betrayed Residents —A Study with Seven Violations of Ethical Guidelines Can Be No Ground for Government Policies. Kagaku. 2019;89(2):e0017-e0024.

Fukushima Thyroid Examination December 2018: 166 Surgically Confirmed as Thyroid Cancer Among 207 Cytology Suspected Cases

*Table for the latest overall results including "unreported" cases was replaced with a corrected version showing that Age 25 Milestone Examination was conducted in FY2017, not FY2016 as stated in the original version.

♦Note: This post is likely to be updated with key points from the meeting in the near future.
♦The February 21, 2019 update begins below the embedded file, "The Status of the Thyroid Ultrasound Examination."
♦On April 9, 2019, links to the third round, fourth round, and Age 25 screening reports in Japanese were replaced with links to English versions.


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: No cytology conducted yet as of September 30, 2018.
• Age 25 Milestone Screening for those born in FY1992: 2 cases diagnosed as suspicious or malignant. No surgery yet.
• Total number of suspected/confirmed thyroid cancer is now 206 (excluding a single case of benign tumor; 115 in the first round, 71 in the second round, 18 in the third round, and 2 in Age 25 Milestone Screening).
• Total number of surgically confirmed thyroid cancer cases has increased by 2 to 166 (101 in the first round, 52 in the second round, and 13 in the third round).

The latest overall results including "unreported" cases:

(See this post for the details of the "unreported" cases.)

On December 27, 2018, the 33rd 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 September 30, 2018) of Thyroid Ultrasound Examination (TUE) including the third and fourth rounds as well as the Age 25 Milestone Screening for those born in FY1992. Official English translation will be available here in the near future. (Note on April 9, 2019: Official English translation was finally posted here on April 5, 2019.) 

A five-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. 

Status of the Thyroid Ultrasound Examination (December 27, 2018) by on Scribd

 
Updated on February 20, 2019
Other topics covered at this Oversight Committee meeting include:

1. Publication report of a paper in Scientific Reports.
2. A report from the Eleventh session of the Thyroid Examination Assessment Subcommittee held on October 29, 2018.
3. Recommendations by the IARC Expert Group on Thyroid Monitoring after Nuclear Accidents (TM-NUC). (See this post on what TM-NUC is all about.) 
4. A compilation of surgical and pathological features of 125 thyroid cancer cases.
5. A revision of the TUE support project provisions.

1. Publication report of a paper in Scientific Reports

   An FMU official reported publication of a paper, "Spatial analysis of the geographical distribution of thyroid cancer cases from the first-round thyroid ultrasound examination in Fukushima Prefecture." (link)  The paper concluded that the thyroid cancer cases detected in the first round are unlikely to be attributable to regional factors, including radiation exposure due to the Fukushima nuclear accident.

2. A report from the Eleventh session of the Thyroid Examination Assessment Subcommittee 

   The subcommittee chair, Gen Suzuki, went over the report including the materials handed out at the October 2018 subcommittee meeting as well as previous meetings. The report (only in Japanese) can be accessed here. (The list of the materials handed out at the subcommittee meeting is available here, and the detailed summary of this subcommittee meeting is included in pages 6-16 of the Japanese article e-published on the Kagaku website.)

   Analyses conducted by FMU on the second round results only include data from those who participated in both the first and the second rounds, consisting of analyses by age groups, regions, the first round results, and the length of time elapsed since the first round screening (aka screening interval). The detection rates of suspected/confirmed thyroid cancer increased with age and the length of screening interval. The screening interval was naturally the longest in the evacuation area and the shortest in Aizu, corresponding to the order of screening in the first round. When the detection rates of "B" test result and suspected/confirmed cancer in the second round were split up by the screening year of the first round (Table 4 on page ①-8 of the report), FY 2011 showed the lowest percentage of the first round "B" among the second round "B" at 19.5%. This was related to the low detection rate of "B" and "C' among the FY 2011 participants in the first round, which in turn was attributed to a unique circumstance of initial chaos and lack of examiners under which the FY 2011 was conducted. 

   Some of the subcommittee members cautioned that interpretation of apparent regional differences in cancer detection rates as dose response must take into consideration regional differences in factors such as participation rates, screening interval, circumstances and results of the first round, and FNAC rates. 

   According to FMU, these analyses were intended to offer to the Subcommittee some materials for reviewing the second round data. This appeared to be an attempt to fulfill the request from the subcommittee members to make data available in actual numbers rather than just percentages in FMU's partial analysis of some of the first and second round data (available only in Japanese here and also included in the report from the 11th subcommittee meeting) released at the 10th subcommittee meeting on July 8, 2018 (described in this post). However, this attempt was still clearly inadequate: Kota Katanoda from the National Cancer Center Japan requested more detailed distribution of tumor diameter in order to evaluate differences in detection rates by the screening year. 

   Subcommittee Chair Suzuki announced that thyroid doses by municipality and age group estimated by UNSCEAR will be used to conduct an analysis of the second round data. Katanoda warned that results from such an analysis should be interpreted with caution due to unadjustable confounders. Suzuki also revealed his intention to eventually shift from a cross-sectional ecological study currently conducted to case control studies in a cohort that has some degree of post-accidental dietary and behavior record (to be used to reconstruct individual thyroid doses).

   Regarding the TUE conducted in a school setting (herein, school screening), it was revealed to have been requested by municipalities and municipal boards of education in order to ensure equal opportunities for participation, lessen families' burden in taking children to the designated TUE facilities, and prevent absence from classes. 

   After Suzuki's reporting on the 11th subcommittee meeting, several points were raised by the oversight committee members. Shoichiro Tsugane from the National Cancer Center Japan remarked that conducting analyses by adjusting for biases and confounding factors is easier said than done. He continued to point out that detection biases were so strong that adjusting any dose response which might be shown for the biases by statistical modeling could be impossible. Noboru Takamura from Nagasaki University brought up uncertainties associated with the UNSCEAR thyroid doses.

   Toru Takano of Osaka University, who is also a subcommittee member (he is the only dual member) and a vocal opponent of the school screening, explained that, in accordance with the Declarations of Helsinki, the adverse effects of the TUE warrant that the school screening be not compulsory. When asked to describe the adverse effects of the TUE, Takano gave examples of psychological distress, commonly experienced by cancer patients, voiced by some patients that have come to see him. Kanae Narui, a clinical psychologist, responded to Takano that such distress was anticipated even before the TUE started, and it is something that can be clinically dealt with psychological care, not something that should be used as a reason to stop the TUE or the school screening. 

Table 1: Detection rates of suspected/confirmed thyroid cancer in the second round by age group

Table 3: Detection rates of suspected/confirmed thyroid cancer in the second round by region

Table 4: Detection rates of suspected/confirmed thyroid cancer in the second round by screening year for the primary examination in the first round

3. Recommendations by the IARC Expert Group on Thyroid Monitoring after Nuclear Accidents (TM-NUC)

   
   An official from Ministry of the Environment (MOE) presented a Japanese translation of the TM-NUC recommendations, which is actually a translation of an article published in the Lancet Oncology, "Long-term strategies for thyroid health monitoring after nuclear accidents: recommendations from an Expert Group convened by IARC." Translation had been commissioned to the Nuclear Safety Research Association (NSRA), along with some clerical work, by the MOE which fully financed this "project." (Read more on the "birth" of the TM-NUC project in this post.) The entire report, "Thyroid health monitoring after nuclear accidents," issued as "IARC Technical Publication 46" can be accessed from the TM-NUC website or the IARC website (or from this PDF link.) For clarification, the TM-NUC recommendations are not meant to be applied to the TUE already undergoing in Fukushima. 

   As described in this summary, the IARC Expert Group recommends against population thyroid screening, defined as actively recruiting all residents of a defined area to participate in thyroid examinations and subsequent diagnostic or follow-up tests as indicated. The Expert Group recommends a long-term thyroid monitoring program in higher-risk individuals. A thyroid monitoring program is defined as an elective activity including education to improve health literacy, registration of participants, and centralized data collection from thyroid examinations and clinical management. Higher-risk individuals are defined as individuals who received a thyroid dose of 100-500 mGy in utero, childhood, or adolescence. Note that screening is distinguished from monitoring. The recommendations do not preclude lower-risk individuals with lower doses from participating in the monitoring program after fully informed of pros and cons of thyroid examinations.

   Despite the clarification that the TM-NUC recommendations are not meant to evaluate Fukushima's TUE, Tsugane remarked that the recommendations were formed after discussions were carried out by the experts who "learned and understood all that has happened in Fukushima's TUE," and that the considerations included thyroid cancer screening in children and adolescents. The rest of his remarks about high survival rates of childhood thyroid cancer and harms of screening on asymptomatic individuals concluding with a plea to the committee members to "think hard" about the TUE on Fukushima children made it sound as if Tsugane was suggesting the TUE conform to the TM-NUC recommendations.

   However, there are major differences in thyroid cancer management between Japan and western countries that make make reliance on data from western studies tricky. For instance, hemithyroidectomy is the surgical method of choice in Japan for preservation of natural thyroid function unless total thyroidectomy is absolutely called for, and almost all cases undergo extensive lymph node dissection. Whereas in the US, total thyroidectomy and radioiodine treatment is considered the mainstream management, which might lead to high survival rates, but QOL (quality of life) might suffer from lifetime thyroid hormone supplementation as well as side effects of radiation treatment including an increased risk of secondary cancer.

   Use of survival rates as the end point (i.e., as in conventional cancer screening) has been a point of contention during both the oversight committee and the subcommittee meetings, with some members (esp. Takano and Tomotaka Sobue, both of Osaka University) calling Fukushima's thyroid cancer cases "overdiagnosis" and even recommending a switch of diagnostic modalities from ultrasound to palpation based on a high survival rate even when diagnosed after symptoms appear. 

   Other members, including a thyroid surgeon, a pediatrician and a pathologist, have cautioned against relying on survival rates and placed importance on high QOL achieved by early diagnosis and treatment. It was also explained that, given the fact that the TUE was started against the backdrop of the Fukushima nuclear accident, the TUE should not be considered as a conventional cancer screening but as a health examination to assess potential effects of radiation exposure. (Note: This was also stated by Shinichi Suzuki, a thyroid surgeon at FMU, at the 2nd subcommittee meeting in 2014. In Japanese, "cancer screening" and "health examination" are both called "ken-shin" but use different kanji characters for "ken.")

   Another issue with Tsugane's remark about how the experts "learned and understood all that has happened in Fukushima's TUE" is that the information about Fukushima's TUE included in the TM-NUC report appears to be mostly limited to the official TUE results that have been released publicly. Lack of transparency has always been an issue with the TUE data, but we now know the official data does not include any cancer cases diagnosed during clinical follow-up ("unreported cases") or undergoing surgery at non-FMU medical facilities. Thus, TM-NUC could not have "learned and understood all that has happened in Fukushima's TUE," as recognized by Tsugane. (This "recognition" by Tsugane was strange, considering Tsugane's criticism when the existence of the "unreported cases" was revealed. Tsugane stated that any paper written excluding the "unreported cases" would not be able to be accepted by journals as international or scientific paper and that it was scientifically expected for cancer screening data to include all cases diagnosed during a given period.)

   Further, review of some of the academic papers used by TM-NUC as references on the TUE also reveals their conclusions of denying radiation effects are mostly based on analyses of the first round data. This "denial" has to be considered too premature, given the second round data have yet to undergone analyses for potential dose response.

4. A compilation of surgical and pathological features of 125 thyroid cancer cases

   This handout titled "Regarding surgical cases at Fukushima Medical University hospital" is a compilation of clinical information already released and included in the following four references:

• "The features of childhood and adolescent thyroid cancer after Fukushima nuclear power plant accident" by Shinichi Suzuki in a book titled "Thyroid Cancer and Nuclear Accidents" which was a compilation of presentations at the 5th International Expert Symposium held on September 26-27, 2016 in Fukushima. (Most of the information is included in Suzuki's presentation slides accessed here and explained in the previous post.)
•  "Lessons from Fukushima: Latest findings of Thyroid Cancer After the Fukushima Nuclear PowerPlant Accident" by Yamashita et al., published in the January 2018 issue of Thyroid. (link)
•  "BRAF(V600E) mutation is highly prevalent in thyroid carcinomas in the young population in Fukushima: a different oncogenic profile from Chernobyl" by Mitsutake et al., published in the November 5, 2015 issue of Scientific Report. (link)
• An additional handout at the 32nd Oversight Committee meeting held on September 5, 2018, titled "Regarding surgically indicated cases (report of corrections)" accessed here. What was actually corrected is explained in this post under the section, "Correction of the number of surgeries conducted outside FMU."

   Basically, there is no new information in this report that hasn't been released up to now. It's that all the clinical and pathological information released so far—albeit limited—is complied in one handout with an additional information about TNM and Ex classifications and an anatomical classification of regional lymph nodes as designated in the seventh edition of the Thyroid Cancer Management Guidelines. Chairman Hoshi commented that this report was put together to address repeated requests by the committee member Fumiko Kasuga of the National Institute of Environmental Studies. Kasuga politely thanked for the report, apparently without realizing it does not contain what she has been asking for: an additional set of information such as a more detailed distribution of tumor diameters.

   More information about inconsistencies of the second and third references will be added at the end of the current post.

5. A revision of the TUE support program provisions

   As explained in the July 2018 post, the TUE support program offers reimbursement for out-of-pocket medical expenses (30% copay) incurred while undergoing follow-up observation or medical treatment for thyroid nodules diagnosed during the TUE. The revision, effective December 12, 2018, retroactively removes one of the previous eligibility criteria requiring participation in the confirmatory examination of the TUE at the FMU-authorized medical facilities. This revision, explained in this handout and read aloud by Yoichi Suzuki, chief of prefectural department of Fukushima Health Management Survey, was called for in order to expand eligibility to those receiving medical care outside FMU or FMU-authorized facilities for various reasons. As laid out on the Fukushima Prefecture website, the revised eligibility criteria are as simple as 1) participation in the TUE and 2) receiving medical care for thyroid nodular lesion(s) at medical facilities. The criterion 1) can even be waived under compelling circumstances such as evacuation. 

   The TUE support program offers financial support in exchange for some clinical information. The revision also calls for an additional collection of clinical information, such as the presence of distant metastasis, which is necessary for continuous support.

   In Fukushima Prefecture, children aged 18 or younger receive free medical care until the end of fiscal year when they turn 18. The TUE support program excludes those receiving free medical care from Fukushima Prefecture or those on welfare. There are also municipal and prefectural medical expense assistance programs with various coverage and age limits throughout Japan, so those who moved out of Fukushima Prefecture receiving such assistance will not qualify for the TUE support program, either.

  

   There were questions from the committee members regarding the actual number of thyroid cancer cases in relation to the statement made by Suzuki to the December 13, 2018 Fukushima Prefectural Assembly. Suzuki stated that all 233 receiving payments from the TUE support program had thyroid cancer, whereas it had previously been reported that 233 received payments including 82 that underwent surgery and 77 of 82 were confirmed with thyroid cancer. This discrepancy caused a confusion, leading some to criticize "underreporting." Suzuki never said his statement at the prefectural assembly was incorrect, but he did clarify that there were indeed 77 cancer cases.