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.
Survey Results Regarding Thyroid Cancer Cases Excluded From the Official Report of the Thyroid Ultrasound E... by Yuri Hiranuma on Scribd
Handout 3
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
(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.
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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.
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