Overview
On October 15, 2021, the 43rd session of the Oversight Committee for the Fukushima Health Management Survey (FHMS) convened online and in Fukushima City, releasing a new set of results (data up to June 30, 2021) from the fourth and fifth rounds of the Thyroid Ultrasound Examination (TUE). The fifth-round data reported this time includes the confirmatory examination results. In addition, a corrected version of the results was released for the Age 25 Milestone Screening originally reported in July 2021.
The 43rd session was the first session of a new two-year term (August 2021-July 2023) for 18 committee members, including 6 new members. (Regrettably, a long-time committee member Fumiko Kasuga, who steadfastly advocated for release of more clinical information as well as inclusion of feedbacks from participants and their families, is no longer included.) A roster for the Thyroid Examination Evaluation Subcommittee was also released, but there was no change. It was revealed that there was no target date for the release of an interim summary for the third round.
At this time, an official English translation is available up to the 40th session of the Oversight Committee on the website (new URL as of April 1, 2022) for the Radiation Medical Science Center of the Fukushima Health Management Survey (RMSC/FHMS). The final results of the third round, released at the 39th session in August 2020, is finally available in English on pages 2-20 of this report.
Highlights
- The fourth round: 3 new cases diagnosed as suspicious or malignant, and 2 new surgical cases.
- The fifth round: 3 new cases diagnosed as suspicious or malignant, and 1 new surgical case
- Total number of suspected/confirmed thyroid cancer has increased by 6 to 266: 116 in the first round (including a single case of benign tumor), 71 in the second round, 31 in the third round, 36 in the fourth round, 3 in the fifth round, and 9 in Age 25 Milestone Screening.
- Total number of surgically confirmed thyroid cancer cases has increased by 3 to 221 (101 in the first round, 55 in the second round, 29 in the third round, 29 in the fourth round, 1 in the fifth round, and 6 in Age 25 Milestone Screening,
The latest overall results including the "unreported" and cancer registry cases
Please refer to the post on the May 2021 report regarding the details of "unreported" cases and cancer registry data.
Official count, as reported in the summary document shown in the next section, is 266 suspected/confirmed and 221 surgically confirmed thyroid cancer cases. An addition of more recent "unreported" cases as well as "outside" cases discovered in cancer registry makes the count a little more complete with 325 cytologically suspected/confirmed and 264 surgically confirmed cancer cases. It should be noted that the actual number of cases is likely more than these as no exhaustive investigation has been and will be conducted by FMU to fully report all the cancer cases discovered outside the framework of the FHMS-TUE.
Summary on the current status of the TUE
A six-page summary of the first through fifth rounds as well as the Age 25 Milestone Screening, "The Status of the Thyroid Ultrasound Examination Results," lists key findings from the primary and confirmatory examinations as well as the surgical information.
Below is an unofficial translation of this summary which is not officially translated.
#43 Status of the Thyroid Ultrasound Examination Results (October 15, 2021) by Yuri Hiranuma on Scribd
The fourth round
For the still ongoing fourth round, originally scheduled from April 1, 2018 through March 31, 2020, only 54 participated in the primary examination between April 2, 2021 and June 30, 2021, with an unchanged participation rate of 62.3%. (Note: This is still below what the prior rounds registered (81.7% for the first round, 71.0% for the second round, and 64.7% for the third round), although it is slowly approaching the third round.)
For the still ongoing fourth round, originally scheduled from April 1, 2018 through March 31, 2020, only 54 participated in the primary examination between April 2, 2021 and June 30, 2021, with an unchanged participation rate of 62.3%. (Note: This is still below what the prior rounds registered (81.7% for the first round, 71.0% for the second round, and 64.7% for the third round), although it is slowly approaching the third round.)
Having received the "B" assessment in the primary examination, 8 newly became eligible for the confirmatory examination. With mere 7 participants newly participating, the confirmatory examination increased its participation rate 0.1% to 73.4%. Out of 5 participants newly undergoing FNAC, 3 individuals (2 males and 1 female) were diagnosed with suspected thyroid cancer. Their third-round results were 1 with A2 cyst and 2 with B. Two males were ages 8 and 14 and the female was age 9 at the time of the 2011 nuclear accident. Both males are from the FY 2018 municipalities, and the single female is from the FY 2019 municipalities. Two are from Nakadori and one is from Hamadori.
Two more cases from the FY 2019 municipalities were newly confirmed with papillary thyroid cancer after undergoing surgery.
In summary, as of June 30, 2021, the number of suspected or confirmed thyroid cancer cases for the fourth round is 36, of which 29 have been surgically confirmed as papillary thyroid cancer.
The previous results from the third round are as follows: 25 with "A" (6 with A1, 13 with A2 cysts, 5 with A2 nodules, and 1 with A2 cysts and nodules), 8 with "B," and 3 with no prior result.
The fifth round
The fifth round targets 252,842 individuals, excluding about 21,000 born in FY 1996 (April 2, 1996 to April 1, 1997) and about 20,000 born in FY 1997 (April 2, 1997 to April 1, 1998) who are earmarked for the Age 25 Milestone Examination in FY 2021-2022. (The previous post discussed how this exclusion skews age distribution graphs to the left.)
The COVID-19 restrictions have had a significant impact on the progress of the fifth round which began in April 2020: school closures initially halted the school-based screening, and a burden on medical facilities reduced participation in the confirmatory examination. [Note: The fifth round was originally earmarked for FY 2020-2021 (April 2, 2020 to March 31, 2022), but the pandemic impact has forced an extension of the screening period by one year as described in this proposal: Elementary and middle school students from FY 2020 municipalities will undergo the TUE in FY 2020-2021, while FY 2021 municipalities will be pushed to FY 2022. For high school students, the TUE will be conducted in FY 2021-2022 with the exception of those who were already examined in FY 2020.]
As of June 30, 2021, 32,404 participated in the primary examination, including 8,992 new participants, and its participation rate increased from 9.3% to 12.8%, still quite low. Participation rates by age group are 24.2% in ages 8-11, 13.1% in ages 12-17, and 5.2% in ages over 18, showing a slow but steady progress of school-bases examination. The primary examination results are available for 24,882 (76.8%), and 291 (68 more) were assessed as "B" qualifying for the confirmatory examination.
One hundred seventy-five out of 291 have participated in the confirmatory examination, and 7 underwent FNAC which diagnosed 3 females with suspected thyroid cancer. Ages and average tumor diameter weren't available for these three, due to a small number of cases. Likely for the same reason, their prior screening results were also not released. Two are from the FY 2020 municipalities and one is from the FY 2021 municipalities.
The single case from the FY 2021 municipalities has been confirmed with papillary thyroid cancer after undergoing surgery.
Age 25 Milestone Screening results corrected
No new results were released for the Age 25 Milestone Screening, but the confusion on the prior screening result of the single new case reported last time was clarified. She tested as "B" in the prior screening as reported verbally, and a corrected version of the results was released. Also, the single A2 case was confirmed to be nodule.
The results from the prior screening for 9 suspected or confirmed cases are: 1 with A2 nodule, 2 with "B," and 6 with no prior screening.
Summary of the results from the previous screening
Below is the summary of the previous screening results for the suspected/confirmed thyroid cancer cases. This information, already mentioned above except for the second round, can be difficult to locate in print. In particular, a breakdown of the "A2" assessment is only verbally reported during the Oversight Committee sessions.
Below is the summary of the previous screening results for the suspected/confirmed thyroid cancer cases. This information, already mentioned above except for the second round, can be difficult to locate in print. In particular, a breakdown of the "A2" assessment is only verbally reported during the Oversight Committee sessions.
Definition"A1": no ultrasound findings."A2": ultrasound findings of nodules ≤ 5.0 mm and/or cysts ≤ 20.0 mm."B": ultrasound findings of nodules ≥ 5.1 mm and/or cysts ≥ 20.1 mm.
Having previous assessments of "A1" or "A2 cysts" means there were no precancerous lesions during the previous screening, i.e., cancer supposedly appeared since the previous screening. (Note: FMU claims that the cancerous lesions did not newly appear but already existed yet "invisible" during the previous screening.)
- Second round (71 cases): 33 cases with A1, 32 cases with A2 (7 nodules and 25 cysts), 5 cases with B, 1 case previously unexamined
- Third round (31 cases): 7 cases with A1, 14 cases with A2 (4 nodules and 10 cysts), 7 cases with B, 3 cases previously unexamined
- Fourth round (36 cases): 6 cases with A1, 19 cases with A2 (5 nodules, 13 cysts, and 1 nodule & cyst), 8 cases with B, 3 cases previously unexamined
- Age 25 Milestone Screening (9 cases): 1 case with A2 (nodule), 2 cases with B, 6 cases previously unexamined
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