tag:blogger.com,1999:blog-92001565150485778122024-03-20T02:13:50.012-07:00Fukushima Voice version 2e@YuriHiranumahttp://www.blogger.com/profile/16819451884150838540noreply@blogger.comBlogger107125tag:blogger.com,1999:blog-9200156515048577812.post-75731720683762049672024-02-29T17:15:00.000-08:002024-02-29T17:15:20.850-08:00Fukushima Thyroid Examination February 2024: 274 Surgically Confirmed as Thyroid Cancer Among 328 Cytology Suspected Cases<p><span style="font-family: trebuchet;"><br /></span></p><p><span style="font-family: trebuchet;">Note: From this post onward, the terms "Age 25+ Survey" and "Age 30+ Survey" are to replace "Age 25 Milestone Screening" and "Age 30 Milestone Screening," in accordance with the terms used in <a href="https://fhms.jp/fhms/uploads/48_20Jul2023.pdf#page=121" target="_blank">official translation of the reports</a>. </span></p><p><b style="font-family: trebuchet; font-size: xx-large;">Overview</b></p><p><span style="font-family: trebuchet;"><span><span><span style="font-size: medium;"> On February 2, 2024, <a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-40.html" target="_blank">t</a></span><span style="font-size: medium;"><a href="https://www.pref.fukushima.lg.jp/sec/21045b/kenkocyosa-kentoiinkai-50.html" target="_blank">he 50th session of the Oversight Committee</a> for the <a href="https://fhms.jp/en/fhms/" target="_blank">Fukushima Health Management Survey</a> (FHMS) convened online and in Fukushima City</span></span></span><span style="font-size: medium;">, releasing a new set of results (data up to September 30, 2023) from the</span><span style="font-size: medium;"><span> </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/611547.pdf" target="_blank">fifth</a><span> and <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/611548.pdf" target="_blank">sixth</a> rounds as well as the <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/611551.pdf" target="_blank">Age 25+</a> and <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/611552.pdf" target="_blank">Age 30+</a> Surveys</span></span><span style="font-size: medium;"> </span><span style="font-size: medium;"><span>of </span><span>the <a href="https://fhms.jp/en/fhms/thyroid/" target="_blank">Thyroid Ultrasound Examination</a> (TUE). </span><span> It amounts to a 3-month worth of data since the previous session held on November 24, 2023 (English translation <a href="https://fhms.jp/fhms/uploads/49_24Nov2023.pdf" target="_blank">here</a>) for the fifth and sixth rounds, and a 6-month worth of data since the July 20, 2023 session (English translation <a href="https://fhms.jp/fhms/uploads/48_20Jul2023.pdf#page=121" target="_blank">here</a>) for the biannually reported Age 25+ and Age 30+ Surveys. </span></span></span></p><p><span style="font-family: trebuchet; font-size: medium;"> Official translations of the reports from the Oversight Committee are available on the Materials and Minutes of Prefectural Oversight Committee Meetings page (<a href="https://fhms.jp/en/fhms/outline/materials/" target="_blank">link</a>) on the <a href="https://fhms.jp/en/" target="_blank">website</a> of </span><span style="font-family: Times; font-size: medium;"><span style="font-family: trebuchet;">Radiation Medical Science Center of the Fukushima Health Management Survey (RMSC/FHMS). After markedly delayed publishing of English translations in the last few years, it has finally caught up: As of today official English translations are available up to the <a href="https://fhms.jp/fhms/uploads/49_24Nov2023.pdf" target="_blank">49th session</a>.</span><span style="font-family: trebuchet;"> </span><span style="font-family: trebuchet;"><span>This website also shows an </span><a href="https://fhms.jp/en/fhms/outline/" target="_blank">overview of the FHMS</a><span> and </span><a href="https://fhms.jp/en/fhms/thyroid/" target="_blank">the TUE itself</a>, which might be informative to those unfamiliar with them<span>.</span></span></span></p><div class="separator" style="clear: both; text-align: center;"><br /></div><div style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 12px auto 6px;"><div><span style="font-weight: 700;"><span><span style="font-family: trebuchet; font-size: x-large;">Highlights</span></span></span></div><b><ul><span style="font-family: trebuchet; font-size: medium;"><li><b>The fifth round: 4 new cases diagnosed as suspicious or malignant, and 7 new surgical case.</b></li><li><b>The sixth round: no confirmatory examination results available.</b></li><span style="font-family: trebuchet; font-size: medium;"><li><b>Age 25+ Survey: 1 new case diagnosed as suspicious or malignant and 3 new surgical cases.</b></li><span style="font-family: trebuchet; font-size: medium;"><li><b>Age 30+ Survey: 2 new cases diagnosed as suspicious or malignant and 2 new surgical cases.</b></li></span></span><li><b>Total number of suspicious or malignant cases has increased by 7 to</b> <span style="color: red;">328</span><b>: </b><b>116 in the first round (in<b>cluding a single case of benign tumor</b>), 71 in the second round, 31 in the third round, 39 in the fourth round, 43 in the fifth round, and 23 in the Age 25+ Survey and 5 in the Age 30+ Survey.</b></li><li><b>Total number of surgically confirmed thyroid cancer cases has increased by 12 to <span style="color: red;">274</span><span style="color: red;"> </span>(101 in the first round, 56 in the second round, 29 in the third round, 34 in the fourth round, 34 in the fifth round, 17 in the <b>Age 25+ Survey</b> and 3 in the Age 30+ Survey.</b></li></span></ul></b><div><span><b><span style="font-family: trebuchet; font-size: x-large;"><br /></span></b></span></div><div><span><b><span style="font-family: trebuchet; font-size: x-large;">The latest overall results including the "unreported" and cancer registry cases</span></b></span></div><div><span><span style="font-family: trebuchet;"><span><span style="font-size: medium;"> </span></span></span></span></div><div><span><span style="font-family: trebuchet;"><span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYCqs6gOLLV2-RGtVhRe0MpW09XTALXvjsBujYL4LKX335AV5hTg147aq2BKJwn0VmUom9eNOX818LyOt0N6v9Pm5LnYBJPVv4eq_n2UfWPJi7jFeFjJYlnTrL1FI44GEyYp8Hksj6hAXQdIL3iSRqZ9IWai0CIKvLrQgUIh28ME2g0JVjEjKGFayuyQcu/s762/%2350%20%20Latest%20results%20screenshot.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="659" data-original-width="762" height="554" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYCqs6gOLLV2-RGtVhRe0MpW09XTALXvjsBujYL4LKX335AV5hTg147aq2BKJwn0VmUom9eNOX818LyOt0N6v9Pm5LnYBJPVv4eq_n2UfWPJi7jFeFjJYlnTrL1FI44GEyYp8Hksj6hAXQdIL3iSRqZ9IWai0CIKvLrQgUIh28ME2g0JVjEjKGFayuyQcu/w640-h554/%2350%20%20Latest%20results%20screenshot.png" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div></span></span></span></div><div><span><span style="font-family: trebuchet;"><span><span style="font-size: medium;"> Please refer to </span></span></span></span><span style="font-size: medium;"><span style="font-family: trebuchet;"><span>the </span><a href="https://fukushimavoice-eng2.blogspot.com/2021/06/fukushima-thyroid-examination-may-2021.html" target="_blank">the post on May 2021 report</a> regarding the details of "unreported" cases and cancer registry data. </span><span style="font-family: trebuchet;">(<a href="https://fukushimavoice-eng2.blogspot.com/2018/07/results-of-survey-on-fukushima-thyroid.html" target="_blank">A July 2018 post</a> describes the origin of the first 11"unreported" cases, and their histological diagnoses were obtained from <a href="https://www.jstage.jst.go.jp/article/fms/65/3/65_2019-26/_html/-char/ja" target="_blank">this paper</a>.)</span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> The o</span>fficial count, as reported above and also in the summary document shown in the next section, is <b>328</b> suspicious or malignant cases and <b>274</b> surgically confirmed thyroid cancer cases. With an addition of the most recent numbers for both "unreported" cases (see <a href="https://fukushimavoice-eng2.blogspot.com/2021/06/fukushima-thyroid-examination-may-2021.html" target="_blank">this post</a>) and "outside" cases discovered in the cancer registry (<a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/524933.pdf" target="_blank">updated</a> at the <a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-b19.html" target="_blank">19th session</a> of the <a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-b.html" target="_blank">TUE Subcommittee</a>), the count increases to <b>406</b> cytologically suspicious or malignant and <b>336 surgically confirmed </b>cancer cases. </span></div><div><span style="font-family: trebuchet; font-size: medium;"> It should be noted that the actual number of cases is likely more due to lack of any past, present or future exhaustive investigation by Fukushima Medical University (FMU), which is necessary to gather <i>all</i> the cancer cases discovered outside the framework of the FHMS-TUE.</span></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 12px auto 6px;"><div><span style="font-family: trebuchet; font-size: x-large;"><b>Summary on the current status of the TUE</b></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> A nine</span>-page <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/611565.pdf" target="_blank">summary</a> of the first through sixth rounds as well as the Age 25+ and Age 30+ Surveys, "The Status of the Thyroid Ultrasound Examination Results," lists key findings from the primary and confirmatory examinations as well as the surgical information. </span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><span> </span>Below is an unofficial translation of this summary which is <i>not</i> officially translated.</span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><p style="-x-system-font: none; display: block; font-family: Helvetica, Arial, sans-serif; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 12px auto 6px;"><a href="https://www.scribd.com/document/709597336/50-Status-of-the-Thyroid-Ultrasound-Examination-Results#from_embed" style="text-decoration: underline;" title="View #50 Status of the Thyroid Ultrasound Examination Results on Scribd">#50 Status of the Thyroid Ultrasound Examination Results (February 2, 2024)</a> by <a href="https://www.scribd.com/user/233065310/Yuri-Hiranuma#from_embed" style="text-decoration: underline;" title="View Yuri Hiranuma's profile on Scribd">Yuri Hiranuma</a></p>
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<br /></span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"> Below is a brief descriptive summary of <i>each</i> round, regardless of the update status, provided for easy reference.</span></span></div><div></div><div><br /></div><div><span><span style="font-family: trebuchet; font-size: large;"><u><b>The first round</b></u></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"> There is no change in data with 116 suspicious or malignant cases (39 males and 77 females), of which 102 underwent surgery which confirmed 1 case with benign nodule and 101 thyroid cancer cases (100 papillary thyroid cancer and 1 poorly-differentiated cancer). </span></div><div><span style="font-family: trebuchet; font-size: medium;"> The last update as of FY 2015 was reported at the 23rd session in June 2016 (<a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/461399.pdf" target="_blank">Japanese</a>, <a href="https://fhms.jp/fhms/uploads/23_6Jun2016.pdf#page=32" target="_blank">English</a>).</span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div><div><span><span style="font-family: trebuchet; font-size: large;"><b><u>The second round</u></b></span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"> There is no change in the number of suspicious or malignant cases at 71 (32 males and 39 females). Surgically confirmed cases remain at 56 (55 papillary thyroid cancer and 1 "other" thyroid cancer) . </span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"> The most recent FY2020 update of the second round data was previously reported at the 42nd session (<a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529202.pdf" target="_blank">Japanese</a>, <a href="https://fhms.jp/fhms/uploads/42_26Jul2021.pdf" target="_blank">English</a>), with the <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529192.pdf" target="_blank">brief update</a> released at the last session showing the latest surgical data.</span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><b><u>The third round</u></b></span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"> </span><span style="font-size: medium;"><span>There is no change in data with 31 suspicious or malignant cases (13 males and 18 males), of which 29 were surgically confirmed as papillary thyroid cancer. The final report from the 39th session in August 2020</span><span><span> (</span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/401325.pdf" target="_blank"><span>Japanese</span></a><span>, </span></span><a href="https://fhms.jp/fhms/uploads/39_31Aug2020.pdf#page=2" target="_blank">English</a><span>) </span><span>was updated as of FY2020 and reported at the 42nd session in July 2021</span><span> (</span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/461565.pdf" target="_blank">Japanese</a><span>, </span><a href="https://fhms.jp/fhms/uploads/42_26Jul2021.pdf#page=4" target="_blank">English</a><span>).</span></span></span></div><div><span style="font-family: trebuchet;"> </span></div></div></div><div><div><span style="font-family: trebuchet;"><span face=""><u><span style="font-size: large;"><b>The fourth round</b></span></u></span><br /><span face=""><span style="font-size: medium;"><span> There is no change in data with </span></span></span></span><span style="font-family: trebuchet;"><span face=""><span style="font-size: medium;">39</span></span></span><span style="font-family: trebuchet; font-size: medium;"><span style="font-family: trebuchet;"> suspicious or malignant cases (17 males and 22 females)</span></span><span style="font-family: trebuchet; font-size: medium;">, of which 34 have been surgically confirmed as papillary thyroid cancer. </span><span style="font-size: medium;"><span style="font-family: trebuchet;">The </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/561337.pdf" style="font-family: trebuchet;" target="_blank">final report</a><span style="font-family: trebuchet;"> was presented to the </span><a href="https://www.pref.fukushima.lg.jp/sec/21045b/kenkocyosa-kentoiinkai-b20.html" style="font-family: trebuchet;" target="_blank">20th TUE Subcommittee session</a><span style="font-family: trebuchet;"> on March 20, 2023 but not independently to the Oversight Committee. Since the meeting materials from the TUE Subcommittee are not officially translated, the final report will also not be translated. However, it is identical to the version presented to the 46th session in December 2022 whose translation can be found <a href="https://fhms.jp/fhms/uploads/46_2Dec2022.pdf" target="_blank">here</a>.</span></span></div><div><span style="font-family: trebuchet;"><br /></span></div><div><span style="font-family: trebuchet;"><u><span><b><span style="font-size: large;">The fifth round</span><span style="font-size: medium;"> (updated this time)</span></b></span></u></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> </span>The <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/611547.pdf" target="_blank">fifth round</a> targets 252,938 individuals who were born in FY 1998-2011. Originally earmarked for FY 2020-21 (April 2, 2020 to March 31, 2022), its implementation was extended by 1 year due to the COVID-19 pandemic. With only a very small increase of new participants in the primary examination and no new participants eligible for the confirmatory examination, the fifth round finally appears to be near completion although it might be a while before the final version of the results is released. (For reference, the final results of the fourth round weren't released until 3 years past its scheduled completion date of March 2020.) </span></span><span style="font-family: trebuchet; font-size: large;"> </span></div><div><span style="font-family: trebuchet;"><span><span style="font-size: medium;"><br /></span></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"> </span><span style="font-family: trebuchet; font-size: medium;">As of September 30, 2023, the total number of participants in the primary examination was </span><span style="font-family: trebuchet; font-size: medium;">113,941 with an addition of 4</span><span style="font-family: trebuchet; font-size: medium;"> new participants (3 residing outside Fukushima). There are no changes in its participation rates either overall or by age group: 45.0% overall, </span><span style="font-family: trebuchet; font-size: medium;">74.0% in ages 8-11, 57.8% in ages 12-17, and 11.2% in ages over 18. The primary examination results increased by 9 to 113,941 with the completion rate of 100%, and there was no new "B" assessment, and the number of individuals qualifying for the confirmatory examination remains at</span><span style="font-family: trebuchet; font-size: medium;"> 1,346</span><span style="font-family: trebuchet; font-size: medium;">. </span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> The number of new participants in</span> the confirmatory examination was 75, and 7 underwent FNAC with 4 being newly diagnosed with suspicion of thyroid cancer. This included 1 male (ages-at-exposure of 1 year) and 3 females (ages-at-exposure of 3, 4, and 7 years). One female was from the FY 2020 municipalities and the rest from the FY2021 municipalities. Their previous results included 1 with A1 and 3 with A2 cyst. </span></div><div><span style="font-family: trebuchet; font-size: medium;"> </span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> </span>There were 7 new surgical cases with 4 from the FY2020 and 3 from the FY2021 municipalities. All 7 cases were confirmed as papillary thyroid cancer.</span></div><div><span style="font-family: trebuchet;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span style="font-family: trebuchet; font-size: medium;"><span> </span>In summary, a</span><span style="font-size: medium;"><span style="font-family: trebuchet;">s of September 30, 2023, t</span><span style="font-family: trebuchet;">he number of suspicious or malignant cases f</span></span><span style="font-family: trebuchet; font-size: medium;">or the fifth round is 43, of which 34 have been surgically confirmed as papillary thyroid cancer. </span></span><span style="font-size: medium;"><span style="font-family: trebuchet;">The</span><span style="font-family: trebuchet;"> previous results from the fourth round are as follows: 31 with "A" (10 with A1, 20 with A2 cysts, 1 with A2 nodules/cysts), 6 with "B," and 6 with no prior result. </span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> The regional distribution of 43 suspicious or malignant cases showed that 2 each of 4 new cases were from Naka-dori and Hama-dori. Overall, 6 were from the evacuation zone, 26 from Naka-dori, 8 from Hama-dori, and 3 from Aizu, and the proportions against the primary examination participants were 0.04%, 0.04%, 0.04%, and 0.02% respectively.</span></span></div><div><br /></div><div><span style="font-family: trebuchet; font-size: medium;"> The fifth round now has more suspicious or confirmed cases than the fourth round (43 vs. 39), and the FMU officials explained that this was due to a natural shift of the target population into ages at which thyroid cancer frequency begins to increase. Also there are now more females diagnosed with suspicion of thyroid cancer, and thyroid cancer incidence is usually higher in females. Aside from any consideration for possible radiation effects, natural sex- and age-related changes in incidence make a clear understanding of the situation more complicated, which is further complicated by any more "unreported" cases which have not come to the surface.</span></div><div><span style="font-family: trebuchet;"><br /></span></div></div><div><div><div><span style="font-family: trebuchet;"><span face=""><span><u><b><span style="font-size: large;">The Sixth Round</span></b></u></span></span></span></div><div><br /></div><div><span style="font-family: trebuchet;"><span face=""><span style="font-size: medium;"> The <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/611548.pdf" target="_blank">sixth round</a> began in April 2023 with a target population of 211,875 which is 41,063 fewer than the fifth round, reflecting an additional exclusion of those born in FY 1998-1999 who will transition to the Age 25+ Survey. </span></span></span></div><div><span style="font-family: trebuchet;"><span face=""><span style="font-size: medium;"><br /></span></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"> As of September 30, 2023, the number of primary examination participants increased by 13,348 to a total of 18,304, which increased the initial participation rate of 2.3% to 8.6%. Of 9,978 whose results are available, 118 received the B assessment. There has been very little progress of the confirmatory examination, and its results were not reported.</span></div></div><span style="font-family: trebuchet;"><div style="font-family: Times;"><span style="font-family: trebuchet;"><div style="text-align: left;"><span style="font-size: medium;"><br /></span></div><div style="text-align: left;"><span style="font-size: medium;">[Important note: </span><span style="font-size: medium;">Transition of each FY birth cohort to the Milestone Screening (Age 25+ Survey and so on) reduces a target population for the main TUE. This reduction began in the third round conducted during FY 2016-2017, which excluded the FY 1992-1993 cohorts in anticipation of the upcoming the Age 25+ Survey. With each FY birth cohort including about 22,000 individuals, this is a sizable reduction which continues as the TUE target population ages. (An exception is an increase from 367,637 for the first round to 381,237 for the second round which is due to an inclusion of those who were in utero at the time of the accident.) From then on, it has decreased to 336,667 for the third round, 294,228 for the fourth round, 252,938 for the fifth round, and now 211,865 for the sixth round. </span><span style="font-family: Times; font-size: medium;"><span style="font-family: trebuchet;"><a href="https://fukushimavoice-eng2.blogspot.com/2021/01/fukushima-thyroid-examination-january.html" target="_blank">The January 2021 post</a> explains </span><span style="font-family: trebuchet;">how this ongoing transition skews age distribution graphs to the left.]</span></span></div><div style="text-align: left;"><span style="font-family: Times; font-size: medium;"><span style="font-family: trebuchet;"><br /></span></span></div><div style="text-align: left;"><span style="font-family: Times; font-size: medium;"><span style="font-family: trebuchet;"><div style="font-family: Times; font-size: medium;"><div><span style="font-family: trebuchet;"><span face=""><span style="font-size: large;"><u><b>The Age 25+ Survey</b></u></span></span><br /></span><span style="font-family: trebuchet; font-size: medium;"> </span><span style="font-family: trebuchet; font-size: medium;">In the Age 25+ Survey, each screening year targets a cohort turning 25 during that fiscal year, and t<span><span face="">he results are reported every 6 months. </span></span><span><span><span face="">The most recent implementation schedule available in English is from</span></span><span> March 2023, which was reported to the 48th session of the Oversight Committee and can be found <a href="https://fhms.jp/fhms/uploads/48_20Jul2023.pdf#page=121" target="_blank">here</a>. </span>(</span></span><span style="font-family: trebuchet; font-size: medium;">No one is supposed to undergo a regular TUE within 2 years of becoming eligible for the Age 25+ Survey.) </span><span style="font-size: medium;"><span style="font-family: trebuchet;">Although each fiscal-year screening is earmarked for those turning 25 during that fiscal year, participants can take part in the screening anytime up to the year before they become eligible for the Age 30+ Survey.</span><span style="font-family: trebuchet;"> </span></span></div><div><span style="font-family: trebuchet;"><div style="font-family: Times;"><br /></div></span></div></div><div style="font-family: Times; font-size: medium;"><div><span style="font-family: trebuchet;"><div style="font-family: Times;"><span style="font-family: trebuchet;"><span><div style="font-family: Times;"><span style="font-family: trebuchet;"><span><span style="font-size: large;"> </span><span style="font-size: medium;">The </span></span><span style="font-size: medium;"><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/611551.pdf" target="_blank">results reported this time</a><span> are from the data up to September 30, 2023, including the results for the newly eligible FY1997 cohort. Although the FY1992 cohort is still included in the results, there is no change in data since this cohort has transitioned to the Age 30+ Survey .</span></span></span></div><div style="font-family: Times;"><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> An addition of the FY1997 cohort increased the target population from 108,711 to 129,006. </span></span></span><span style="font-size: medium;">The primary examination participation increased only by 86 to total participants of 11,867, and the participation rate slightly increased from 9.1% to 9.2%</span><span style="font-size: medium;">.</span></div><div style="font-family: Times;"><span style="font-family: trebuchet; font-size: medium;"><span style="font-size: medium;"> An additional 12 participants received</span> "B" assessment in the primary examination this time, making the total eligible for the confirmatory examination to be 647. </span><span style="font-size: medium;">With 22 newly participating in the confirmatory examination, a total of 545 participated and the results have been finalized for 535 (35 more than last time). After the FNAC was conducted in 6 individuals (with total FNAC cases of 49), 1 female (age-at-exposure of 14 years) was diagnosed with suspicion of thyroid cancer. She did not participate in the prior screening. There is no residence location information available for the case because the regional data is only reported for the primary examination.</span></div><div style="font-family: Times;"><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div style="font-family: Times;"><span style="font-family: trebuchet;"><span style="font-size: large;"> </span><span style="font-size: medium;">In summary, the number of suspicious or malignant cases from the Age 25+ Survey increased by 1 to 23. The results from the prior screening are: 5 with "A" (1 with A1, </span></span><span style="font-family: trebuchet; font-size: medium;">1 with A2 nodules, 3 with A2 cysts), 4 with "B" and 14 with no prior screening.</span></div><div style="font-family: Times;"><span style="font-family: trebuchet; font-size: medium;"><br /></span></div></span></span></div></span></div><div><span style="font-family: trebuchet;"><span style="font-family: trebuchet;"><span><div style="font-family: Times;"><span style="font-family: trebuchet; font-size: medium;"> Three new surgical cases were added and confirmed as papillary thyroid cancer, and the number of surgically confirmed thyroid cancer increased to 17, including 16 papillary thyroid cancers and 1 follicular thyroid cancer.</span></div><div style="font-family: Times;"><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div style="font-family: Times;"><span style="font-family: trebuchet; font-size: large;"><u><b>Age 30+ Survey</b></u></span></div><div><span style="font-family: Times;"> T</span><span style="font-size: medium;">he Age 30+ Survey, began in April 2022, targeting 22,625 born in FY1992. The <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/611552.pdf" target="_blank">second set of results</a> as of September 30, 2023 were reported this time and included the average age and tumor diameter for the suspected/confirmed thyroid cancer cases.<br /></span></div><div><br /></div><div><span style="font-size: medium;"> The primary examination participants increased by 47 to 1,571, slightly increasing the participation rate from 6.7% to 6.9%. The results are confirmed in 1,562, and 8 more received the B assessment increasing the number of participants eligible for the confirmatory examination to 134. With 32 newly undergoing the </span><span style="font-size: medium;">confirmatory examination, its participants increased to 107, of which 96 had the results finalized with a new addition of 38. Eight underwent the FNAC, and 2 females were diagnosed with suspicion of thyroid cancer. The average age information newly released this time (average age-at-exposure of 18 with a range of 18 to 18) shows that they were both 18 at exposure.</span></div><div><span style="font-size: medium;"><br /></span></div><div><span style="font-size: medium;"> </span><span style="font-family: trebuchet;"><span style="font-size: medium;">In summary, the number of suspicious or malignant cases from the Age 30+ Survey increased by 2 to 5. Although age distribution graph has not been released due to a small number of cases, the average age information reveals that all 5 were 18 at the time of the accident. The average tumor diameter was also newly reported to be 12.6 mm (range: 9.9 mm to 18.6 mm). This is smaller than 14.2 mm (range: 5.3 mm to 49.9 mm) in the Age 25+ cases, but this is likely accounted for by the presence of a follicular cancer case in the Age 25+ data which contributed to a large maximum diameter of 49.9 mm. In fact, the minimum diameter in the Age 30+ cases is almost twice as large as the Age 25+. </span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"> </span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"> Also newly reported this time are the results from the prior screening: 1 with "A" (1 with </span></span><span style="font-family: trebuchet; font-size: medium;">A2 cysts), 1 with "B" and 3 with no prior screening.</span></div><div><br /></div></span></span></span></div></div></span></span></div></span></div></span></div><div><div><div><span style="font-family: trebuchet; font-size: large;"><u><b>Expected changes in the dataset</b></u></span><span style="font-family: trebuchet;"> </span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"> There are two factors inherent to the implementation structure of the TUE, leading to a smaller dataset with each screening cycle. One is a reduced size of target population (see above) and the other is a decline in participation rates, both of which are already being observed and expected to progress.</span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"> As described above, a shift of a cohort to the Age 25+ and Age 30+ (and so on) Surveys with time reduces the target population in each successive screening cycle. Furthermore, school-based screening conducted through high school dwindles with each cohort graduating from high school. It will eventually come to a natural halt when the youngest cohort born in FY2011 (between April 2, 2011 and April 1, 2012) finishes high school in 2029. It should be noted that the school-based screening is completely voluntary, no less the TUE itself.</span></span></div><div><span style="font-size: medium;"><span style="font-family: trebuchet;"> Convenience of the school-based screening contributes to higher participation rates for ages up to 18 than past age 18. This is clearly shown in the most recent participation rates by age reported in this post: 74.0</span><span style="font-family: trebuchet;">% in ages 8-11, 57.8% in ages 12-17, and 11.2% in ages over 18 in the fifth round, 9.2% for the Age 25+ Survey, and 6.9% for the Age 30+ Survey. </span></span></div><div><span style="font-size: medium;"><span style="font-family: trebuchet;"> It is critical to recognize these expected changes for future datasets when reviewing the TUE data because they cast doubt on reliability and/or integrity of the TUE data itself and any analysis conducted using such data. Retrieval of "missing data" due to "unreported cases" at any age is being attempted by matching the TUE data with regional (up to 2015) and national (from 2016 on) cancer registry data. For instance, reconciliation with the most recently available national cancer registry data up to 2018 (</span><span style="font-family: trebuchet;"><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/524933.pdf" target="_blank">document</a> from the 19th Subcommittee session<span>)</span><span> revealed 43 cases from the cancer registry, </span></span></span><span style="font-family: trebuchet; font-size: medium;">which are not included in the official TUE count. This is an increase from 27 cases up to 2017 (<a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/488957.pdf" target="_blank">reported</a> to the 18th Subcommittee session). Nonetheless the cancer registry is far from fool-proof because patients who move their official residence registry outside Fukushima are <i>not</i> reported as Fukushima cases.</span></div><div><span style="font-family: trebuchet;"><br /></span></div><div><span style="font-family: trebuchet;"><span face=""><b><span style="font-size: large;"><u>Summary of the results from the previous screen</u></span><span style="font-size: large;"><u>ing</u></span> </b></span><br /><span face=""><span><span style="font-size: large;"> </span><span style="font-size: medium;">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. </span></span></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div><span style="font-family: trebuchet; font-size: medium;"><u>Definition</u></span></div><div><span style="font-family: trebuchet; font-size: medium;">"A1": no ultrasound findings. </span></div><div><div><span style="font-family: trebuchet; font-size: medium;"><span>"A2": ultrasound findings of nodules </span><span>≤ 5.0 mm and/or cysts </span><span>≤ 20.0 mm. </span></span></div></div><div><div><span style="font-family: trebuchet; font-size: medium;"><span>"B": ultrasound findings of nodules </span><span>≥</span><span> 5.1 mm and/or cysts </span><span>≥</span><span> 20.1 mm.</span></span></div></div></blockquote><div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> </span>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.)</span></div><div><ul><li><span style="font-family: trebuchet; font-size: medium;">Second round (71 cases): 33 cases with A1, 32 cases with A2 (7 nodules and 25 cysts), 5 cases with B, and 1 case previously unexamined</span></li><li><span style="font-family: trebuchet; font-size: medium;">Third round (31 cases): 7 cases with A1, 14 cases with A2 (4 nodules and 10 cysts), 7 cases with B, and 3 cases previously unexamined</span></li><li><span style="font-family: trebuchet; font-size: medium;">Fourth round (39 cases): 6 cases with A1, 20 cases with A2 (6 nodules, 13 cysts, and 1 nodule & cyst), 9 cases with B, and 4 cases previously unexamined</span></li><li><span style="font-family: trebuchet;"><span style="font-size: medium;">Fifth round (43 cases): 10</span><span style="font-size: medium;"> cases with A1, 21 cases with A2 (20 cysts and 1 nodule & cyst), 6 cases with B, and 6 cases previously unexamined</span></span></li><li><span style="font-family: trebuchet; font-size: medium;"><span>Age 25+ Survey (23 cases): 1 case with A1, 4</span> cases with A2 (1 nodule and 3 cyst), 4 cases with B, and 14 cases previously unexamined</span></li><li><span style="font-family: trebuchet; font-size: medium;"><span>Age 30+ Survey (5 cases): 1 case with A2 (1 cyst), 1 case with B, and 3 cases previously unexamined</span></span></li></ul></div></div></div><p><span style="font-family: trebuchet;"><span style="font-size: medium;"> </span></span></p><div><span style="font-family: trebuchet; font-size: medium;"> </span></div>@YuriHiranumahttp://www.blogger.com/profile/16819451884150838540noreply@blogger.com0tag:blogger.com,1999:blog-9200156515048577812.post-26504576373859332572023-12-08T17:21:00.000-08:002024-02-29T12:39:59.197-08:00Fukushima Thyroid Examination December 2023: 262 Surgically Confirmed as Thyroid Cancer Among 321 Cytology Suspected Cases<p> </p>
<p><b style="font-family: trebuchet; font-size: xx-large;">Overview</b></p><p><span style="font-family: trebuchet;"><span><span><span style="font-size: medium;"> On November 24, 2023, <a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-40.html" target="_blank">t</a></span><span style="font-size: medium;"><a href="https://www.pref.fukushima.lg.jp/sec/21045b/kenkocyosa-kentoiinkai-49.html" target="_blank">he 49th session of the Oversight Committee</a> for the <a href="https://fhms.jp/en/fhms/" target="_blank">Fukushima Health Management Survey</a> (FHMS) convened online and in Fukushima City</span></span></span><span style="font-size: medium;">, releasing a new set of results (data up to June 30, 2023) from the</span><span style="font-size: medium;"><span> </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/603844.pdf" target="_blank">fifth round</a><span> and the newly started <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/603845.pdf" target="_blank">sixth </a></span></span><span style="font-size: medium;"><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/603845.pdf" target="_blank">round</a> </span><span style="font-size: medium;"><span>of </span><span>the <a href="https://fhms.jp/en/fhms/thyroid/" target="_blank">Thyroid Ultrasound Examination</a> (TUE). </span><span> It amounts to 3-month worth of data since the previous session held on July 20, 2023 for the fifth round, and first-time reporting of the sixth round which commenced in April 2023. </span></span></span></p><p><span style="font-family: trebuchet; font-size: medium;"> Official translations of the reports from the Oversight Committee will eventually appear on the Materials and Minutes of Prefectural Oversight Committee Meetings page (<a href="https://fhms.jp/en/fhms/outline/materials/" target="_blank">link</a>) on the <a href="https://fhms.jp/en/" target="_blank">website</a> of </span><span style="font-family: Times; font-size: medium;"><span style="font-family: trebuchet;">Radiation Medical Science Center of the Fukushima Health Management Survey (RMSC/FHMS). As of today, official English translations are available up to the 47th session</span><span style="font-family: trebuchet;">. </span><span style="font-family: trebuchet;"><span>This website also shows an </span><a href="https://fhms.jp/en/fhms/outline/" target="_blank">overview of the FHMS</a><span> and </span><a href="https://fhms.jp/en/fhms/thyroid/" target="_blank">the TUE itself</a>, which might be informative to those unfamiliar with them<span>.</span></span></span></p><p><span style="font-family: Times;"><span style="font-family: trebuchet;"><span style="font-size: large;"><b>New Member Rosters and the Subcommittee Summary</b></span></span></span></p><p><span style="font-family: trebuchet; font-size: medium;"> This was the first session for a new two-year term beginning on August 1, 2023, which makes this the seventh term of the Oversight Committee which was started in 2011, and the <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/603854.pdf" target="_blank">new member roster</a> showed 5 new members. Also released was a <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/603848.pdf#page=3" target="_blank">new roster</a> for the fifth term of the Thyroid Examination Evaluation Subcommittee (herein the TUE Subcommittee) with 3 new members. Some details regarding the replaced members are covered in the <a href="https://fukushimavoice2.blogspot.com/2023/12/2023112414.html" target="_blank">Japanese post</a> (automatic English translation is mostly reasonable for the applicable content), but an oust of Takahiro Sobue warrants a special mention. </span></p><p><span style="font-family: trebuchet; font-size: large;"> </span><span style="font-size: medium;"><span style="font-family: trebuchet;">As covered in the </span><a href="https://fukushimavoice-eng2.blogspot.com/2023/08/fukushima-thyroid-examination-july-2023.html" style="font-family: trebuchet;" target="_blank">previous post</a><span style="font-family: trebuchet;">, </span><span style="font-family: trebuchet;">Sobue, a cancer statistician from Osaka University,</span><span style="font-family: trebuchet;"> expressed a strong disagreement with the conclusion of the </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/587696.pdf" style="font-family: trebuchet;" target="_blank">summary draft</a><span style="font-family: trebuchet;"> which was presented to the 21st session of the TUE Subcommittee (aka the very last session of the 4th term) in July 2023</span><span style="font-family: trebuchet;">. This summary draft covers up to the fourth round and concluded that</span><span style="font-family: trebuchet;"> no consistent dose response relationship was seen between the exposure dose and the thyroid cancer detection rate.</span><span style="font-family: trebuchet;"> </span><span style="font-family: trebuchet;">However, Sobue did not agree that such a definite conclusion could be drawn based on the data and analyses provided. The</span><span style="font-family: trebuchet;"> <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/603847.pdf" target="_blank">revised summary</a> presented this time reflects discussions from the 21st session </span><span style="font-family: trebuchet;">including Sobue's dissents. Just to show the extent of the revision which is mostly on page 4 of both <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/587696.pdf#page=4" target="_blank">draft</a> and <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/603847.pdf#page=4" target="_blank">revised</a> versions, a screenshot of the respective part of the summary draft (in Japanese) is shown here.</span></span></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyEUkaAkGq3SXszIdAUy0RWBNWOTzqsJMZZxLwJm9mDc6jS_-ws-SCo9PhzRJR8hfGHqDlk3TcH2XXR_bHHTmYQXb26dXar9uDekqMwKsFJzOk5WUaP1ab85-wPUzbXEfou8OQ5l74Jydp3qPj294WMgQBTILejyhI1hS0YMt_JZcX9HFVxuXMhmp0rWJ6/s624/%E9%83%A8%E4%BC%9A%E3%81%BE%E3%81%A8%E3%82%81%E6%A1%88%E3%80%802%E3%80%80%E7%96%AB%E5%AD%A6%E7%9A%84%E8%A7%A3%E6%9E%90%E3%81%AE%E7%B5%90%E6%9E%9C%E3%81%AB%E3%81%A4%E3%81%84%E3%81%A6%E3%80%80.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="311" data-original-width="624" height="199" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyEUkaAkGq3SXszIdAUy0RWBNWOTzqsJMZZxLwJm9mDc6jS_-ws-SCo9PhzRJR8hfGHqDlk3TcH2XXR_bHHTmYQXb26dXar9uDekqMwKsFJzOk5WUaP1ab85-wPUzbXEfou8OQ5l74Jydp3qPj294WMgQBTILejyhI1hS0YMt_JZcX9HFVxuXMhmp0rWJ6/w400-h199/%E9%83%A8%E4%BC%9A%E3%81%BE%E3%81%A8%E3%82%81%E6%A1%88%E3%80%802%E3%80%80%E7%96%AB%E5%AD%A6%E7%9A%84%E8%A7%A3%E6%9E%90%E3%81%AE%E7%B5%90%E6%9E%9C%E3%81%AB%E3%81%A4%E3%81%84%E3%81%A6%E3%80%80.png" width="400" /></a></div><p> <span style="font-size: medium;"><span style="font-family: trebuchet;">And this is the same part in the revised draft with the added content highlighted, which reflects </span><span style="font-family: trebuchet;"><span>Sobue's </span></span><span><span style="font-family: trebuchet;">opinion that there was a difficulty in drawing conclusions on the relationship between thyroid cancer and radiation due to an insufficient control of the confounding factor. </span></span></span></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiMNUfdU48G5_gpgiMKatxxYdrpfYNGDeknS6ksNQ_df9V1zK4ZJaSrpQy0XqO-di0tYz1YivtDLdaxPVUQMDiZbj7GROME91RLNXgU5_meZm1FYnuh82oe-Fg9fwZdcUpqPNQPZwIG_YnU-u4YfOH-XWjE4wmt4lbYTjVS51JlHo7wa8U4WZuvzfcGfHy/s628/%E9%83%A8%E4%BC%9A%E3%81%BE%E3%81%A8%E3%82%81%E3%80%802%E3%80%80%E7%96%AB%E5%AD%A6%E7%9A%84%E8%A7%A3%E6%9E%90%E3%81%AE%E7%B5%90%E6%9E%9C%E3%81%AB%E3%81%A4%E3%81%84%E3%81%A6.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="602" data-original-width="628" height="384" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiMNUfdU48G5_gpgiMKatxxYdrpfYNGDeknS6ksNQ_df9V1zK4ZJaSrpQy0XqO-di0tYz1YivtDLdaxPVUQMDiZbj7GROME91RLNXgU5_meZm1FYnuh82oe-Fg9fwZdcUpqPNQPZwIG_YnU-u4YfOH-XWjE4wmt4lbYTjVS51JlHo7wa8U4WZuvzfcGfHy/w400-h384/%E9%83%A8%E4%BC%9A%E3%81%BE%E3%81%A8%E3%82%81%E3%80%802%E3%80%80%E7%96%AB%E5%AD%A6%E7%9A%84%E8%A7%A3%E6%9E%90%E3%81%AE%E7%B5%90%E6%9E%9C%E3%81%AB%E3%81%A4%E3%81%84%E3%81%A6.png" width="400" /></a></div><div style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 12px auto 6px;"><div><span style="font-weight: 700;"><span><span style="font-family: trebuchet; font-size: x-large;">Highlights</span></span></span></div><b><ul><span style="font-family: trebuchet; font-size: medium;"><li><b>The fifth round: 5 new cases diagnosed as suspicious or malignant, and 1 new surgical case.</b></li><li><b>The sixth round: just started and no confirmatory examination results available.</b></li><li><b>Total number of suspected/confirmed thyroid cancer has increased by 5 to</b> <span style="color: red;">321</span><b>: </b><b>116 in the first round (in<b>cluding a single case of benign tumor</b>), 71 in the second round, 31 in the third round, 39 in the fourth round, 39 in the fifth round, and 22 in Age 25 Milestone Screening, and 3 in Age 30 Milestone Screening.</b></li><li><b>Total number of surgically confirmed thyroid cancer cases has increased by 14 to <span style="color: red;">262</span><span style="color: red;"> </span>(101 in the first round, 56 in the second round, 29 in the third round, 34 in the fourth round, 27 in the fifth round, 14 in Age 25 Milestone Screening and 1 in Age 25 Milestone Screening,</b></li></span></ul></b><div><span><b><span style="font-family: trebuchet; font-size: x-large;"><br /></span></b></span></div><div><span><b><span style="font-family: trebuchet; font-size: x-large;">The latest overall results including the "unreported" and cancer registry cases</span></b></span></div><div><span><span style="font-family: trebuchet;"><span><span style="font-size: medium;"> </span></span></span></span></div><div><span><span style="font-family: trebuchet;"><span><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4DQ8mXMBZnGlkwXaNDXWkLhpCzPGsuTnCcG-UuWZ9SD4Kxc10FtOz4F8o2fEAQzd_BUzmjklw4qxydbL_i6EyjOyX46xll_OIOEM434w25KYZXfT2lRFjJEnwuYdzVeKT_4efJcne5s5XGLD9ZpYqBJwSjB_L4Nbuu1sLyayRUnsDHCLI6hvZ6sTPfC4w/s785/%2349%20Latest%20results%20screenshot.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="674" data-original-width="785" height="550" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4DQ8mXMBZnGlkwXaNDXWkLhpCzPGsuTnCcG-UuWZ9SD4Kxc10FtOz4F8o2fEAQzd_BUzmjklw4qxydbL_i6EyjOyX46xll_OIOEM434w25KYZXfT2lRFjJEnwuYdzVeKT_4efJcne5s5XGLD9ZpYqBJwSjB_L4Nbuu1sLyayRUnsDHCLI6hvZ6sTPfC4w/w640-h550/%2349%20Latest%20results%20screenshot.png" width="640" /></a></div><span style="font-size: medium;"><br /></span></span></span></span></div><div><span><span style="font-family: trebuchet;"><span><span style="font-size: medium;"> Please refer to </span></span></span></span><span style="font-size: medium;"><span style="font-family: trebuchet;"><span>the </span><a href="https://fukushimavoice-eng2.blogspot.com/2021/06/fukushima-thyroid-examination-may-2021.html" target="_blank">the post on May 2021 report</a> regarding the details of "unreported" cases and cancer registry data. </span><span style="font-family: trebuchet;">(<a href="https://fukushimavoice-eng2.blogspot.com/2018/07/results-of-survey-on-fukushima-thyroid.html" target="_blank">A July 2018 post</a> describes the origin of the first 11"unreported" cases, and their histological diagnoses were obtained from <a href="https://www.jstage.jst.go.jp/article/fms/65/3/65_2019-26/_html/-char/ja" target="_blank">this paper</a>.)</span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> The o</span>fficial count, as reported above and also in the summary document shown in the next section, is <b>321</b> suspected/confirmed and <b>262</b> surgically confirmed thyroid cancer cases. With an addition of the most recent numbers for both "unreported" cases (see <a href="https://fukushimavoice-eng2.blogspot.com/2021/06/fukushima-thyroid-examination-may-2021.html" target="_blank">this post</a>) and "outside" cases discovered in the cancer registry (<a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/524933.pdf" target="_blank">updated</a> at the <a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-b19.html" target="_blank">19th session</a> of the <a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-b.html" target="_blank">TUE Subcommittee</a>), the count increases to <b>399</b> cytologically suspected/confirmed and <b>324 surgically confirmed </b>cancer cases. </span></div><div><span style="font-family: trebuchet; font-size: medium;"> It should be noted that the actual number of cases is likely more due to lack of any past, present or future exhaustive investigation by Fukushima Medical University (FMU), which is necessary to gather <i>all</i> the cancer cases discovered outside the framework of the FHMS-TUE.</span></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 12px auto 6px;"><div><span style="font-family: trebuchet; font-size: x-large;"><b>Summary on the current status of the TUE</b></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> A nine</span>-page <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/603849.pdf" target="_blank">summary</a> of the first through sixth rounds as well as the Age 25 and Age 30 Milestone Screenings, "The Status of the Thyroid Ultrasound Examination Results," lists key findings from the primary and confirmatory examinations as well as the surgical information. </span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><span> </span>Below is an unofficial translation of this summary which is <i>not</i> officially translated.</span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><p style="-x-system-font: none; display: block; font-family: Helvetica, Arial, sans-serif; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 12px auto 6px;"><a href="https://www.scribd.com/document/690893729/49-Status-of-the-Thyroid-Ultrasound-Examination-Results#from_embed" style="text-decoration: underline;" title="View #49 Status of the Thyroid Ultrasound Examination Results on Scribd">#49 Status of the Thyroid Ultrasound Examination Results (November 24, 2023)</a> by <a href="https://www.scribd.com/user/233065310/Yuri-Hiranuma#from_embed" style="text-decoration: underline;" title="View Yuri Hiranuma's profile on Scribd">Yuri Hiranuma</a></p>
<iframe class="scribd_iframe_embed" data-aspect-ratio="0.7729220222793488" data-auto-height="true" frameborder="0" height="600" scrolling="no" src="https://www.scribd.com/embeds/690893729/content?start_page=1&view_mode=scroll&access_key=key-TAZFeMmLin2vQbZpiqDJ" tabindex="0" title="#49 Status of the Thyroid Ultrasound Examination Results" width="100%"></iframe><p style="-x-system-font: none; display: block; font-family: Helvetica, Arial, sans-serif; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 12px auto 6px;"><br /></p></span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"> Below is a brief descriptive summary of <i>each</i> round, regardless of the update status, provided for easy reference.</span></span></div><div></div><div><br /></div><div><span><span style="font-family: trebuchet; font-size: large;"><u><b>The first round</b></u></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"> There is no change in data with 116 suspected/confirmed thyroid cancer cases (39 males and 77 females), of which 102 underwent surgery confirming 1 benign nodule and 101 thyroid cancer cases (100 papillary thyroid cancer and 1 poorly-differentiated cancer). </span></div><div><span style="font-family: trebuchet; font-size: medium;"> The last update as of FY 2015 was reported at the 23rd session in June 2016 (<a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/461399.pdf" target="_blank">Japanese</a>, <a href="https://fhms.jp/fhms/uploads/23_6Jun2016.pdf#page=32" target="_blank">English</a>).</span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div><div><span><span style="font-family: trebuchet; font-size: large;"><b><u>The second round</u></b></span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"> There is no change in the number of suspected/confirmed thyroid cancer cases at 71 (32 males and 39 females). Surgical cases remain at 56 (55 papillary thyroid cancer and 1 "other" thyroid cancer) . </span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"> The most recent FY2020 update of the second round data was previously reported at the 42nd session (<a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529202.pdf" target="_blank">Japanese</a>, <a href="https://fhms.jp/fhms/uploads/42_26Jul2021.pdf" target="_blank">English</a>), with the <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529192.pdf" target="_blank">brief update</a> released at the last session showing the latest surgical data.</span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div><div><span><span style="font-family: trebuchet; font-size: large;"><b><u>The third round</u></b></span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"> </span><span style="font-size: medium;"><span>There is no change in data with 31 suspected/confirmed thyroid cancer cases (13 males and 18 males), of which 29 were surgically confirmed as papillary thyroid cancer. The final report from the 39th session in August 2020</span><span><span> (</span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/401325.pdf" target="_blank"><span>Japanese</span></a><span>, </span></span><a href="https://fhms.jp/fhms/uploads/39_31Aug2020.pdf#page=2" target="_blank">English</a><span>) </span><span>was updated as of FY2020 and reported at the 42nd session in July 2021</span><span> (</span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/461565.pdf" target="_blank">Japanese</a><span>, </span><a href="https://fhms.jp/fhms/uploads/42_26Jul2021.pdf#page=4" target="_blank">English</a><span>).</span></span></span></div><div><span style="font-family: trebuchet;"> </span></div></div></div><div><div><span style="font-family: trebuchet;"><span face=""><u><span style="font-size: large;"><b>The fourth round</b></span></u></span><br /><span face=""><span style="font-size: medium;"><span> There is no change in data with </span></span></span></span><span style="font-family: trebuchet;"><span face=""><span style="font-size: medium;">39</span></span></span><span style="font-family: trebuchet; font-size: medium;"><span style="font-family: trebuchet;"> suspected/confirmed thyroid cancer cases (17 males and 22 females)</span></span><span style="font-family: trebuchet; font-size: medium;">, of which 34 have been surgically confirmed as papillary thyroid cancer. </span><span style="font-size: medium;"><span style="font-family: trebuchet;">The </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/561337.pdf" style="font-family: trebuchet;" target="_blank">final report</a><span style="font-family: trebuchet;"> was presented to the </span><a href="https://www.pref.fukushima.lg.jp/sec/21045b/kenkocyosa-kentoiinkai-b20.html" style="font-family: trebuchet;" target="_blank">20th TUE Subcommittee session</a><span style="font-family: trebuchet;"> on March 20, 2023 but not independently to the Oversight Committee. Since the meeting materials from the TUE Subcommittee are not officially translated, the final report will also not be translated. However, it is identical to the version presented to the 46th session in December 2022 whose translation can be found <a href="https://fhms.jp/fhms/uploads/46_2Dec2022.pdf" target="_blank">here</a>.</span></span></div><div><span style="font-family: trebuchet;"><br /></span></div><div><span style="font-family: trebuchet;"><u><span><b><span style="font-size: large;">The fifth round</span><span style="font-size: medium;"> (updated this time)</span></b></span></u></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> </span>The <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/603844.pdf" target="_blank">fifth round</a> targets 252,938 individuals who were born in FY 1998-2011. Originally earmarked for FY 2020-21 (April 2, 2020 to March 31, 2022), its implementation was extended by 1 year due to the COVID-19 pandemic. With only a two-digit increase in participants, the fifth round finally appears to be near completion although it might be a while before the final version of the results is released. (For reference, the final results of the fourth round weren't released until 3 years past its scheduled completion date of March 2020.) </span></span><span style="font-family: trebuchet; font-size: large;"> </span></div><div><span style="font-family: trebuchet;"><span><span style="font-size: medium;"><br /></span></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"> </span><span style="font-family: trebuchet; font-size: medium;">As of June 30, 2023, the total number of participants in the primary examination was </span><span style="font-family: trebuchet; font-size: medium;">113,937 with an addition of </span><span style="font-family: trebuchet; font-size: medium;">85 new participants (41 residing outside Fukushima). There are no changes in its participation rates either overall or by age group: 45.0% overall, </span><span style="font-family: trebuchet; font-size: medium;">74.0% in ages 8-11, 57.8% in ages 12-17, and 11.2% in ages over 18. The primary examination results increased by 5,682 to 113,932 and the number of "B" assessment, which qualifies for the confirmatory examination, </span><span style="font-family: trebuchet; font-size: medium;">increased by 47 to 1,346</span><span style="font-family: trebuchet; font-size: medium;">. </span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> The number of new participants in</span> the confirmatory examination was also smaller at 47, and 12 underwent FNAC with 5 being newly diagnosed with suspected thyroid cancer. This included 2 males (ages-at-exposure of 4 and 10 years) and 3 females (ages-at-exposure of 2, 4, and 6 years). One male and 1 female were from the FY 2020 municipalities and 1 male and 2 females were from the FY2021 municipalities. Their previous results included 1 with A1, 3 with A2 cyst, and 1 with no prior examination. </span></div><div><span style="font-family: trebuchet; font-size: medium;"> </span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> </span>There was only 1 new surgical case in from the FY2020 municipalities which was confirmed as papillary thyroid cancer.</span></div><div><span style="font-family: trebuchet;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span style="font-family: trebuchet; font-size: medium;"><span> </span>In summary, a</span><span style="font-size: medium;"><span style="font-family: trebuchet;">s of June 30, 2023, t</span><span style="font-family: trebuchet;">he number of suspected or confirmed thyroid cancer cases f</span></span><span style="font-family: trebuchet; font-size: medium;">or the fifth round is 39, of which 27 have been surgically confirmed as papillary thyroid cancer. </span></span><span style="font-size: medium;"><span style="font-family: trebuchet;">The</span><span style="font-family: trebuchet;"> previous results from the fourth round are as follows: 27 with "A" (9 with A1, 17 with A2 cysts, 1 with A2 nodules/cysts), 6 with "B," and 6 with no prior result. </span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> The regional distribution of 39 suspected/confirmed thyroid cancer cases showed that 6 were from the evacuation zone, 24 from Naka-dori, 6 from Hama-dori, and 3 from Aizu. The proportions against the primary examination participants were 0.04%, 0.04%, 0.02%, and 0.03% respectively.</span></span></div><div><span style="font-family: trebuchet;"><br /></span></div></div><div><div><div><span style="font-family: trebuchet;"><span face=""><span><u><b><span style="font-size: large;">The Sixth Round </span><span style="font-size: medium;">(newly reported)</span></b></u></span></span></span></div><div><br /></div><div><span style="font-family: trebuchet;"><span face=""><span style="font-size: medium;"> The <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/603845.pdf" target="_blank">sixth round</a> just began in April 2023 with a target population of 211,865 which is 41,073 fewer than the fifth round, reflecting an additional exclusion of those born in FY 1998-1999 who will transition to the Age 25 Milestone Screening. </span></span></span></div><div><span style="font-family: trebuchet;"><span face=""><span style="font-size: medium;"><br /></span></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"> As of June 30, 2023, only 4,956 participated in the primary examination with the initial participation rate of 2.3%. Of 208 whose results are available, 4 received the B assessment none of who underwent the confirmatory examination.</span><span style="font-family: trebuchet; font-size: x-large;"> </span></div></div><span style="font-family: trebuchet;"><div style="font-family: Times;"><span style="font-family: trebuchet;"><div style="text-align: left;"><span style="font-size: medium;"><br /></span></div><div style="text-align: left;"><span style="font-size: medium;">[Important note: </span><span style="font-size: medium;">Transition of each FY birth cohort to the Milestone Screening reduces a target population for the main TUE. This reduction began in the third round conducted during FY 2016-2017, which excluded the FY 1992-1993 cohorts in anticipation of the upcoming Age 25 Milestone Screening. With each FY birth cohort including about 22,000 individuals, this is a sizable reduction which continues as the TUE target population ages. (An exception is an increase from 367,637 for the first round to 381,237 for the second round which is due to an inclusion of those who were in utero at the time of the accident.) From then on, it has decreased to 336,667 for the third round, 294,228 for the fourth round, 252,938 for the fifth round, and now 211,865 for the sixth round. </span><span style="font-family: Times; font-size: medium;"><span style="font-family: trebuchet;"><a href="https://fukushimavoice-eng2.blogspot.com/2021/01/fukushima-thyroid-examination-january.html" target="_blank">The January 2021 post</a> explains </span><span style="font-family: trebuchet;">how this ongoing transition skews age distribution graphs to the left.]</span></span></div><div style="text-align: left;"><span style="font-family: Times; font-size: medium;"><span style="font-family: trebuchet;"><br /></span></span></div></span></div></span></div><div><div><div><span style="font-family: trebuchet; font-size: large;"><u><b>Expected changes in the dataset</b></u></span><span style="font-family: trebuchet;"> </span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"> There are two factors inherent to the implementation structure of the TUE, leading to a smaller dataset with each screening cycle. One is a reduced size of target population (see above) and the other is a decline in participation rates, both of which are already being observed and expected to progress.</span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"> As described above, a shift of a cohort to the Milestone Screening (Age 25, Age 30, etc.) with time reduces the target population in each successive screening cycle. Furthermore, school-based screening conducted through high school dwindles with each cohort graduating from high school. It will eventually come to a natural halt when the youngest cohort born in FY2011 (between April 2, 2011 and April 1, 2012) finishes high school in 2029. It should be noted that the school-based screening is completely voluntary, no less the TUE itself.</span></span></div><div><span style="font-size: medium;"><span style="font-family: trebuchet;"> Convenience of the school-based screening contributes to higher participation rates for ages up to 18 than past age 18. This is clearly shown in the most recent participation rates by age reported in this post: 74.0</span><span style="font-family: trebuchet;">% in ages 8-11, 57.8% in ages 12-17, and 11.2% in ages over 18 in the fifth round, 9.1% for the Age 25 Milestone Screening, and 6.7% for the Age 30 Milestone Screening. </span></span></div><div><span style="font-size: medium;"><span style="font-family: trebuchet;"> It is critical to recognize these expected changes for future datasets when reviewing the TUE data because they cast doubt on reliability and integrity of the TUE data itself and any analysis conducted using such data. Retrieval of "missing data" due to "unreported cases" at any age is being attempted by matching the TUE data with regional (up to 2015) and national (from 2016 on) cancer registry data. For instance, reconciliation with the most recently available national cancer registry data up to 2018 (</span><span style="font-family: trebuchet;"><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/524933.pdf" target="_blank">document</a> from the 19th Subcommittee session<span>)</span><span> revealed 43 cases from the cancer registry, </span></span></span><span style="font-family: trebuchet; font-size: medium;">which are not included in the official TUE count. This is an increase from 27 cases up to 2017 (<a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/488957.pdf" target="_blank">reported</a> to the 18th Subcommittee session). Nonetheless the cancer registry is far from fool-proof because patients who move their official residence registry outside Fukushima are <i>not</i> reported as Fukushima cases.</span></div><div><span style="font-family: trebuchet;"><br /></span></div><div><span style="font-family: trebuchet;"><span face=""><b><span style="font-size: large;"><u>Summary of the results from the previous screen</u></span><span style="font-size: large;"><u>ing</u></span> </b></span><br /><span face=""><span><span style="font-size: large;"> </span><span style="font-size: medium;">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. </span></span></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div><span style="font-family: trebuchet; font-size: medium;"><u>Definition</u></span></div><div><span style="font-family: trebuchet; font-size: medium;">"A1": no ultrasound findings. </span></div><div><div><span style="font-family: trebuchet; font-size: medium;"><span>"A2": ultrasound findings of nodules </span><span>≤ 5.0 mm and/or cysts </span><span>≤ 20.0 mm. </span></span></div></div><div><div><span style="font-family: trebuchet; font-size: medium;"><span>"B": ultrasound findings of nodules </span><span>≥</span><span> 5.1 mm and/or cysts </span><span>≥</span><span> 20.1 mm.</span></span></div></div></blockquote><div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> </span>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.)</span></div><div><ul><li><span style="font-family: trebuchet; font-size: medium;">Second round (71 cases): 33 cases with A1, 32 cases with A2 (7 nodules and 25 cysts), 5 cases with B, and 1 case previously unexamined</span></li><li><span style="font-family: trebuchet; font-size: medium;">Third round (31 cases): 7 cases with A1, 14 cases with A2 (4 nodules and 10 cysts), 7 cases with B, and 3 cases previously unexamined</span></li><li><span style="font-family: trebuchet; font-size: medium;">Fourth round (39 cases): 6 cases with A1, 20 cases with A2 (6 nodules, 13 cysts, and 1 nodule & cyst), 9 cases with B, and 4 cases previously unexamined</span></li><li><span style="font-family: trebuchet;"><span style="font-size: medium;">Fifth round (39 cases): 9</span><span style="font-size: medium;"> cases with A1, 18 cases with A2 (17 cysts and 1 nodule & cyst), 6 cases with B, and 6 cases previously unexamined</span></span></li><li><span style="font-family: trebuchet; font-size: medium;"><span>Age 25 Milestone Screening (22 cases): 1 case with A1, 4</span> cases with A2 (1 nodule and 3 cyst), 4 cases with B, and 13 cases previously unexamined</span></li><li><span style="font-family: trebuchet; font-size: medium;"><span>Age 30 Milestone Screening (3 cases): unknown</span></span></li></ul></div></div></div><p><span style="font-family: trebuchet;"><span style="font-size: medium;"> </span></span></p><div><span style="font-family: trebuchet; font-size: medium;"> </span></div>@YuriHiranumahttp://www.blogger.com/profile/16819451884150838540noreply@blogger.com0tag:blogger.com,1999:blog-9200156515048577812.post-5448539704227601072023-08-29T19:51:00.000-07:002024-02-29T12:38:29.532-08:00Fukushima Thyroid Examination July 2023: 261 Surgically Confirmed as Thyroid Cancer Among 316 Cytology Suspected Cases<p><b style="font-family: trebuchet; font-size: xx-large;">Overview</b></p><p><span style="font-family: trebuchet;"><span><span><span style="font-size: medium;"> On July 20, 2023, <a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-40.html" target="_blank">t</a></span><span style="font-size: medium;"><a href="https://www.pref.fukushima.lg.jp/sec/21045b/kenkocyosa-kentoiinkai-48.html" target="_blank">he 48th session of the Oversight Committee</a> for the <a href="https://fhms.jp/en/fhms/" target="_blank">Fukushima Health Management Survey</a> (FHMS) convened online and in Fukushima City</span></span></span><span style="font-size: medium;">, releasing a new set of results (data up to March 31, 2023) from the</span><span style="font-size: medium;"><span> </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/561237.pdf" target="_blank">fifth</a><span> </span></span><span style="font-size: medium;">round as well as the biannually reported <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/585384.pdf" target="_blank">Age 25</a> and <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/585385.pdf" target="_blank">Age 30</a> Milestone Screenings </span><span style="font-size: medium;"><span>of </span><span>the <a href="https://fhms.jp/en/fhms/thyroid/" target="_blank">Thyroid Ultrasound Examination</a> (TUE). </span><span> It amounts to 6-month worth of data since the previous session held on March 22, 2023 for the fifth round and the Age 25 Milestone Screening, and first-time reporting of the Age 30 Milestone Screening. </span></span></span><span style="font-family: trebuchet; font-size: medium;">This was the last session for the existing committee members whose two-year term ended on July 31, 2023.</span></p><p><span style="font-family: trebuchet; font-size: medium;"><span style="font-family: trebuchet; font-size: medium;"><span><span><span style="font-size: medium;"><span> </span>Official translations of the reports from the Oversight Committee will eventually appear on the Materials and Minutes of Prefectural Oversight Committee Meetings page (<a href="https://fhms.jp/en/fhms/outline/materials/" target="_blank">link</a>) on the <a href="https://fhms.jp/en/" target="_blank">website</a> of </span></span></span></span><span style="font-family: Times; font-size: medium;"><span style="font-family: trebuchet;">Radiation Medical Science Center of the Fukushima Health Management Survey (RMSC/FHMS). As of today, official English translations are available up to the 43rd session </span><span style="font-family: trebuchet;">(</span><a href="https://fhms.jp/fhms/uploads/43_15Oct2021.pdf" style="font-family: trebuchet;" target="_blank">PDF link</a><span style="font-family: trebuchet;">)</span><span style="font-family: trebuchet;">. </span><span style="font-family: trebuchet;"><span>This website also shows an </span><a href="https://fhms.jp/en/fhms/outline/" target="_blank">outline of the FHMS</a><span> and </span><a href="https://fhms.jp/en/fhms/thyroid/" target="_blank">TUE itself</a>, which might be informative to those unfamiliar with them<span>.</span></span></span></span></p><p><span style="font-family: trebuchet; font-size: large;"><b>Special Note: A Draft Summary by the Thyroid Examination Evaluation Committee</b></span></p><p><span style="font-family: trebuchet;"><span style="font-size: medium;"> Only 8 days later on July 28, 2023, <a href="https://www.pref.fukushima.lg.jp/sec/21045b/kenkocyosa-kentoiinkai-b21.html" target="_blank">the 21st session of the Thyroid Examination Evaluation Subcommittee</a> (herein TUE Subcommittee) was held. The back-to-back schedule also marked the end of a two-year term for the existing subcommittee members who all served two consecutive terms. This last subcommittee session was notable for a hasty presentation of <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/587696.pdf" target="_blank">a draft version of a summary report covering the first through fourth rounds</a> prepared by Subcommittee Chair Gen Suzuki. </span></span></p><p><span style="font-family: trebuchet;"><span style="font-size: medium;"> Some of the subcommittee members expressed disagreement with parts of </span><span style="font-size: medium;">the summary draft. The strongest criticism came from Tomotaka Sobue who disagreed with the phrase that no consistent dose response relationship was seen between the exposure dose and thyroid cancer detection rate. </span></span></p><p><span style="font-family: trebuchet; font-size: medium;"><span> </span>The TUE was initially rolled out region by region over several years, and timing of participation in the TUE is one of the confounding factors which were matched in the case control analyses conducted by FMU. </span><span style="font-family: trebuchet;"><span style="font-size: medium;">Sobue explained that when the analyses were <i>not</i> limited to specific regions (as in analyses <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/587677.pdf" target="_blank">3-1</a>, <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/587678.pdf" target="_blank">3-2</a>, <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/587680.pdf" target="_blank">3-3</a>, <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/587686.pdf" target="_blank">3-7</a>, <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/587687.pdf" target="_blank">3-8</a>, <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/587688.pdf" target="_blank">3-9</a>), odds ratios appeared to increase suggestive of dose response, albeit lack of statistical significance. However, the analyses limited to specific regions (<a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/587682.pdf" target="_blank">3-4</a>, <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/587683.pdf" target="_blank">3-5</a>, <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/587685.pdf" target="_blank">3-6</a>) showed a flatter or negative response, and according to Sobue this discrepancy implies </span></span><span style="font-family: trebuchet;"><span style="font-size: medium;">an inadequate control of what is considered the biggest confounding factor in the analyses: timing of participation in the TUE. </span></span></p><p><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> </span>In Sobue's </span></span><span style="font-size: medium;"><span style="font-family: trebuchet;">opinion the phrase should more accurately reflect the fact that there was a difficulty to draw conclusions on the relationship between thyroid cancer and radiation due to insufficient control of the confounding factor. (It should be noted that competence of the analysis by FMU is not much different from the second-round analysis covered in </span><a href="https://fukushimavoice-eng2.blogspot.com/2019/06/how-conclusion-transpired-on-thyroid.html" style="font-family: trebuchet;" target="_blank">this 2019 post</a><span style="font-family: trebuchet;">. The summary draft for the second round also met criticisms which were not incorporated into <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/336455.pdf" target="_blank">the final version</a> but published as a <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/339633.pdf" target="_blank">separate document</a>, both of which were presented at the 35th Session of the Oversight Committee held in July 2019.)</span></span></p><div style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 12px auto 6px;"><div><span style="font-weight: 700;"><span><span style="font-family: trebuchet; font-size: x-large;">Highlights</span></span></span></div><b><ul><span style="font-family: trebuchet; font-size: medium;"><li><b>The fifth round: 8 new cases diagnosed as suspicious or malignant, and 10 new surgical cases.</b></li><li><b>Age 25 Milestone Screening: 3 new cases diagnosed as suspicious or malignant and 3 new surgical cases.</b></li><span style="font-family: trebuchet; font-size: medium;"><li><b>Age 30 Milestone Screening: 3 new cases diagnosed as suspicious or malignant and 1 new surgical case.</b></li></span><li><b>Total number of suspected/confirmed thyroid cancer has increased by 14 to</b> <span style="color: red;">316</span><b>: </b><b>116 in the first round (in<b>cluding a single case of benign tumor</b>), 71 in the second round, 31 in the third round, 39 in the fourth round, 34 in the fifth round, and 22 in Age 25 Milestone Screening, and 3 in Age 30 Milestone Screening.</b></li><li><b>Total number of surgically confirmed thyroid cancer cases has increased by 14 to <span style="color: red;">261</span><span style="color: red;"> </span>(101 in the first round, 56 in the second round, 29 in the third round, 34 in the fourth round, 26 in the fifth round, 14 in Age 25 Milestone Screening and 1 in Age 25 Milestone Screening,</b></li></span></ul></b><div><span><b><span style="font-family: trebuchet; font-size: x-large;"><br /></span></b></span></div><div><span><b><span style="font-family: trebuchet; font-size: x-large;">The latest overall results including the "unreported" and cancer registry cases</span></b></span></div><div><span><span style="font-family: trebuchet;"><span><span style="font-size: medium;"> Please refer to </span></span></span></span><span style="font-size: medium;"><span style="font-family: trebuchet;"><span>the </span><a href="https://fukushimavoice-eng2.blogspot.com/2021/06/fukushima-thyroid-examination-may-2021.html" target="_blank">the post on May 2021 report</a> regarding the details of "unreported" cases and cancer registry data. </span><span style="font-family: trebuchet;">(<a href="https://fukushimavoice-eng2.blogspot.com/2018/07/results-of-survey-on-fukushima-thyroid.html" target="_blank">A July 2018 post</a> describes the origin of the first 11"unreported" cases, and their histological diagnoses were obtained from <a href="https://www.jstage.jst.go.jp/article/fms/65/3/65_2019-26/_html/-char/ja" target="_blank">this paper</a>.)</span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> The o</span>fficial count, as reported above and also in the summary document shown in the next section, is <b>316</b> suspected/confirmed and <b>261</b> surgically confirmed thyroid cancer cases. With an addition of the most recent numbers for both "unreported" cases (see <a href="https://fukushimavoice-eng2.blogspot.com/2021/06/fukushima-thyroid-examination-may-2021.html" target="_blank">this post</a>) and "outside" cases discovered in the cancer registry (<a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/524933.pdf" target="_blank">updated</a> at the <a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-b19.html" target="_blank">19th session</a> of the <a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-b.html" target="_blank">TUE Subcommittee</a>), the count increases to <b>394</b> cytologically suspected/confirmed and <b>323 surgically confirmed </b>cancer cases. </span></div><div><span style="font-family: trebuchet; font-size: medium;"> It should be noted that the actual number of cases is likely more due to lack of any past, present or future exhaustive investigation by Fukushima Medical University (FMU), which is necessary to gather <i>all</i> the cancer cases discovered outside the framework of the FHMS-TUE.</span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-xoKLQl3fONRwosY7DIrJXWVIGCfKFMwGy6z0D2mookWqtE5HKx8Cd2pC4c0tOPEvMlTmTxPCSV66xE5LMWxWQebm59py8E1_Ke5AtwWxWnbiwp-nMYfNmVM1wxMUiU28wkSjOGVE27S3VA5-hBFGQfy09riE0YdMKuNQzxo5tlb5TFcRQ1heucxeqkke/s617/%2348%20Latest%20results%20screenshot.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="538" data-original-width="617" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-xoKLQl3fONRwosY7DIrJXWVIGCfKFMwGy6z0D2mookWqtE5HKx8Cd2pC4c0tOPEvMlTmTxPCSV66xE5LMWxWQebm59py8E1_Ke5AtwWxWnbiwp-nMYfNmVM1wxMUiU28wkSjOGVE27S3VA5-hBFGQfy09riE0YdMKuNQzxo5tlb5TFcRQ1heucxeqkke/s16000/%2348%20Latest%20results%20screenshot.png" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 12px auto 6px;"><div><span style="font-family: trebuchet; font-size: x-large;"><b>Summary on the current status of the TUE</b></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> </span>An eight-page <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/585390.pdf" target="_blank">summary</a> of the first through fifth rounds as well as the Age 25 and Age 30 Milestone Screenings, "The Status of the Thyroid Ultrasound Examination Results," lists key findings from the primary and confirmatory examinations as well as the surgical information. </span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><span> </span>Below is an unofficial translation of this summary which is <i>not</i> officially translated.</span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><a href="https://www.scribd.com/document/662918657/48-Status-of-the-Thyroid-Ultrasound-Examination-Results-July-20-2023#from_embed" style="font-family: Helvetica, Arial, sans-serif; font-size: 14px;" title="View #48 Status of the Thyroid Ultrasound Examination Results (July 20, 2023) on Scribd">#48 Status of the Thyroid Ultrasound Examination Results (July 20, 22, 2023)</a><span face="Helvetica, Arial, sans-serif" style="font-size: 14px;"> by </span><a href="https://www.scribd.com/user/233065310/Yuri-Hiranuma#from_embed" style="font-family: Helvetica, Arial, sans-serif; font-size: 14px;" title="View Yuri Hiranuma's profile on Scribd">Yuri Hiranuma</a></span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;">
<iframe class="scribd_iframe_embed" data-aspect-ratio="0.7729220222793488" data-auto-height="true" frameborder="0" height="600" scrolling="no" src="https://www.scribd.com/embeds/662918657/content?start_page=1&view_mode=scroll&access_key=key-2W3KloWLL7WGo8XFvqyP" tabindex="0" title="#48 Status of the Thyroid Ultrasound Examination Results (July 20, 2023)" width="100%"></iframe><br /><br /></span></span></div><div></div><div><span><span style="font-family: trebuchet; font-size: large;"><u><b><br /></b></u></span></span></div><div><span><span style="font-family: trebuchet; font-size: large;"><u><b>The first round</b></u></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"> There is no change in data with 116 suspected/confirmed thyroid cancer cases (39 males and 77 females), of which 102 underwent surgery confirming 1 benign nodule and 101 thyroid cancer cases (100 papillary thyroid cancer and 1 poorly-differentiated cancer). </span></div><div><span style="font-family: trebuchet; font-size: medium;"> The last update as of FY 2015 was reported at the 23rd session in June 2016 (<a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/461399.pdf" target="_blank">Japanese</a>, <a href="https://fhms.jp/fhms/uploads/23_6Jun2016.pdf#page=32" target="_blank">English</a>).</span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div><div><span><span style="font-family: trebuchet; font-size: large;"><b><u>The second round</u></b></span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"> There is no change in the number of suspected/confirmed thyroid cancer cases at 71 (32 males and 39 females). Surgical cases remain at 56 (55 papillary thyroid cancer and 1 "other" thyroid cancer) . </span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"> The most recent FY2020 update of the second round data was previously reported at the 42nd session (<a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529202.pdf" target="_blank">Japanese</a>, <a href="https://fhms.jp/fhms/uploads/42_26Jul2021.pdf" target="_blank">English</a>), with the <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529192.pdf" target="_blank">brief update</a> released at the last session showing the latest surgical data.</span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div><div><span><span style="font-family: trebuchet; font-size: large;"><b><u>The third round</u></b></span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"> </span><span style="font-size: medium;"><span>There is no change in data with 31 suspected/confirmed thyroid cancer cases (13 males and 18 males), of which 29 were surgically confirmed as papillary thyroid cancer. The final report from the 39th session in August 2020</span><span><span> (</span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/401325.pdf" target="_blank"><span>Japanese</span></a><span>, </span></span><a href="https://fhms.jp/fhms/uploads/39_31Aug2020.pdf#page=2" target="_blank">English</a><span>) </span><span>was updated as of FY2020 and reported at the 42nd session in July 2021</span><span> (</span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/461565.pdf" target="_blank">Japanese</a><span>, </span><a href="https://fhms.jp/fhms/uploads/42_26Jul2021.pdf#page=4" target="_blank">English</a><span>).</span></span></span></div><div><span style="font-family: trebuchet;"> </span></div></div></div><div><div><span style="font-family: trebuchet;"><span face=""><u><span style="font-size: large;"><b>The fourth round</b></span></u></span><br /><span face=""><span style="font-size: medium;"><span> There is no change in data with </span></span></span></span><span style="font-family: trebuchet;"><span face=""><span style="font-size: medium;">39</span></span></span><span style="font-family: trebuchet; font-size: medium;"><span style="font-family: trebuchet;"> suspected/confirmed thyroid cancer cases (17 males and 22 females)</span></span><span style="font-family: trebuchet; font-size: medium;">, of which 34 have been surgically confirmed as papillary thyroid cancer. </span><span style="font-size: medium;"><span style="font-family: trebuchet;">The </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/561337.pdf" style="font-family: trebuchet;" target="_blank">final report</a><span style="font-family: trebuchet;"> was presented to the </span><a href="https://www.pref.fukushima.lg.jp/sec/21045b/kenkocyosa-kentoiinkai-b20.html" style="font-family: trebuchet;" target="_blank">20th TUE Subcommittee session</a><span style="font-family: trebuchet;"> on March 20, 2023. </span></span></div><div><span style="font-family: trebuchet;"><br /></span></div><div><span style="font-family: trebuchet;"><u><span style="font-size: large;"><b>The fifth round</b></span></u></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> </span>The <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/543339.pdf" target="_blank">fifth round</a> targets 252,938 individuals who were born in FY 1998-2011. Originally earmarked for FY 2020-21 (April 2, 2020 to March 31, 2022), its implementation was extended by 1 year due to school closures and an extraordinary burden on medical facilities from the COVID-19 pandemic which began in March 2020. (</span></span><span style="font-family: trebuchet; font-size: medium;">The </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529194.pdf" style="font-family: trebuchet; font-size: medium;" target="_blank">sixth round</a><span style="font-family: trebuchet; font-size: medium;"> has returned to a two-year screening cycle beginning April 2023.) </span><span style="font-family: trebuchet;"><span style="font-size: medium;">Note that the target population has been reduced by one-third compared to the first round, owing to the transition of individuals born in FY1992-1997 to the Age 25 and 30 Milestone Examinations.</span><span style="font-size: medium;"> </span></span><span style="font-size: medium;"><span style="font-family: trebuchet;">(<a href="https://fukushimavoice-eng2.blogspot.com/2021/01/fukushima-thyroid-examination-january.html" target="_blank">The January 2021 post</a> explains </span><span style="font-family: trebuchet;">how this ongoing transition skews age distribution graphs to the left.)</span></span><span style="font-family: trebuchet; font-size: medium;"> </span></div><div><span style="font-family: trebuchet;"><span><span style="font-size: medium;"><br /></span></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"> </span><span style="font-family: trebuchet; font-size: medium;">As of March 31, 2023, 113,852 participated in the primary examination, including 24,758 new participants, and its participation rate increased from </span><span style="font-family: trebuchet; font-size: medium;">35.2</span><span style="font-family: trebuchet; font-size: medium;">% to 45.0%. Participation rates by age group changed from 58.4% to 74.0% in ages 8-11, from 43.3% to 57.8% in ages 12-17, and from 10.8% to 11.2% in ages over 18, reflecting progress of the school-based screening in the first two age groups as well as persistently low participation of the over 18 age group. The primary examination results increased by 25,882 to 108,250 and the number of "B" assessment, which qualifies for the confirmatory examination, </span><span style="font-family: trebuchet; font-size: medium;">increased by 298 to 1,299</span><span style="font-family: trebuchet; font-size: medium;">. </span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> </span>Of 217 who newly participated in the confirmatory examination, 14 underwent FNAC, and 8 were newly diagnosed with suspected thyroid cancer. This included 3 males (ages-at-exposure of 7, 8, and 11 years) and 5 females (ages-at-exposure of 4, 6, 9, 11 and 12 years). Five were from the FY 2020 municipalities and 3 from the FY2021 municipalities. Their previous results include 3 with A2 cyst, 2 with B, and 3 with no prior examination. </span></div><div><span style="font-family: trebuchet; font-size: medium;"> </span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> </span>There are an addition of 10 surgical cases in the fifth round — eight from FY 2020 and two from FY2021 municipalities — and all were confirmed with papillary thyroid cancer.</span></div><div><span style="font-family: trebuchet;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span style="font-family: trebuchet; font-size: medium;"><span> </span>In summary, a</span><span style="font-size: medium;"><span style="font-family: trebuchet;">s of March 31, 2023, t</span><span style="font-family: trebuchet;">he number of suspected or confirmed thyroid cancer cases f</span></span><span style="font-family: trebuchet; font-size: medium;">or the fifth round is 34, of which 26 have been surgically confirmed as papillary thyroid cancer. </span></span><span style="font-size: medium;"><span style="font-family: trebuchet;">The</span><span style="font-family: trebuchet;"> previous results from the fourth round are as follows: 23 with "A" (8 with A1, 14 with A2 cysts, 1 with A2 nodules/cysts), 6 with "B," and 5 with no prior result. </span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> Additionally, the progress and results of the confirmatory examination by region were reported for the first time for the fifth round. Of 34 suspected/confirmed thyroid cancer cases, 5 were from the evacuation zone, 21 from Naka-dori, 5 from Hama-dori, and 3 from Aizu. The most populous Naka-dori had the highest number, but for all 4 regions the proportion against the primary examination participants was similar in the range of 0.02 to 0.03%</span></span></div><div><span style="font-family: trebuchet;"><br /></span></div></div><div><div><div><span style="font-family: trebuchet;"><span face=""><span style="font-size: large;"><u><b>Age 25 Milestone Screening</b></u></span></span><br /></span><span style="font-family: trebuchet; font-size: medium;"> </span><span style="font-family: trebuchet; font-size: medium;">In the Age 25 Milestone Screening, each screening year targets a cohort turning 25 during each fiscal year, and t<span><span face="">he results are reported every 6 months. </span></span><span><span><span face="">The most recent implementation schedule available in English is from</span></span><span> September 2020, which was reported to the 41st session of the Oversight Committee and can be found <a href="https://fhms.jp/fhms/uploads/33_27Dec2018.pdf#page=37" target="_blank">here</a>. </span>(</span></span><span style="font-family: trebuchet; font-size: medium;">No one is supposed to undergo a regular TUE within 2 years of becoming eligible for the Age 25 Milestone Screening.) </span><span style="font-size: medium;"><span style="font-family: trebuchet;">Although each fiscal-year screening is earmarked for those turning 25 during that fiscal year, participants can take part in the screening anytime up to the year before they become eligible for the Age 30 Milestone Screening.</span><span style="font-family: trebuchet;"> </span></span></div><div><span style="font-family: trebuchet;"><div style="font-family: Times;"><span style="font-family: trebuchet;"><span><span style="font-size: large;"> </span></span></span></div></span></div></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><span style="font-family: trebuchet;"><div style="font-family: Times;"><span style="font-family: trebuchet;"><div><span style="font-size: medium;">Note: </span><span style="font-size: medium;">Transition of each FY birth cohort to the Age 25 Milestone Screening reduces a target population for the main TUE. This reduction began in the third round conducted during FY 2016-2017, which excluded the FY 1992 and 1993 cohorts in anticipation of the upcoming Age 25 Milestone Screening. With each FY birth cohort including about 22,000 individuals, this is a sizable reduction which continues as the TUE target population ages. An exception is an increase from 367,637 for the first round to 381,237 for the second round which is due to an inclusion of those who were in utero at the time of the accident. From then on, it has decreased to 336,667 for the third round, 294,228 for the fourth round, and now 252,938 for the fifth round.</span></div></span></div></span></blockquote><div><div><span style="font-family: trebuchet;"></span><span style="font-family: trebuchet;"><div style="font-family: Times;"><span style="font-family: trebuchet;"><span style="font-size: medium;"><br /></span></span></div><div style="font-family: Times;"><span style="font-family: trebuchet;"><span><div style="font-family: Times;"><span style="font-family: trebuchet;"><span><span style="font-size: large;"> </span><span style="font-size: medium;">The </span></span><span style="font-size: medium;"><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/585384.pdf" target="_blank">results reported this time</a><span> are from the data up to March 31, 2023, including the results for the newly eligible FY1997 cohort. Although the FY1992 cohort is still included in the results, there is no change in data since this cohort has transitioned to the Age 30 Milestone Examination.</span></span></span></div><div style="font-family: Times;"><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> An addition of the FY1997 cohort increased the target population from 108,711 to 129,007. </span></span></span><span style="font-size: medium;">The primary examination participation increased by 1,541 to total participants of 11,781, and the participation rate dipped from 9.4% to 9.1% </span><span style="font-size: medium;">due to a larger denominator from an increase of the target population</span><span style="font-size: medium;">.</span></div><div style="font-family: Times;"><span style="font-family: trebuchet; font-size: medium;"><span style="font-size: medium;"> An additional 85 participants received</span> "B" assessment in the primary examination this time, making the total eligible for the confirmatory examination to be 635. </span><span style="font-size: medium;">With 85 newly participating in the confirmatory examination, a total of 635 participated and the results have been finalized for 500 (84 more than last time). After FNAC was conducted in 7 individuals (with total FNAC cases of 43), 3 females were diagnosed with suspected thyroid cancer. Their ages-at-exposure were 12, 13, and 14 years, and none had participated in prior screening. There is no residence location information available for these cases because the regional data is only reported for the primary examination.</span></div><div style="font-family: Times;"><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div style="font-family: Times;"><span style="font-family: trebuchet;"><span style="font-size: large;"> </span><span style="font-size: medium;">In summary, the number of suspected or confirmed thyroid cancer cases from the Age 25 Milestone Screening increased by 3 to 22. The results from the prior screening are: 5 with "A" (1 with A1, </span></span><span style="font-family: trebuchet; font-size: medium;">1 with A2 nodules, 3 with A2 cysts), 4 with "B" and 13 with no prior screening.</span></div><div style="font-family: Times;"><span style="font-family: trebuchet; font-size: medium;"><br /></span></div></span></span></div></span></div><div><span style="font-family: trebuchet;"><div><span style="font-family: trebuchet;"><span><div style="font-family: Times;"><span style="font-family: trebuchet; font-size: medium;"> Three new surgical cases, confirmed as papillary thyroid cancer, were added, and the number of surgically confirmed thyroid cancer increased to 14, including 13 papillary thyroid cancers and 1 follicular thyroid cancer.</span></div><div style="font-family: Times;"><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div style="font-family: Times;"><span style="font-family: trebuchet; font-size: large;"><u><b>Age 30 Milestone Screening</b></u></span></div><div><span style="font-family: Times;"> </span><span style="font-size: medium;">A second milestone screening, the Age 30 Milestone Screening, began in FY2022 starting in April 2022, targeting 22,626 born in FY1992. The <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/585385.pdf" target="_blank">first set of results</a> as of March 31, 2023 were reported this time.<br /></span></div><div><span style="font-size: medium;"><br /></span></div><div><span style="font-size: medium;"> Of 1,524 participants in the primary examination with participation rate of 6.7%, 126 had the B assessment becoming eligible for the confirmatory examination. Of 75 who underwent the confirmatory examination, the results have been finalized in 58. Five underwent FNAC, and 3 females were diagnosed with suspected/confirmed thyroid cancer. One of three has been confirmed with papillary thyroid cancer after undergoing surgery. No other details such as age, tumor diameter or prior examination results are available for them.</span></div><div style="font-family: Times;"><br /></div><div style="font-family: Times;"><br /></div></span></span></div></span></div></div></div><div><div><div><span style="font-family: trebuchet; font-size: large;"><u><b>Expected changes in the dataset</b></u></span><span style="font-family: trebuchet;"> </span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"> There are two factors inherent to the implementation structure of the TUE, leading to a smaller dataset with each screening cycle. One is a reduced size of target population and the other is a decline in participation rates, both of which are already being observed and expected to progress.</span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"> As described above, a shift of a cohort to the Milestone Screening (Age 25, Age 30, etc.) with time reduces the target population in each successive screening cycle. Furthermore, school-based screening conducted through high school slows down with each cohort graduating from high school. It will eventually come to a natural halt when the youngest cohort born in FY2011 (between April 2, 2011 and April 1, 2012) finishes high school in 2029. It should be noted that the school-based screening is completely voluntary, no less the TUE itself.</span></span></div><div><span style="font-size: medium;"><span style="font-family: trebuchet;"> Convenience of the school-based screening contributes to a higher participation rate for ages up to 18 than past age 18. This is clearly shown in the most recent participation rates by age reported in this post: 74.0</span><span style="font-family: trebuchet;">% in ages 8-11, 57.8% in ages 12-17, and 11.2% in ages over 18 in the fifth round, 9.1% for the Age 25 Milestone Screening, and 6.7% for the Age 30 Milestone Screening. </span></span></div><div><span style="font-size: medium;"><span style="font-family: trebuchet;"> It is critical to recognize these expected changes for future datasets when reviewing the TUE data because they cast doubt on reliability and integrity of the TUE data itself and any analysis conducted. Retrieval of "missing data" due to "unreported cases" at any age is being attempted by matching the TUE data with regional (up to 2015) and national (from 2016 on) cancer registry data. For instance, reconciliation with the most recently available national cancer registry data up to 2018 (</span><span style="font-family: trebuchet;"><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/524933.pdf" target="_blank">document</a> from the 19th Subcommittee session<span>)</span><span> revealed 43 cases from the cancer registry, </span></span></span><span style="font-family: trebuchet; font-size: medium;">which are not included in the official TUE count. This is an increase from 27 cases up to 2017 (<a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/488957.pdf" target="_blank">reported</a> to the 18th Subcommittee session). Nonetheless the cancer registry is far from fool-proof because patients who move their official residence registry outside Fukushima are <i>not</i> reported as Fukushima cases.</span></div><div><span style="font-family: trebuchet;"><br /></span></div><div><span style="font-family: trebuchet;"><span face=""><b><span style="font-size: large;"><u>Summary of the results from the previous screen</u></span><span style="font-size: large;"><u>ing</u></span> </b></span><br /><span face=""><span><span style="font-size: large;"> </span><span style="font-size: medium;">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. </span></span></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div><span style="font-family: trebuchet; font-size: medium;"><u>Definition</u></span></div><div><span style="font-family: trebuchet; font-size: medium;">"A1": no ultrasound findings. </span></div><div><div><span style="font-family: trebuchet; font-size: medium;"><span>"A2": ultrasound findings of nodules </span><span>≤ 5.0 mm and/or cysts </span><span>≤ 20.0 mm. </span></span></div></div><div><div><span style="font-family: trebuchet; font-size: medium;"><span>"B": ultrasound findings of nodules </span><span>≥</span><span> 5.1 mm and/or cysts </span><span>≥</span><span> 20.1 mm.</span></span></div></div></blockquote><div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> </span>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.)</span></div><div><ul><li><span style="font-family: trebuchet; font-size: medium;">Second round (71 cases): 33 cases with A1, 32 cases with A2 (7 nodules and 25 cysts), 5 cases with B, and 1 case previously unexamined</span></li><li><span style="font-family: trebuchet; font-size: medium;">Third round (31 cases): 7 cases with A1, 14 cases with A2 (4 nodules and 10 cysts), 7 cases with B, and 3 cases previously unexamined</span></li><li><span style="font-family: trebuchet; font-size: medium;">Fourth round (39 cases): 6 cases with A1, 20 cases with A2 (6 nodules, 13 cysts, and 1 nodule & cyst), 9 cases with B, and 4 cases previously unexamined</span></li><li><span style="font-family: trebuchet;"><span style="font-size: medium;">Fifth round (34 cases): 8</span><span style="font-size: medium;"> cases with A1, 15 cases with A2 (14 cysts and 1 nodule & cyst), 6 cases with B, and 5 cases previously unexamined</span></span></li><li><span style="font-family: trebuchet; font-size: medium;"><span>Age 25 Milestone Screening (22 cases): 1 case with A1, 4</span> cases with A2 (1 nodule and 3 cyst), 4 cases with B, and 13 cases previously unexamined</span></li><li><span style="font-family: trebuchet; font-size: medium;"><span>Age 30 Milestone Screening (3 cases): unknown</span></span></li></ul></div></div></div><p><span style="font-family: trebuchet;"><span style="font-size: medium;"> </span></span></p><div><span style="font-family: trebuchet; font-size: medium;"> </span></div>@YuriHiranumahttp://www.blogger.com/profile/16819451884150838540noreply@blogger.com0tag:blogger.com,1999:blog-9200156515048577812.post-10692678083447731712023-04-09T16:17:00.001-07:002023-08-03T19:46:32.847-07:00Fukushima Thyroid Examination March 2023: 247 Surgically Confirmed as Thyroid Cancer Among 302 Cytology Suspected Cases<p><span style="font-family: trebuchet;"> </span></p><p><span style="font-family: trebuchet;"><span><span style="font-size: medium;"><b style="font-size: xx-large;">Overview</b></span></span></span></p><p><span style="font-family: trebuchet;"><span><span><span style="font-size: medium;"> On March 22, 2023, <a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-40.html" target="_blank">t</a></span><span style="font-size: medium;"><a href="https://www.pref.fukushima.lg.jp/sec/21045b/kenkocyosa-kentoiinkai-47.html" target="_blank">he 47th session of the Oversight Committee</a> for the <a href="https://fhms.jp/en/fhms/" target="_blank">Fukushima Health Management Survey</a> (FHMS) convened online and in Fukushima City</span></span></span><span style="font-size: medium;">, releasing a new set of results (data up to September 30, 2022) from the</span><span style="font-size: medium;"><span> </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/561237.pdf" target="_blank">fifth</a><span> </span></span><span style="font-size: medium;">round as well as the biannually reported <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/561239.pdf" target="_blank">Age 25 Milestone Screening</a> </span><span style="font-size: medium;"><span>of </span><span>the <a href="https://fhms.jp/en/fhms/thyroid/" target="_blank">Thyroid Ultrasound Examination</a> (TUE). </span><span> It amounts to 3-month worth of data since the previous session held on December 2, 2022 for the fifth round (see <a href=" https://fukushimavoice-eng2.blogspot.com/2022/12/fukushima-thyroid-examination-december.html" target="_blank">previous post</a>) and 6-month worth of data for the Age 25 Milestone Screening since the 45th Oversight Committee session (as reported in <a href="https://fukushimavoice-eng2.blogspot.com/2022/09/fukushima-thyroid-examination-september.html" target="_blank">this post</a>). </span></span></span></p><p><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> In addition, the <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/561337.pdf" target="_blank">final results of the 4th round</a> were released at the <a href="https://www.pref.fukushima.lg.jp/sec/21045b/kenkocyosa-kentoiinkai-b20.html" target="_blank">20th session of the TUE Assessment Subcommittee</a> (TUE Subcommittee herein) held on March 20, 2023. Unless it is also reported to the next Oversight Committee session, the fourth-round final results might have the same fate as the second-round final results, which was only reported to the TUE Subcommittee, for not having official English translation. However, because the content of the fourth-round final results is identical to the <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/543338.pdf" target="_blank">results reported at the 46th session</a> of the Oversight Committee, official translation will eventually appear on the Materials and Minutes of Prefectural Oversight Committee Meetings page (<a href="https://fhms.jp/en/fhms/outline/materials/" target="_blank">link</a>) of the <a href="https://fhms.jp/en/" target="_blank">website</a> of </span></span></span><span style="font-family: trebuchet; font-size: medium;">Radiation Medical Science Center of the Fukushima Health Management Survey (RMSC/FHMS). As of today, official English translation is available up to the 42nd session </span><span style="font-family: trebuchet; font-size: medium;">(</span><a href="https://fhms.jp/fhms/uploads/42_26Jul2021.pdf" style="font-family: trebuchet; font-size: medium;" target="_blank">PDF link</a><span style="font-family: trebuchet; font-size: medium;">)</span><span style="font-family: trebuchet; font-size: medium;">. </span><span style="font-family: trebuchet; font-size: medium;">This website also shows an </span><a href="https://fhms.jp/en/fhms/outline/" style="font-family: trebuchet; font-size: medium;" target="_blank">outline of the FHMS</a><span style="font-family: trebuchet; font-size: medium;"> and </span><a href="https://fhms.jp/en/fhms/thyroid/" style="font-family: trebuchet; font-size: medium;" target="_blank">TUE itself</a><span style="font-family: trebuchet; font-size: medium;">.</span></p><div style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 12px auto 6px;"><div><span style="font-weight: 700;"><span><span style="font-family: trebuchet; font-size: medium;"> </span></span></span></div><div><span style="font-weight: 700;"><span><span style="font-family: trebuchet; font-size: x-large;">Highlights</span></span></span></div><b><ul><span style="font-family: trebuchet; font-size: medium;"><li><b>The fourth round: The final report issued.</b></li><li><b>The fifth round: 3 new cases diagnosed as suspicious or malignant, and 9 new surgical cases.</b></li><li><b>Age 25 Milestone Screening: 3 new cases diagnosed as suspicious or malignant and 1 new surgical case.</b></li><li><b>Total number of suspected/confirmed thyroid cancer has increased by 6 to</b> <span style="color: red;">302</span><b>: </b><b>116 in the first round (in<b>cluding a single case of benign tumor</b>), 71 in the second round, 31 in the third round, 39 in the fourth round, 26 in the fifth round, and 19 in Age 25 Milestone Screening.</b></li><li><b>Total number of surgically confirmed thyroid cancer cases has increased by 10 to <span style="color: red;">247</span><span style="color: red;"> </span>(101 in the first round, 56 in the second round, 29 in the third round, 34 in the fourth round, 16 in the fifth round, and 11 in Age 25 Milestone Screening,</b></li></span></ul></b><div><span><b><span style="font-family: trebuchet; font-size: x-large;"><br /></span></b></span></div><div><span><b><span style="font-family: trebuchet; font-size: x-large;">The latest overall results including the "unreported" and cancer registry cases</span></b></span></div><div><span><span style="font-family: trebuchet;"><span><span style="font-size: medium;"> Please refer to </span></span></span></span><span style="font-size: medium;"><span style="font-family: trebuchet;"><span>the </span><a href="https://fukushimavoice-eng2.blogspot.com/2021/06/fukushima-thyroid-examination-may-2021.html" target="_blank">the post on May 2021 report</a> regarding the details of "unreported" cases and cancer registry data. </span><span style="font-family: trebuchet;">(<a href="https://fukushimavoice-eng2.blogspot.com/2018/07/results-of-survey-on-fukushima-thyroid.html" target="_blank">A July 2018 post</a> describes the origin of the first 11"unreported" cases, and their histological diagnoses were obtained from <a href="https://www.jstage.jst.go.jp/article/fms/65/3/65_2019-26/_html/-char/ja" target="_blank">this paper</a>.)</span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> The o</span>fficial count, as reported above and also in the summary document shown in the next section, is <b>302</b> suspected/confirmed and <b>247</b> surgically confirmed thyroid cancer cases. With an addition of the most recent numbers for both "unreported" cases (see <a href="https://fukushimavoice-eng2.blogspot.com/2021/06/fukushima-thyroid-examination-may-2021.html" target="_blank">this post</a>) and "outside" cases discovered in the cancer registry (<a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/524933.pdf" target="_blank">updated</a> at the <a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-b19.html" target="_blank">19th session</a> of the <a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-b.html" target="_blank">TUE Subcommittee</a>), the count increases to <b>380</b> cytologically suspected/confirmed and <b>309 surgically confirmed </b>cancer cases. </span></div><div><span style="font-family: trebuchet; font-size: medium;"> It should be noted that the actual number of cases is likely more due to lack of any past, present or future exhaustive investigation by Fukushima Medical University (FMU), which is necessary to gather <i>all</i> the cancer cases discovered outside the framework of the FHMS-TUE.</span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkN8oPISYeEBMofvByQRSl6YeTBGGCJn7Yi5hsNRv8TAsLouxQUgsmZKYQNJVvdgJsGrCgfrGhLVQxJo7IuZBvVh1UL_lTerfYh-U5ta6OgMwo-8VXQx1pqPIu-G_TbhoIeLq2dYM1NHuFOJOklCszuPP9F4hZPfKDkEIFXZFrlRN6wWyBsP7CNJ1XKw/s590/%2347%20Latest%20data%20screenshot.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="470" data-original-width="590" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjkN8oPISYeEBMofvByQRSl6YeTBGGCJn7Yi5hsNRv8TAsLouxQUgsmZKYQNJVvdgJsGrCgfrGhLVQxJo7IuZBvVh1UL_lTerfYh-U5ta6OgMwo-8VXQx1pqPIu-G_TbhoIeLq2dYM1NHuFOJOklCszuPP9F4hZPfKDkEIFXZFrlRN6wWyBsP7CNJ1XKw/s16000/%2347%20Latest%20data%20screenshot.png" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 12px auto 6px;"><div><span style="font-family: trebuchet; font-size: x-large;"><b>Summary on the current status of the TUE</b></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> </span>A seven-page <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/561251.pdf" target="_blank">summary</a> 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. </span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><span> </span>Below is an unofficial translation of this summary which is <i>not</i> officially translated.</span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;">
<p style="-x-system-font: none; display: block; font-family: Helvetica, Arial, sans-serif; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 12px auto 6px;"> <a href="https://www.scribd.com/document/637140868/47-Status-of-the-Thyroid-Ultrasound-Examination-Results-March-22-2023#from_embed" style="text-decoration: underline;" title="View #47 Status of the Thyroid Ultrasound Examination Results (March 22, 2023) on Scribd">#47 Status of the Thyroid Ultrasound Examination Results (March 22, 2023)</a> by <a href="https://www.scribd.com/user/233065310/Yuri-Hiranuma#from_embed" style="text-decoration: underline;" title="View Yuri Hiranuma's profile on Scribd">Yuri Hiranuma</a> on Scribd</p><iframe class="scribd_iframe_embed" data-aspect-ratio="0.7729220222793488" data-auto-height="false" frameborder="0" height="600" id="doc_17557" scrolling="no" src="https://www.scribd.com/embeds/637140868/content?start_page=1&view_mode=scroll&access_key=key-f7FGYYRgqchmzfiWwu8G" title="#47 Status of the Thyroid Ultrasound Examination Results (March 22, 2023)" width="100%"></iframe><br /> </span></span></div><div></div><div><span><span style="font-family: trebuchet; font-size: large;"><u><b><br /></b></u></span></span></div><div><span><span style="font-family: trebuchet; font-size: large;"><u><b>The first round</b></u></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"> There is no change in data with 116 suspected/confirmed thyroid cancer cases (39 males and 77 females), of which 102 underwent surgery confirming 1 benign nodule and 101 thyroid cancer cases (100 papillary thyroid cancer and 1 poorly-differentiated cancer). </span></div><div><span style="font-family: trebuchet; font-size: medium;"> The last update as of FY 2015 was reported at the 23rd session in June 2016 (<a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/461399.pdf" target="_blank">Japanese</a>, <a href="https://fhms.jp/fhms/uploads/23_6Jun2016.pdf#page=32" target="_blank">English</a>).</span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div><div><span><span style="font-family: trebuchet; font-size: large;"><b><u>The second round</u></b></span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"> There is no change in the number of suspected/confirmed thyroid cancer cases at 71 (32 males and 39 females). Surgical cases remain at 56 (55 papillary thyroid cancer and 1 "other" thyroid cancer) . </span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"> The most recent FY2020 update of the second round data was previously reported at the 42nd session (<a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529202.pdf" target="_blank">Japanese</a>, <a href="https://fhms.jp/fhms/uploads/42_26Jul2021.pdf" target="_blank">English</a>), with the <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529192.pdf" target="_blank">brief update</a> released at the last session showing the latest surgical data.</span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div><div><span><span style="font-family: trebuchet; font-size: large;"><b><u>The third round</u></b></span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"> </span><span style="font-size: medium;"><span>There is no change in data with 31 suspected/confirmed thyroid cancer cases (13 males and 18 males), of which 29 were surgically confirmed as papillary thyroid cancer. The final report from the 39th session in August 2020</span><span><span> (</span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/401325.pdf" target="_blank"><span>Japanese</span></a><span>, </span></span><a href="https://fhms.jp/fhms/uploads/39_31Aug2020.pdf#page=2" target="_blank">English</a><span>) </span><span>was updated as of FY2020 and reported at the 42nd session in July 2021</span><span> (</span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/461565.pdf" target="_blank">Japanese</a><span>, </span><a href="https://fhms.jp/fhms/uploads/42_26Jul2021.pdf#page=4" target="_blank">English</a><span>).</span></span></span></div><div><span style="font-family: trebuchet;"> </span></div></div></div><div><div><span style="font-family: trebuchet;"><span face=""><u><span style="font-size: large;"><b>The fourth round</b></span></u></span><br /><span face=""><span style="font-size: medium;"><span> The</span> <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529187.pdf" target="_blank">fourth round</a>, originally scheduled from April 1, 2018 through March 31, 2020, is now complete. The <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/561337.pdf" target="_blank">final report</a> was presented to the <a href="https://www.pref.fukushima.lg.jp/sec/21045b/kenkocyosa-kentoiinkai-b20.html" target="_blank">20th TUE Subcommittee session</a> on March 20, 2023. There are 39</span></span></span><span style="font-family: trebuchet; font-size: medium;"><span style="font-family: trebuchet;"> suspected or confirmed thyroid cancer cases</span></span><span style="font-family: trebuchet; font-size: medium;">, of which 34 have been surgically confirmed as papillary thyroid cancer. </span></div><div><span style="font-family: trebuchet;"><br /></span></div><div><span style="font-family: trebuchet;"><u><span style="font-size: large;"><b>The fifth round</b></span></u></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> </span>The <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/543339.pdf" target="_blank">fifth round</a> targets 252,915 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. (It has <a href="https://fukushimavoice-eng2.blogspot.com/2021/01/fukushima-thyroid-examination-january.html" target="_blank">previously been discussed</a> how this exclusion skews age distribution graphs to the left.)</span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> </span>Th</span><span><span style="font-size: medium;">e 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.</span></span><span><span><span style="font-size: medium;"> [Note: </span></span><span style="font-size: medium;">The fifth round was originally earmarked for FY 2020-2021 (April 2, 2020 to March 31, 2022), but the pandemic has forced an extension of the screening period by one year as described in <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/446622.pdf" target="_blank">this proposal</a>: 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.] </span></span></span></div><div><span style="font-family: trebuchet;"><span><span style="font-size: medium;"> The <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529194.pdf" target="_blank">sixth round</a> is expected to return to a two-year screening cycle beginning April 2023.</span></span></span></div><div><span style="font-family: trebuchet;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"> </span><span style="font-family: trebuchet; font-size: medium;">As of September 30, 2022, 89,094 participated in the primary examination, including 8,889 new participants, and its participation rate slightly increased from 31.7% to 35.2%, finally exceeding half of the fourth-round participation rate. Participation rates by age group changed from 52.7% to 58.4% in ages 8-11, from 38.1% to 43.3% in ages 12-17, and from 10.6% to 10.8% in ages over 18: changes in the first two age groups probably reflecting progress of the school-based screening. The primary examination results only increased by 6,475 to 82,368 and the number of "B" assessment, which qualifies for the confirmatory examination, </span><span style="font-family: trebuchet; font-size: medium;">only increased by 62 to 1,001</span><span style="font-family: trebuchet; font-size: medium;">. </span></div><div><span style="font-family: trebuchet; font-size: medium;"> Of sixty-two who newly participated in the confirmatory examination, 6 underwent FNAC, and 3 females were newly diagnosed with suspected thyroid cancer. Their ages-at-exposure include ages 1, 4, and 9 years, and all 3 are from the FY 2020 municipalities. Their previous results include 1 with A1, 1 with A2 cyst, and 1 with B. </span></div><div><span style="font-family: trebuchet; font-size: medium;"> </span></div><div><span style="font-family: trebuchet; font-size: medium;"> Nine participants — seven from FY 2020 and two from FY2021 municipalities — have been confirmed with papillary thyroid cancer after undergoing surgery.</span></div><div><span style="font-family: trebuchet;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span style="font-family: trebuchet; font-size: medium;"> In summary, a</span><span style="font-size: medium;"><span style="font-family: trebuchet;">s of September 30, 2022, t</span><span style="font-family: trebuchet;">he number of suspected or confirmed thyroid cancer cases f</span></span><span style="font-family: trebuchet; font-size: medium;">or the fifth round is 26, of which 16 have been surgically confirmed as papillary thyroid cancer. </span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> The</span> previous results from the fourth round are as follows: 20 with "A" (8 with A1, 11 with A2 cysts, 1 with A2 nodules), 4 with "B," and 2 with no prior result. </span></div><div><span style="font-family: trebuchet;"><br /></span></div></div><div><div><div><span style="font-family: trebuchet;"><span face=""><span style="font-size: large;"><u><b>Age 25 Milestone Screening</b></u></span></span><br /></span><span style="font-family: trebuchet; font-size: medium;"> </span><span style="font-family: trebuchet; font-size: medium;">In the Age 25 Milestone Screening, each screening year targets a cohort turning 25 during each fiscal year, and t<span><span face="">he results are reported every 6 months. </span></span><span><span><span face="">The most recent implementation schedule available in English is from</span></span><span> September 2020, which was reported to the 41st session of the Oversight Committee and can be found <a href="https://fhms.jp/fhms/uploads/33_27Dec2018.pdf#page=37" target="_blank">here</a>. </span>(</span></span><span style="font-family: trebuchet; font-size: medium;">No one is supposed to undergo a regular TUE within 2 years of becoming eligible for the Age 25 Milestone Screening.) </span><span style="font-size: medium;"><span style="font-family: trebuchet;">Although each fiscal-year screening is earmarked for those turning 25 during that fiscal year, participants can take part in the screening anytime up to the year before they become eligible for the Age 30 Milestone Screening.</span><span style="font-family: trebuchet;"> </span></span></div><div><span style="font-family: trebuchet;"><div style="font-family: Times;"><span style="font-family: trebuchet;"><span><span style="font-size: large;"> </span></span></span></div></span></div></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><span style="font-family: trebuchet;"><div style="font-family: Times;"><span style="font-family: trebuchet;"><div><span style="font-size: medium;">Note: </span><span style="font-size: medium;">Transition of each FY birth cohort to the Age 25 Milestone Screening reduces a target population for the main TUE. This reduction began in the third round conducted during FY 2016-2017, which excluded the FY 1992 and 1993 cohorts in anticipation of the upcoming Age 25 Milestone Screening. With each FY birth cohort including about 22,000 individuals, this is a sizable reduction which continues as the TUE target population ages. An exception is an increase from 367,637 for the first round to 381,237 for the second round which is due to an inclusion of those who were in utero at the time of the accident). From then on, it has decreased to 336,667 for the third round, 294,228 for the fourth round, and now 252,902 for the fifth round.</span></div></span></div></span></blockquote><div><div><span style="font-family: trebuchet;"></span><span style="font-family: trebuchet;"><div style="font-family: Times;"><span style="font-family: trebuchet;"><span style="font-size: medium;"><br /></span></span></div><div style="font-family: Times;"><span style="font-family: trebuchet;"><span><div style="font-family: Times;"><span style="font-family: trebuchet;"><span><span style="font-size: large;"> </span><span style="font-size: medium;">The </span></span><span style="font-size: medium;"><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/561239.pdf" target="_blank">results reported this time</a><span> are from the data up to September 30, 2022, including the secondary examination results for the FY1996 cohort which were excluded in the <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529190.pdf" target="_blank">last report</a>. Also in FY2022, those born in FY1992 became eligible to participate in the Age 30 Milestone Screening, but no data was reported on this.</span></span></span></div><div style="font-family: Times;"><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> Target population from the FY1992 to FY1996 cohorts remains stable at</span></span></span><span style="font-family: trebuchet; font-size: large;"> 108,711</span><span style="font-family: trebuchet;"><span style="font-size: medium;"><span>. </span></span></span><span style="font-size: medium;">The primary examination participation increased by 399 to total participants of 10,240, and the participation rate, which had previously dipped </span><span style="font-size: medium;">due to a larger denominator from the target population increase, </span><span style="font-size: medium;">recovered from 9.1% to 9.4%.</span></div><div style="font-family: Times;"><span style="font-family: trebuchet; font-size: medium;"><span style="font-size: medium;"> An additional 46 participants received</span> "B" assessment in the primary examination this time. Together with 74 from the FY1996 cohort who were previously excluded from the confirmatory examination results, 120 more were added to the confirmatory examination qualifiers, making the total of 550. </span><span style="font-size: medium;">Eighty-three more participated in the confirmatory examination, making the total participants 436, and 416 (72 more than last time) have the final results. After FNAC was conducted in 5 individuals (with total FNAC cases of 36), 3 females were diagnosed with suspected thyroid cancer. Their ages at exposure were 14, 14, and 15 years, and their prior screening results were 1 with A1, 1 with B, and 1 with no prior screening. There is no residence location information available for these cases because the regional data is only reported for the primary examination.</span></div><div style="font-family: Times;"><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div style="font-family: Times;"><span style="font-family: trebuchet;"><span style="font-size: large;"> </span><span style="font-size: medium;">In summary, the number of suspected or confirmed thyroid cancer cases from the Age 25 Milestone Screening increased by 3 to 19. The results from the prior screening are: 5 with "A" (1 with A1, </span></span><span style="font-family: trebuchet; font-size: medium;">1 with A2 nodules, 3 with A2 cysts), 4 with "B" and 10 with no prior screening.</span></div></span></span></div></span></div><div><span style="font-family: trebuchet;"><div style="font-family: Times;"><span style="font-family: trebuchet;"><span><div style="font-family: Times;"><span style="font-family: trebuchet; font-size: medium;"> One new surgical case, confirmed as papillary thyroid cancer, was added, and the number of surgically confirmed thyroid cancer increased to 11, including 10 papillary thyroid cancers and 1 follicular thyroid cancer.</span></div><div><br /></div></span></span></div></span></div></div></div><div><div><div><span style="font-family: trebuchet; font-size: large;"><u><b>Expected upcoming changes in the dataset</b></u></span><span style="font-family: trebuchet;"> </span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"> There are two factors inherent to the implementation structure of the TUE, leading to a smaller dataset with each screening cycle. One is a reduced size of target population and the other is a decline in participation rates, both of which are already being observed and expected to progress.</span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"> As described above, a shift of a cohort to the Milestone Screening (Age 25, Age 30, etc.) with time reduces the target population in each successive screening cycle. Furthermore, school-based screening conducted through high school slows down with each cohort graduating from high school. It will eventually come to a natural halt when the youngest cohort born in FY2011 (between April 2, 2011 and April 1, 2012) finishes high school in 2029. It should be noted that the school-based screening is completely voluntary, no less the TUE itself.</span></span></div><div><span style="font-size: medium;"><span style="font-family: trebuchet;"> Convenience of the school-based screening contributes to a higher participation rate for ages up to 18 than past age 18. This is clearly shown in the most recent participation rates by age reported in this post: 58.4</span><span style="font-family: trebuchet;">% in ages 8-11, 43.3% in ages 12-17, and 10.8% in ages over 18 in the fifth round, and 9.4% for the Age 25 Milestone Screening. </span></span></div><div><span style="font-size: medium;"><span style="font-family: trebuchet;"> It is critical to recognize these expected changes for future datasets when reviewing the TUE data because they cast doubt on reliability and integrity of the TUE data itself and any analysis conducted. Retrieval of "missing data" due to "unreported cases" at any age is being attempted by matching the TUE data with regional (up to 2015) and national (from 2016 on) cancer registry data. For instance, reconciliation with the most recently available national cancer registry data up to 2018 (</span><span style="font-family: trebuchet;"><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/524933.pdf" target="_blank">document</a> from the 19th Subcommittee session<span>)</span><span> revealed 43 cases from the cancer registry, </span></span></span><span style="font-family: trebuchet; font-size: medium;">which are not included in the official TUE count. This is an increase from 27 cases up to 2017 (<a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/488957.pdf" target="_blank">reported</a> to the 18th Subcommittee session). Nonetheless the cancer registry is far from fool-proof because patients who move their official residence registry outside Fukushima are <i>not</i> reported as Fukushima cases.</span></div><div><span style="font-family: trebuchet;"><br /></span></div><div><span style="font-family: trebuchet;"><span face=""><b><span style="font-size: large;"><u>Summary of the results from the previous screen</u></span><span style="font-size: large;"><u>ing</u></span> </b></span><br /><span face=""><span><span style="font-size: large;"> </span><span style="font-size: medium;">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. </span></span></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div><span style="font-family: trebuchet; font-size: medium;"><u>Definition</u></span></div><div><span style="font-family: trebuchet; font-size: medium;">"A1": no ultrasound findings. </span></div><div><div><span style="font-family: trebuchet; font-size: medium;"><span>"A2": ultrasound findings of nodules </span><span>≤ 5.0 mm and/or cysts </span><span>≤ 20.0 mm. </span></span></div></div><div><div><span style="font-family: trebuchet; font-size: medium;"><span>"B": ultrasound findings of nodules </span><span>≥</span><span> 5.1 mm and/or cysts </span><span>≥</span><span> 20.1 mm.</span></span></div></div></blockquote><div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> </span>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.)</span></div><div><ul><li><span style="font-family: trebuchet; font-size: medium;">Second round (71 cases): 33 cases with A1, 32 cases with A2 (7 nodules and 25 cysts), 5 cases with B, and 1 case previously unexamined</span></li><li><span style="font-family: trebuchet; font-size: medium;">Third round (31 cases): 7 cases with A1, 14 cases with A2 (4 nodules and 10 cysts), 7 cases with B, and 3 cases previously unexamined</span></li><li><span style="font-family: trebuchet; font-size: medium;">Fourth round (39 cases): 6 cases with A1, 20 cases with A2 (6 nodules, 13 cysts, and 1 nodule & cyst), 9 cases with B, and 4 cases previously unexamined</span></li><li><span style="font-family: trebuchet;"><span style="font-size: medium;">Fifth round (26 cases): 8</span><span style="font-size: medium;"> case with A1, 12 cases with A2 (11 cysts and 1 nodule & cyst), 4 cases with B, and 2 cases previously unexamined</span></span></li><li><span style="font-family: trebuchet; font-size: medium;"><span>Age 25 Milestone Screening (19 cases): 1 case with A1, 4</span> cases with A2 (1 nodule and 3 cyst), 4 cases with B, and 10 cases previously unexamined</span></li></ul></div></div></div><p><span style="font-family: trebuchet;"><span style="font-size: medium;"> </span></span></p><div><span style="font-family: trebuchet; font-size: medium;"> </span></div>@YuriHiranumahttp://www.blogger.com/profile/16819451884150838540noreply@blogger.com0tag:blogger.com,1999:blog-9200156515048577812.post-73353106912355286882022-12-13T23:01:00.000-08:002022-12-13T23:01:22.447-08:00Fukushima Thyroid Examination December 2022: 237 Surgically Confirmed as Thyroid Cancer Among 296 Cytology Suspected Cases<p><span style="font-family: trebuchet;"> </span></p><p><span style="font-family: trebuchet;"><span><span style="font-size: medium;"><b style="font-size: xx-large;">Overview</b></span></span></span></p><p><span style="font-family: trebuchet;"><span><span><span style="font-size: medium;"> On December 2, 2022, <a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-40.html" target="_blank">t</a></span><span style="font-size: medium;"><a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-46.html" target="_blank">he 46th session of the Oversight Committee</a> for the <a href="https://fhms.jp/en/fhms/" target="_blank">Fukushima Health Management Survey</a> (FHMS) convened online and in Fukushima City</span></span></span><span style="font-size: medium;">, releasing a new set of results (data up to June 30, 2022) from the</span><span style="font-size: medium;"><span> </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/543338.pdf" target="_blank">fourth</a><span> and </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/543339.pdf" target="_blank">fifth</a><span> </span></span><span style="font-size: medium;">rounds </span><span style="font-size: medium;"><span>of </span><span>the <a href="https://fhms.jp/en/fhms/thyroid/" target="_blank">Thyroid Ultrasound Examination</a> (TUE). </span><span> It amounts to 3-month worth of data since the previous session held on September 1, 2022 (see <a href="https://fukushimavoice-eng2.blogspot.com/2022/09/fukushima-thyroid-examination-september.html" target="_blank">previous post</a>). </span></span></span></p><p><span style="font-size: medium;"><span><span style="font-family: trebuchet;"> Official English translation (<a href="https://fhms.jp/en/fhms/outline/materials/" target="_blank">link</a>) is available up to the 42nd session (<a href="https://fhms.jp/fhms/uploads/42_26Jul2021.pdf" target="_blank">PDF link</a>) of the Oversight Committee on <a href="https://fhms.jp/en/fhms/outline/materials/" target="_blank">this page</a> of the <a href="https://fhms.jp/en/" target="_blank">website</a> of t</span><span style="font-family: trebuchet;">he Radiation Medical Science Center of the Fukushima Health Management Survey (RMSC/FHMS). This website also shows an <a href="https://fhms.jp/en/fhms/outline/" target="_blank">outline of the FHMS</a> and <a href="https://fhms.jp/en/fhms/thyroid/" target="_blank">TUE itself</a>.</span></span></span></p><div style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 12px auto 6px;"><div><span style="font-weight: 700;"><span><span style="font-family: trebuchet; font-size: medium;"> </span></span></span></div><div><span style="font-weight: 700;"><span><span style="font-family: trebuchet; font-size: x-large;">Highlights</span></span></span></div><b><ul><span style="font-family: trebuchet; font-size: medium;"><li><b>The fourth round: no change. The final report could be imminent.</b></li><li><b>The fifth round: 12 new cases diagnosed as suspicious or malignant, and 1 new surgical case.</b></li><li><b>Total number of suspected/confirmed thyroid cancer has increased by 12 to</b> <span style="color: red;">296</span><b>: </b><b>116 in the first round (in<b>cluding a single case of benign tumor</b>), 71 in the second round, 31 in the third round, 39 in the fourth round, 23 in the fifth round, and 16 in Age 25 Milestone Screening.</b></li><li><b>Total number of surgically confirmed thyroid cancer cases has increased by 1 to <span style="color: red;">237</span><span style="color: red;"> </span>(101 in the first round, 56 in the second round, 29 in the third round, 34 in the fourth round, 7 in the fifth round, and 10 in Age 25 Milestone Screening,</b></li></span></ul></b><div><span><b><span style="font-family: trebuchet; font-size: x-large;"><br /></span></b></span></div><div><span><b><span style="font-family: trebuchet; font-size: x-large;">The latest overall results including the "unreported" and cancer registry cases</span></b></span></div><div><span><span style="font-family: trebuchet;"><span><span style="font-size: medium;"> Please refer to </span></span></span></span><span style="font-size: medium;"><span style="font-family: trebuchet;"><span>the </span><a href="https://fukushimavoice-eng2.blogspot.com/2021/06/fukushima-thyroid-examination-may-2021.html" target="_blank">the post on May 2021 report</a> regarding the details of "unreported" cases and cancer registry data. </span><span style="font-family: trebuchet;">(<a href="https://fukushimavoice-eng2.blogspot.com/2018/07/results-of-survey-on-fukushima-thyroid.html" target="_blank">A July 2018 post</a> describes the origin of the first 11"unreported" cases, and their histological diagnoses were obtained from <a href="https://www.jstage.jst.go.jp/article/fms/65/3/65_2019-26/_html/-char/ja" target="_blank">this paper</a>.)</span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> The o</span>fficial count, as reported above and also in the summary document shown in the next section, is <b>284</b> suspected/confirmed and <b>236</b> surgically confirmed thyroid cancer cases. With an addition of the most recent numbers for both "unreported" cases (see <a href="https://fukushimavoice-eng2.blogspot.com/2021/06/fukushima-thyroid-examination-may-2021.html" target="_blank">this post</a>) and "outside" cases discovered in the cancer registry (<a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/524933.pdf" target="_blank">updated</a> at the <a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-b19.html" target="_blank">19th session</a> of the <a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-b.html" target="_blank">TUE Subcommittee</a>), the count increases to <b>362</b> cytologically suspected/confirmed and <b>297 surgically confirmed </b>cancer cases. </span></div><div><span style="font-family: trebuchet; font-size: medium;"> It should be noted that the actual number of cases is likely more due to lack of any past, present or future exhaustive investigation by Fukushima Medical University (FMU), which is necessary to gather <i>all</i> the cancer cases discovered outside the framework of the FHMS-TUE.</span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEief0zJKjnDAFFa7Z2OyHz7d5bqjGexERii7Evfxs2dxKSOWpAU13lXatkWqJ_MILq6KNnV9aefxYuT9Wly3n9y7SkD54lx-WNB1gVhOmXQp9CU_Id0t2SSow1CHj0Gy32LUI8vqitZKuBP4mB45jLSUQjCxrYEMk5A5MmwrMjCwef1j2_poBkLVy6wGg/s592/%2346%20Latest%20results%20screenshot.png" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: trebuchet;"><img border="0" data-original-height="469" data-original-width="592" height="508" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEief0zJKjnDAFFa7Z2OyHz7d5bqjGexERii7Evfxs2dxKSOWpAU13lXatkWqJ_MILq6KNnV9aefxYuT9Wly3n9y7SkD54lx-WNB1gVhOmXQp9CU_Id0t2SSow1CHj0Gy32LUI8vqitZKuBP4mB45jLSUQjCxrYEMk5A5MmwrMjCwef1j2_poBkLVy6wGg/w640-h508/%2346%20Latest%20results%20screenshot.png" width="640" /></span></a></div><span style="font-family: trebuchet;"><br /></span><div class="separator" style="clear: both; text-align: center;"><span style="font-family: trebuchet;"><br /></span></div><div style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 12px auto 6px;"><div><span style="font-family: trebuchet; font-size: x-large;"><b>Summary on the current status of the TUE</b></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> </span>A seven-page <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/543346.pdf" target="_blank">summary</a> 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. </span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><span> </span>Below is an unofficial translation of this summary which is <i>not</i> officially translated.</span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;">
<p style="-x-system-font: none; display: block; font-family: Helvetica,Arial,Sans-serif; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 12px auto 6px;"> <a href="https://www.scribd.com/document/613376279/46-Status-of-the-Thyroid-Ultrasound-Examination-Results-Released-on-December-2-2022#from_embed" style="text-decoration: underline;" title="View #46 Status of the Thyroid Ultrasound Examination Results (Released on December 2, 2022) on Scribd">#46 Status of the Thyroid Ultrasound Examination Results (Released on December 2, 2022)</a> by <a href="https://www.scribd.com/user/233065310/Yuri-Hiranuma#from_embed" style="text-decoration: underline;" title="View Yuri Hiranuma's profile on Scribd">Yuri Hiranuma</a> on Scribd</p><iframe class="scribd_iframe_embed" data-aspect-ratio="0.7729220222793488" data-auto-height="true" frameborder="0" height="600" id="doc_8095" scrolling="no" src="https://www.scribd.com/embeds/613376279/content?start_page=1&view_mode=scroll&access_key=key-Kh7VaQUFSGOmqmzXnmHd" title="#46 Status of the Thyroid Ultrasound Examination Results (Released on December 2, 2022)" width="100%"></iframe><script type="text/javascript">(function() { var scribd = document.createElement("script"); scribd.type = "text/javascript"; scribd.async = true; scribd.src = "https://www.scribd.com/javascripts/embed_code/inject.js"; var s = document.getElementsByTagName("script")[0]; s.parentNode.insertBefore(scribd, s); })();</script> </span></span></div><div><span><span style="font-family: trebuchet; font-size: large;"><u><b>The first round</b></u></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"> There is no change in data with 116 suspected/confirmed thyroid cancer cases (39 males and 77 females), of which 102 underwent surgery confirming 1 benign nodule and 101 thyroid cancer cases (100 papillary thyroid cancer and 1 poorly-differentiated cancer). </span></div><div><span style="font-family: trebuchet; font-size: medium;"> The last update as of FY 2015 was reported at the 23rd session in June 2016 (<a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/461399.pdf" target="_blank">Japanese</a>, <a href="https://fhms.jp/fhms/uploads/23_6Jun2016.pdf#page=32" target="_blank">English</a>).</span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div><div><span><span style="font-family: trebuchet; font-size: large;"><b><u>The second round</u></b></span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"> There is no change in the number of suspected/confirmed thyroid cancer cases at 71 (32 males and 39 females). Surgical cases remain at 56 (55 papillary thyroid cancer and 1 "other" thyroid cancer) . </span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"> The most recent FY2020 update of the second round data was previously reported at the 42nd session (<a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529202.pdf" target="_blank">Japanese</a>, <a href="https://fhms.jp/fhms/uploads/42_26Jul2021.pdf" target="_blank">English</a>), with the <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529192.pdf" target="_blank">brief update</a> released at the last session showing the latest surgical data.</span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div><div><span><span style="font-family: trebuchet; font-size: large;"><b><u>The third round</u></b></span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"> </span><span style="font-size: medium;"><span>There is no change in data with 31 suspected/confirmed thyroid cancer cases (13 males and 18 males), of which 29 were surgically confirmed as papillary thyroid cancer. The final report from the 39th session in August 2020</span><span><span> (</span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/401325.pdf" target="_blank"><span>Japanese</span></a><span>, </span></span><a href="https://fhms.jp/fhms/uploads/39_31Aug2020.pdf#page=2" target="_blank">English</a><span>) </span><span>was updated as of FY2020 and reported at the 42nd session in July 2021</span><span> (</span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/461565.pdf" target="_blank">Japanese</a><span>, </span><a href="https://fhms.jp/fhms/uploads/42_26Jul2021.pdf#page=4" target="_blank">English</a><span>).</span></span></span></div><div><span style="font-family: trebuchet;"> </span></div></div></div><div><div><span style="font-family: trebuchet;"><span face=""><u><span style="font-size: large;"><b>The fourth round</b></span></u></span><br /><span face=""><span style="font-size: medium;"><span> The</span> <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529187.pdf" target="_blank">fourth round</a>, originally scheduled from April 1, 2018 through March 31, 2020, appears to be near completion. Only 3 more participated in the primary examination between April 1, 2022 and June 30, 2022, with no change in participation rate of </span></span></span><span style="font-family: trebuchet;"><span face=""><span style="font-size: medium;">62.3%</span><span style="font-size: medium;"><span>. This is still below what the prior rounds registered (</span></span></span></span><span style="font-size: medium;"><span style="font-family: trebuchet;">81.7% for the first round, 71.0% for the second round, and 64.7% for the third round).</span></span></div><div><span style="font-family: trebuchet;"><span face=""><span style="font-size: medium;"> Two participants newly received the "B" assessment, but no one underwent the </span></span></span><span style="font-size: medium;"><span style="font-family: trebuchet;">confirmatory examination or FNAC (fine-needle aspiration cytology). There were no new surgical cases, either.</span></span></div><div><span style="font-family: trebuchet;"><span face=""><span style="font-size: medium;"><div><span style="font-size: medium;"><span style="font-family: trebuchet;"><br /></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> </span>In summary, a</span><span style="font-size: medium;"><span style="font-family: trebuchet;">s of June 30, 2022, t</span><span style="font-family: trebuchet;">he number of suspected or confirmed thyroid cancer cases f</span></span><span style="font-family: trebuchet; font-size: medium;">or the fourth round remains at 39, of which 34 have been surgically confirmed as papillary thyroid cancer. </span></div><div><span style="font-family: trebuchet;"><span face="" style="font-size: medium;"><span> The</span> previous results from the third round are as follows: 26 with "A" (6 with A1, 13 with A2 cysts, 6 with A2 nodules, and 1 with A2 cysts and nodules), 9 with "B," and 4 with no prior result. </span></span></div></span></span></span></div><div><span style="font-family: trebuchet;"><br /></span></div><div><span style="font-family: trebuchet;"><u><span style="font-size: large;"><b>The fifth round</b></span></u></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> </span>The <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/543339.pdf" target="_blank">fifth round</a> targets 252,908 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. (It has <a href="https://fukushimavoice-eng2.blogspot.com/2021/01/fukushima-thyroid-examination-january.html" target="_blank">previously been discussed</a> how this exclusion skews age distribution graphs to the left.)</span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> </span>Th</span><span><span style="font-size: medium;">e 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.</span></span><span><span><span style="font-size: medium;"> [Note: </span></span><span style="font-size: medium;">The fifth round was originally earmarked for FY 2020-2021 (April 2, 2020 to March 31, 2022), but the pandemic has forced an extension of the screening period by one year as described in <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/446622.pdf" target="_blank">this proposal</a>: 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.] </span></span></span></div><div><span style="font-family: trebuchet;"><span><span style="font-size: medium;"> The <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529194.pdf" target="_blank">sixth round</a> is expected to return to a two-year screening cycle beginning April 2023.</span></span></span></div><div><span style="font-family: trebuchet;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"> </span><span style="font-family: trebuchet; font-size: medium;">As of June 30, 2022, 80,205 participated in the primary examination, including 5,241 new participants, and its participation rate slightly increased from 29.6% to 31.7%, still quite low at only half of the fourth-round participation rate. Participation rates by age group slightly increased from 48.1% to 52.7% in ages 8-11, from 36.0% to 38.1% in ages 12-17, and from 10.3% to 10.6% in ages over 18. The primary examination results only increased by 6,046 to 75,868, and the number of "B" assessment, which qualifies for the confirmatory examination, </span><span style="font-family: trebuchet; font-size: medium;">only increased by 70 to 939</span><span style="font-family: trebuchet; font-size: medium;">. </span></div><div><span style="font-family: trebuchet; font-size: medium;"> Sixty-six newly participated in the confirmatory examination, 16 underwent FNAC, and 12 (4 males and 8 females) were newly diagnosed with suspected thyroid cancer. Their ages-at-exposure include age 2, 4, 7 and 10 years for males and ages 2, 3, 5, 6 (four), and 12 for females. Two males and all 8 females are from the FY 2020 municipalities, with the remaining two males from the FY 2021 municipalities. Their previous results include 4 with A1, 6 with A2 cyst, 1 with B, and 1 with no prior examination. </span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"> Maximum tumor diameter increased by 32.0 mm to 46.7 mm. It's not as if this increased occurred during the 3-month period since the last data compilation date, but most likely it's from a participant who never underwent prior rounds of screening.</span></div><div><span style="font-family: trebuchet; font-size: medium;"> </span></div><div><span style="font-family: trebuchet; font-size: medium;"> One from FY 2020 municipalities has been confirmed with papillary thyroid cancer after undergoing surgery.</span></div><div><span style="font-family: trebuchet;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span style="font-family: trebuchet; font-size: medium;"> In summary, a</span><span style="font-size: medium;"><span style="font-family: trebuchet;">s of June 30, 2022, t</span><span style="font-family: trebuchet;">he number of suspected or confirmed thyroid cancer cases f</span></span><span style="font-family: trebuchet; font-size: medium;">or the fifth round is 23, of which 7 have been surgically confirmed as papillary thyroid cancer. </span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> The</span> previous results from the fourth round are as follows: 18 with "A" (7 with A1, 10 with A2 cysts, 1 with A2 nodules), 3 with "B," and 1 with no prior result. </span></div><div><span style="font-family: trebuchet;"><br /></span></div></div><div><u><b><span style="font-family: trebuchet; font-size: large;">TUE questionnaire survey</span></b></u></div><div><span style="font-family: trebuchet;"><br /></span></div><div><span style="font-family: trebuchet;"> <span style="font-size: medium;">Agenda for this session included a draft questionnaire survey (see <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/543340.pdf" target="_blank">this link</a>) designed to gauge participants' understanding of the TUE itself as well as its pros and cons. The survey targets four populations including approximately 64,000 individuals under age 15, 52,000 individuals aged 15-18, 52,000 guardians of individuals aged 15-18, and 266,000 individuals over 18. Four thousands from each group will be selected as survey subjects and receive the questionnaire, with four hundred responses (written or online) expected. Selection criteria for the survey subjects are unclear other than being drawn from those who signed a consent form for the TUE. Because the consent form for participants under age 16 is signed by guardians, survey subjects for the first group (under age 15) will be the guardians by default. Survey subjects for the third group, another set of guardians, will not be necessarily from the same household as the second group.</span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"> During the discussion, questions were raised regarding the sampling method of the proposed survey, especially if the responses will constitute a fairly representation of the respective population. Discussion became further heated when the Ministry of the Environment (MOE) official Masahiro Kaminota made a request that the questionnaire (see the draft version <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/543341.pdf" target="_blank">here</a>) should fully inform the survey subjects of "the conclusion by the UNSCEAR 2020/2021 report that future health effects by radiation exposure are not likely." His view takes words from authoritative international agencies at face values, and it appeared to draw a few endorsers. However, multiple committee members made rebuttals doubting the validity of this so-called "conclusion." Furthermore, doubts were raised regarding appropriateness to include such a definitive clause in a survey whose main purpose is to study how the pros and cons of the TUE are recognized and understood. </span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"> To put these discussions in perspective, it should not be forgotten that it was the MOE itself that <i>planned and fully funded</i> the IARC international expert group "TM-NUC" that ended up recommending against systematic thyroid cancer screening, like Fukushima's TUE, after future nuclear accidents. Academic discourse within Japan about thyroid cancer in Fukushima has essentially taken a binary form, with the overdiagnosis group advocating discontinuation of the TUE while FMU claims that early diagnosis and treatment have been beneficial and the TUE should be continued. Although the TM-NUC has repeatedly expressed that their work was not meant for Fukushima's TUE, their recommendations have been hailed by the overdiagnosis group as a proof that the TUE should be scaled down. However, official data and analyses sourced by international agencies are biased and lack transparency. Please see <a href="https://fukushimavoice-eng2.blogspot.com/2017/11/circumstances-regarding-japan-sponsored.html" target="_blank">this post</a> on how the TM-NUC transpired and <a href="https://fukushimavoice-eng2.blogspot.com/2019/06/pediatric-and-adolescent-thyroid-cancer.html" target="_blank">this post</a> to understand the contorted and chaotic chain of events surrounding Fukushima's thyroid cancer saga. </span></div><div><span style="font-family: trebuchet;"><br /></span></div><div><div><span style="font-family: trebuchet; font-size: large;"><b><u>Journal of Epidemiology Special Issue</u></b></span></div><div><span style="font-family: trebuchet;"> </span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"> It was announced that the December 5, 2022 issue of Journal of Epidemiology, an official English publication of the Japan Epidemiological Association, would include 11 articles related to the FHMS. These articles can be accessed <a href="https://www.jstage.jst.go.jp/browse/jea/32/Supplement_XII/_contents/-char/en" target="_blank">here</a>. </span></span></div></div><div><span style="font-family: trebuchet;"><br /></span></div><div><div><div><span style="font-family: trebuchet; font-size: large;"><u><b>Expected upcoming changes in the dataset</b></u></span></div><div><span style="font-family: trebuchet;"> </span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"> There are two factors inherent to the implementation structure of the TUE, leading to a smaller dataset with each screening cycle. One is a reduced size of target population and the other is a decline in participation rates, both of which are already being observed and expected to progress.</span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"> As described above, a shift of a cohort to the Milestone Screening (Age 25, Age 30, etc.) with time reduces the target population in each successive screening cycle. Furthermore, school-based screening conducted through high school slows down with each cohort graduating from high school. It will eventually come to a natural halt when the youngest cohort born in FY2011 (between April 2, 2011 and April 1, 2012) finishes high school in 2029. It should be noted that the school-based screening is completely voluntary, no less the TUE itself.</span></span></div><div><span style="font-size: medium;"><span style="font-family: trebuchet;"> Convenience of the school-based screening contributes to a higher participation rate for ages up to 18 than past age 18. This is clearly shown in the most recent participation rates by age reported in this post: </span><span style="font-family: trebuchet;">48.1% in ages 8-11, 36.0% in ages 12-17, and 10.3% in ages over 18 in the fifth round, and 9.1% for the Age 25 Milestone Screening. </span></span></div><div><span style="font-size: medium;"><span style="font-family: trebuchet;"> It is critical to recognize these expected changes for future datasets when reviewing the TUE data because they cast doubt on reliability and integrity of the TUE data itself and any analysis conducted. Retrieval of "missing data" due to "unreported cases" at any age is being attempted by matching the TUE data with regional (up to 2015) and national (from 2016 on) cancer registry data. For instance, reconciliation with the most recently available national cancer registry data up to 2018 (</span><span style="font-family: trebuchet;"><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/524933.pdf" target="_blank">document</a> from the 19th Subcommittee session<span>)</span><span> revealed 43 cases from the cancer registry, </span></span></span><span style="font-family: trebuchet; font-size: medium;">which are not included in the official TUE count. This is an increase from 27 cases up to 2017 (<a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/488957.pdf" target="_blank">reported</a> to the 18th Subcommittee session). Nonetheless the cancer registry is far from fool-proof because patients who move their official residence registry outside Fukushima are <i>not</i> reported as Fukushima cases.</span></div><div><span style="font-family: trebuchet;"><br /></span></div><div><span style="font-family: trebuchet;"><span face=""><b><span style="font-size: large;"><u>Summary of the results from the previous screen</u></span><span style="font-size: large;"><u>ing</u></span> </b></span><br /><span face=""><span><span style="font-size: large;"> </span><span style="font-size: medium;">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. </span></span></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div><span style="font-family: trebuchet; font-size: medium;"><u>Definition</u></span></div><div><span style="font-family: trebuchet; font-size: medium;">"A1": no ultrasound findings. </span></div><div><div><span style="font-family: trebuchet; font-size: medium;"><span>"A2": ultrasound findings of nodules </span><span>≤ 5.0 mm and/or cysts </span><span>≤ 20.0 mm. </span></span></div></div><div><div><span style="font-family: trebuchet; font-size: medium;"><span>"B": ultrasound findings of nodules </span><span>≥</span><span> 5.1 mm and/or cysts </span><span>≥</span><span> 20.1 mm.</span></span></div></div></blockquote><div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> </span>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.)</span></div><div><ul><li><span style="font-family: trebuchet; font-size: medium;">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</span></li><li><span style="font-family: trebuchet; font-size: medium;">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</span></li><li><span style="font-family: trebuchet; font-size: medium;">Fourth round (39 cases): 6 cases with A1, 20 cases with A2 (6 nodules, 13 cysts, and 1 nodule & cyst), 9 cases with B, 4 cases previously unexamined</span></li><li><span style="font-family: trebuchet;"><span style="font-size: medium;">Fifth round (23 cases): 7</span><span style="font-size: medium;"> case with A1, 11 cases with A2 (10 cysts and 1 nodule & cyst), 3 cases with B, 2 cases previously unexamined</span></span></li><li><span style="font-family: trebuchet; font-size: medium;"><span>Age 25 Milestone Screening (16 cases): 4</span> cases with A2 (1 nodule and 3 cyst), 3 cases with B, 9 cases previously unexamined</span></li></ul></div></div></div><p><span style="font-family: trebuchet;"><span style="font-size: medium;"> </span></span></p><div><span style="font-family: trebuchet; font-size: medium;"> </span></div>@YuriHiranumahttp://www.blogger.com/profile/16819451884150838540noreply@blogger.com0tag:blogger.com,1999:blog-9200156515048577812.post-41685523444014832562022-09-18T23:41:00.004-07:002023-04-09T15:49:51.535-07:00Fukushima Thyroid Examination September 2022: 236 Surgically Confirmed as Thyroid Cancer Among 284 Cytology Suspected Cases<p> </p><p><span style="font-family: trebuchet;"><span><span style="font-size: medium;"><b style="font-size: xx-large;">Overview</b></span></span></span></p><p><span style="font-family: trebuchet;"><span><span style="font-size: medium;"> On September 1, 2022, <a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-40.html" target="_blank">t</a></span><span style="font-size: medium;"><a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-45.html" target="_blank">he 45th session of the Oversight Committee</a> for the <a href="https://fhms.jp/en/fhms/" target="_blank">Fukushima Health Management Survey</a> (FHMS) convened online and in Fukushima City</span></span></span><span style="font-family: trebuchet; font-size: medium;">, releasing a new set of results (data up to March 31, 2022) from the</span><span style="font-size: medium;"><span style="font-family: trebuchet;"> </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529187.pdf" style="font-family: trebuchet;" target="_blank">fourth</a><span style="font-family: trebuchet;"> and </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529188.pdf" style="font-family: trebuchet;" target="_blank">fifth</a><span style="font-family: trebuchet;"> </span></span><span style="font-family: trebuchet; font-size: medium;">rounds as well as the </span><span style="font-size: medium;"><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529190.pdf" style="font-family: trebuchet;" target="_blank">Age 25 Milestone Screening</a> <span style="font-family: trebuchet;">of </span><span style="font-family: trebuchet;">the <a href="https://fhms.jp/en/fhms/thyroid/" target="_blank">Thyroid Ultrasound Examination</a> (TUE). </span><span style="font-family: trebuchet;"> Four and a half months have elapsed since the previous session held on May 13, 2022 (see <a href="https://wise.com/ja/help/articles/2559761/%E9%8A%80%E8%A1%8C%E6%8C%AF%E8%BE%BC%E3%81%AB%E3%82%88%E3%82%8B%E5%85%A5%E9%87%91%E6%96%B9%E6%B3%95" target="_blank">previous post</a>). This time 6 months worth of data was released, narrowing the widened gap </span></span><span style="font-family: trebuchet; font-size: medium;">between compilation and report dates of the data. (Only 3 months worth of data was reported at the last session despite the 7-month pause since the previous session. ) Still it's not the most recent data possible because FMU could have reported data through June. </span></p><p><span style="font-family: trebuchet; font-size: medium;"> As the data is usually compiled every 3 months, data between October 1, 2021 and December 31, 2021 was released separately as supplementary materials </span><span style="font-family: trebuchet; font-size: medium;">for both the <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529199.pdf" target="_blank">fourth</a> and <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529201.pdf" target="_blank">fifth</a> rounds in addition to data between October 1, 2021 and March 31, 2022. The Age 25 Milestone Screening data report, biannually released, is right on schedule. The fifth-round data reported this time includes the age and sex distribution of cancer cases for the first time. Also a brief update was reported on the <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529192.pdf" target="_blank">second-round data</a> with an addition of one surgical case.</span></p><p><span style="font-family: trebuchet; font-size: medium;"><span> The</span> 45th session now consists of a <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529343.pdf" target="_blank">full roster</a> of 18 members with <a href="https://seeds.office.hiroshima-u.ac.jp/profile/en.28f19d4b4ecd004f520e17560c007669.html" target="_blank">Nobuyuki Hirohashi</a> of Hiroshima University replacing former Vice Chair Toshiya Inaba who <a href="https://fukushimavoice-eng2.blogspot.com/2022/05/fukushima-thyroid-examination-may-2022.html" target="_blank">abruptly resigned</a> at the last session. Chair Noboru Takamura, a disciple of Shunichi Yamashita, has to be given credit for presiding over the meetings in a calm and logical manner </span><span style="font-family: trebuchet; font-size: medium;">despite his history of downplaying radiation health effects (see the <a href="https://fukushimavoice-eng2.blogspot.com/2022/05/fukushima-thyroid-examination-may-2022.html" target="_blank">previous post</a>). This peaceful proceeding is in contrast to how dramatic and emotional it had been under the previous Chair Hokuto Hoshi who is now an LDP Upper House member representing Fukushima Prefecture. However, the moderator who is deputy chief of the Section of FHMS in the prefectural government has a strict and stern attitude during the press conference, severely and often rudely limiting question topics and time.</span></p><p><span style="font-size: medium;"><span><span style="font-family: trebuchet;"> Official English translation (<a href="https://fhms.jp/en/fhms/outline/materials/" target="_blank">link</a>) has been added for two more sessions and now is available up to the 42nd session (<a href="https://fhms.jp/fhms/uploads/42_26Jul2021.pdf" target="_blank">PDF link</a>) of the Oversight Committee on <a href="https://fhms.jp/en/fhms/outline/materials/" target="_blank">this page</a> of the <a href="https://fhms.jp/en/" target="_blank">website</a> of t</span><span style="font-family: trebuchet;">he Radiation Medical Science Center of the Fukushima Health Management Survey (RMSC/FHMS). This website also shows an <a href="https://fhms.jp/en/fhms/outline/" target="_blank">outline of the FHMS</a> and <a href="https://fhms.jp/en/fhms/thyroid/" target="_blank">TUE itself</a>.</span></span></span></p><div style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 12px auto 6px;"><div><span style="font-weight: 700;"><span><span style="font-family: trebuchet; font-size: medium;"> </span></span></span></div><div><span style="font-weight: 700;"><span><span style="font-family: trebuchet; font-size: x-large;">Highlights</span></span></span></div><b><ul><span style="font-family: trebuchet; font-size: medium;"><li><b>The second round: 1 new surgical case.</b></li><li><b>The fourth round: 2 new cases diagnosed as suspicious or malignant, and 2 new surgical cases. </b></li><li><b>The fifth round: 5 new cases diagnosed as suspicious or malignant, and 3 new surgical cases.</b></li><li><b>Age 25 Milestone Screening: 3 new cases diagnosed as suspicious or malignant, and 4 new surgical cases.</b></li><li><b>Total number of suspected/confirmed thyroid cancer has increased by 10 to</b> <span style="color: red;">284</span><b>: </b><b>116 in the first round (in<b>cluding a single case of benign tumor</b>), 71 in the second round, 31 in the third round, 39 in the fourth round, 11 in the fifth round, and 16 in Age 25 Milestone Screening.</b></li><li><b>Total number of surgically confirmed thyroid cancer cases has also increased by 10 to <span style="color: red;">236</span><span style="color: red;"> </span>(101 in the first round, 56 in the second round, 29 in the third round, 34 in the fourth round, 6 in the fifth round, and 10 in Age 25 Milestone Screening,</b></li></span></ul></b><div><span><b><span style="font-family: trebuchet; font-size: x-large;"><br /></span></b></span></div><div><span><b><span style="font-family: trebuchet; font-size: x-large;">The latest overall results including the "unreported" and cancer registry cases</span></b></span></div><div><span><span style="font-family: trebuchet;"><span><span style="font-size: medium;"> Please refer to </span></span></span></span><span style="font-size: medium;"><span style="font-family: trebuchet;"><span>the </span><a href="https://fukushimavoice-eng2.blogspot.com/2021/06/fukushima-thyroid-examination-may-2021.html" target="_blank">the post on May 2021 report</a> regarding the details of "unreported" cases and cancer registry data. </span><span style="font-family: trebuchet;">(<a href="https://fukushimavoice-eng2.blogspot.com/2018/07/results-of-survey-on-fukushima-thyroid.html" target="_blank">A July 2018 post</a> describes the origin of the first 11"unreported" cases, and their histological diagnoses were obtained from <a href="https://www.jstage.jst.go.jp/article/fms/65/3/65_2019-26/_html/-char/ja" target="_blank">this paper</a>.)</span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> The o</span>fficial count, as reported above and also in the summary document shown in the next section, is <b>284</b> suspected/confirmed and <b>236</b> surgically confirmed thyroid cancer cases. With an addition of the most recent numbers for both "unreported" cases (see <a href="https://fukushimavoice-eng2.blogspot.com/2021/06/fukushima-thyroid-examination-may-2021.html" target="_blank">this post</a>) and "outside" cases discovered in the cancer registry (<a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/524933.pdf" target="_blank">updated</a> at the <a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-b19.html" target="_blank">19th session</a> of the <a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-b.html" target="_blank">TUE Subcommittee</a>), the count increases to <b>362</b> cytologically suspected/confirmed and <b>297 surgically confirmed </b>cancer cases. </span></div><div><span style="font-family: trebuchet; font-size: medium;"> It should be noted that the actual number of cases is likely more due to lack of any past, present or future exhaustive investigation by Fukushima Medical University (FMU), which is necessary to gather <i>all</i> the cancer cases discovered outside the framework of the FHMS-TUE.</span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4yM5nRsiYNDXFUMMrcTNIjfLxoQqwbXj5OudcuimtI_sELOliNVz_Yl4zajehsGVUiGiagoaLEBW7YpHWFZtYvQWGFLPdVhxKC3ymcP6iE4JJl35Yn4NDnKlgIc05yaZUyPkTasv84BLguTgJY6RwHllfeYw48hknNOwNE7oKEWgNfIpFoAxLc3mrmA/s727/%2345%20Latest%20data%20screenshot.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="582" data-original-width="727" height="512" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg4yM5nRsiYNDXFUMMrcTNIjfLxoQqwbXj5OudcuimtI_sELOliNVz_Yl4zajehsGVUiGiagoaLEBW7YpHWFZtYvQWGFLPdVhxKC3ymcP6iE4JJl35Yn4NDnKlgIc05yaZUyPkTasv84BLguTgJY6RwHllfeYw48hknNOwNE7oKEWgNfIpFoAxLc3mrmA/w640-h512/%2345%20Latest%20data%20screenshot.png" width="640" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 12px auto 6px;"><div><span style="font-family: trebuchet; font-size: x-large;"><b>Summary on the current status of the TUE</b></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> </span>A seven-page <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529204.pdf" target="_blank">summary</a> 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. </span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><span> </span>Below is an unofficial translation of this summary which is <i>not</i> officially translated.</span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><a href="https://www.scribd.com/document/595332645/45-Status-of-the-Thyroid-Ultrasound-Examination-Results-September-1-2022#from_embed" style="font-family: Helvetica, Arial, sans-serif; font-size: 14px;" title="View #45 Status of the Thyroid Ultrasound Examination Results (September 1, 2022) on Scribd">#45 Status of the Thyroid Ultrasound Examination Results (September 1, 2022)</a><span face="Helvetica, Arial, sans-serif" style="font-size: 14px;"> by </span><a href="https://www.scribd.com/user/233065310/Yuri-Hiranuma#from_embed" style="font-family: Helvetica, Arial, sans-serif; font-size: 14px;" title="View Yuri Hiranuma's profile on Scribd">Yuri Hiranuma</a></span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><iframe class="scribd_iframe_embed" data-aspect-ratio="0.7729220222793488" data-auto-height="true" frameborder="0" height="600" scrolling="no" src="https://www.scribd.com/embeds/595332645/content?start_page=1&view_mode=scroll&access_key=key-ir1AhfiIJvblEjPG8B19" tabindex="0" title="#45 Status of the Thyroid Ultrasound Examination Results (September 1, 2022)" width="100%"></iframe></span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div><div><span><span style="font-family: trebuchet; font-size: large;"><u><b>The first round</b></u></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"> There is no change in data with 116 suspected/confirmed thyroid cancer cases (39 males and 77 females), of which 102 underwent surgery confirming 1 benign nodule and 101 thyroid cancer cases (100 papillary thyroid cancer and 1 poorly-differentiated cancer). </span></div><div><span style="font-family: trebuchet; font-size: medium;"> The last update as of FY 2015 was reported at the 23rd session in June 2016 (<a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/461399.pdf" target="_blank">Japanese</a>, <a href="https://fhms.jp/fhms/uploads/23_6Jun2016.pdf#page=32" target="_blank">English</a>).</span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div><div><span><span style="font-family: trebuchet; font-size: large;"><b><u>The second round</u></b></span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"> There is no change in the number of suspected/confirmed thyroid cancer cases at 71 (32 males and 39 females). There was one new surgical case in the second round which was diagnosed as papillary thyroid cancer, increasing the confirmed cancer cases to 56 (55 papillary thyroid cancer and 1 "other" thyroid cancer) as shown in the <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529192.pdf" target="_blank">brief update</a>. </span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"> The most recent FY2020 update of the second round data was previously reported at the 42nd session (<a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529202.pdf" target="_blank">Japanese</a>, <a href="https://fhms.jp/fhms/uploads/42_26Jul2021.pdf" target="_blank">English</a>).</span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div><div><span><span style="font-family: trebuchet; font-size: large;"><b><u>The third round</u></b></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"> </span><span style="font-size: medium;"><span style="font-family: trebuchet;">There is no change in data with 31 suspected/confirmed thyroid cancer cases (13 males and 18 males), of which 29 were surgically confirmed as papillary thyroid cancer. The final report from the 39th session in August 2020</span><span style="font-family: trebuchet;"><span> (</span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/401325.pdf" target="_blank"><span>Japanese</span></a><span>, </span></span><a href="https://fhms.jp/fhms/uploads/39_31Aug2020.pdf#page=2" style="font-family: trebuchet;" target="_blank">English</a><span style="font-family: trebuchet;">) </span><span style="font-family: trebuchet;">was updated as of FY2020 and reported at the 42nd session in July 2021</span><span style="font-family: trebuchet;"> (</span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/461565.pdf" style="font-family: trebuchet;" target="_blank">Japanese</a><span style="font-family: trebuchet;">, </span><a href="https://fhms.jp/fhms/uploads/42_26Jul2021.pdf#page=4" style="font-family: trebuchet;" target="_blank">English</a><span style="font-family: trebuchet;">).</span></span></div><div> <span style="font-family: trebuchet; font-size: medium;">FMU is currently conducting an analysis of the third-round data, which has been presented to the <a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-b.html" target="_blank">TUE Subcommittee</a>. FMU does not allow outside researchers to handle the data, yet FMU researchers conducting the analysis seem to lack expertise in statistical analysis which was apparent in the analysis of the second-round data (see <a href="https://fukushimavoice-eng2.blogspot.com/2019/06/how-conclusion-transpired-on-thyroid.html" target="_blank">this post</a>). Recent TUE Subcommittee sessions have all but morphed into an "open statistical lecture series" with two subcommittee members, <a href="https://researchmap.jp/read_0159567?lang=en" target="_blank">Tomotaka Sobue</a> of Osaka University and <a href="https://researchmap.jp/read0212354?lang=en" target="_blank">Kota Katanoda</a> of the National Cancer Center, giving advices and feedbacks on the analytical results presented by FMU. </span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"> At the 45th session of the Oversight Committee, a </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529181.pdf" target="_blank"><span style="font-size: medium;">summary</span></a><span style="font-size: medium;"> of the most recent TUE Subcommittee session--the </span><a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-b19.html" target="_blank"><span style="font-size: medium;">19th session</span></a><span style="font-size: medium;"> held on August 1, 2022--was reported. The summary includes the interim results of the nested case control study <i>which show an increased odds ratio at higher doses in any matching models (see pages 21, 25, 29, 33, 37, and so on, of the <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529181.pdf" target="_blank">session summary</a></i>)</span><i><span style="font-size: medium;"> </span><span style="font-size: x-small;">(added on September 19, 2022)</span></i><span style="font-size: medium;">, but FMU claims the number of cases is too small and there is no statistical significance. Because only about half of the thyroid cancer cases have reconstructed doses, it was suggested that the third- and fourth-round data be analyzed together in order to increase the statistical power. This suggestion was approved by the Oversight Committee, and the joint analysis will begin when the final report of the fourth round becomes available. Although this might seem like a feasible idea, it does blur the line between the rounds.</span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div></div></div><div><div><span style="font-family: trebuchet;"><span face=""><u><span style="font-size: large;"><b>The fourth round</b></span></u></span><br /><span face=""><span style="font-size: medium;"><span> The</span> <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529187.pdf" target="_blank">fourth round</a>, originally scheduled from April 1, 2018 through March 31, 2020, is winding down. Only 24 more participated in the primary examination between October 1, 2021 and March 31, 2022, with no change in participation rate of </span></span></span><span style="font-family: trebuchet;"><span face=""><span style="font-size: medium;">62.3%</span><span style="font-size: medium;"><span>. This is still below what the prior rounds registered (</span></span></span></span><span style="font-size: medium;"><span style="font-family: trebuchet;">81.7% for the first round, 71.0% for the second round, and 64.7% for the third round).</span></span></div><div><span style="font-family: trebuchet;"><span face=""><span style="font-size: medium;"> No one newly received the "B" assessment. Five</span></span></span><span style="font-size: medium;"><span style="font-family: trebuchet;"> </span><span style="font-family: trebuchet;">newly participated in the confirmatory examination with 2 undergoing FNAC (fine-needle aspiration cytology). They, two females, were both diagnosed with suspected thyroid cancer. </span></span><span style="font-size: medium;"><span style="font-family: trebuchet;">One, <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529199.pdf" target="_blank">diagnosed between October and December 2021</a>, was age 9 at the time of the 2011 nuclear accident. She is from a FY2018- targeted municipality and resided in Aizu. Her third-round result was A2 nodules. The other one, <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529187.pdf" target="_blank">diagnosed between January and March 2022</a>, was age 14 and resided in Nakadori in 2011. She was never examined prior to the fourth round. </span></span></div><div><span style="font-family: trebuchet;"><span face=""><span style="font-size: medium;"><div><span style="font-family: trebuchet; font-size: medium;"> Two (one each</span><span style="font-size: medium;"><span style="font-family: trebuchet;"> from FY 2018 and FY2019 municipalities) </span><span style="font-family: trebuchet;">were newly confirmed with papillary thyroid cancer after undergoing surgery. </span></span></div><div><span style="font-size: medium;"><span style="font-family: trebuchet;"><br /></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> </span>In summary, a</span><span style="font-size: medium;"><span style="font-family: trebuchet;">s of September 30, 2021, t</span><span style="font-family: trebuchet;">he number of suspected or confirmed thyroid cancer cases f</span></span><span style="font-family: trebuchet; font-size: medium;">or the fourth round is 39, of which 34 have been surgically confirmed as papillary thyroid cancer. </span></div><div><span style="font-family: trebuchet;"><span face="" style="font-size: medium;"><span> The</span> previous results from the third round are as follows: 26 with "A" (6 with A1, 13 with A2 cysts, 6 with A2 nodules, and 1 with A2 cysts and nodules), 9 with "B," and 4 with no prior result. </span></span></div></span></span></span></div><div><br /></div><div><span style="font-family: trebuchet;"><u><span style="font-size: large;"><b>The fifth round</b></span></u></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> </span>The <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529188.pdf" target="_blank">fifth round</a> targets 252,902 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. (It has <a href="https://fukushimavoice-eng2.blogspot.com/2021/01/fukushima-thyroid-examination-january.html" target="_blank">previously been discussed</a> how this exclusion skews age distribution graphs to the left.)</span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> </span>Th</span><span><span style="font-size: medium;">e 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.</span></span><span><span><span style="font-size: medium;"> [Note: </span></span><span style="font-size: medium;">The fifth round was originally earmarked for FY 2020-2021 (April 2, 2020 to March 31, 2022), but the pandemic has forced an extension of the screening period by one year as described in <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/446622.pdf" target="_blank">this proposal</a>: 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.] </span></span></span></div><div><span style="font-family: trebuchet;"><span><span style="font-size: medium;"> The <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/529194.pdf" target="_blank">sixth round</a> is expected to return to a two-year screening cycle beginning April 2023.</span></span></span></div><div><br /></div><div><span style="font-family: trebuchet; font-size: medium;"> </span><span style="font-family: trebuchet; font-size: medium;">As of March 31, 2022, 74,986 participated in the primary examination, including 29,104 new participants, and its participation rate increased from 18.1% to 29.6%, still quite low. Participation rates by age group increased from 31.3% to 48.1% in ages 8-11, from 20.1% to 36.0% in ages 12-17, and from 7.4% to 10.3% in ages over 18. The primary examination results available nearly doubled to 69,822 (93.1%), and so did the number of "B" assessment to 869 (an additional 411 new cases) which qualifies for the confirmatory examination. </span></div><div><span style="font-family: trebuchet; font-size: medium;"> Two hundred seventy-nine newly participated in the confirmatory examination, 15 underwent FNAC, and 5 (all females) were diagnosed with suspected thyroid cancer. One was diagnosed from 5 FNAC participants between October and December 2021, and she is from a FY2021 municipality. Her previous result was A1. Remaining 4 were diagnosed from 10 FNAC participants, and 3 are from FY2020 municipalities and 1 from a FY2021 municipality. Their previous results include 1 with A1 and 3 with A2 cyst. </span></div><div><span style="font-family: trebuchet; font-size: medium;"> Age and sex distributions of suspected/confirmed cancer cases for the fifth round are available for the first time, likely because the number of suspected/confirmed cancer cases reached two digits. It shows 3 were ages 5 or younger at the time of the March 2011 nuclear accident: a male at age 2, a female at age 4, and a female at age 5.</span></div><div><span style="font-family: trebuchet; font-size: medium;"> Two from FY 2020 municipalities and 1 from a FY2021 municipality have been confirmed with papillary thyroid cancer after undergoing surgery.</span></div><div><br /></div><div><span style="font-family: trebuchet; font-size: medium;"><span style="font-family: trebuchet; font-size: medium;"> In summary, a</span><span style="font-size: medium;"><span style="font-family: trebuchet;">s of March 31, 2022, t</span><span style="font-family: trebuchet;">he number of suspected or confirmed thyroid cancer cases f</span></span><span style="font-family: trebuchet; font-size: medium;">or the fifth round is 11, of which 6 have been surgically confirmed as papillary thyroid cancer. </span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> The</span> previous results from the fourth round are as follows: 8 with "A" (3 with A1, 4 with A2 cysts, 1 with A2 nodules), 2 with "B," and 1 with no prior result. </span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><br /></span></span></div><div><span style="font-family: trebuchet;"><span face=""><span style="font-size: large;"><u><b>Age 25 Milestone Screening</b></u></span></span><br /></span><span style="font-family: trebuchet; font-size: medium;"> </span><span style="font-family: trebuchet; font-size: medium;">In the Age 25 Milestone Screening, each screening year targets a cohort turning 25 during each fiscal year, and t<span><span face="">he results are reported every 6 months. </span></span><span><span><span face="">The most recent implementation schedule available in English is from</span></span><span> September 2020, which was reported to the 41st session of the Oversight Committee and can be found <a href="https://fhms.jp/fhms/uploads/33_27Dec2018.pdf#page=37" target="_blank">here</a>. </span>(</span></span><span style="font-family: trebuchet; font-size: medium;">No one is supposed to undergo a regular TUE within 2 years of becoming eligible for the Age 25 Milestone Screening.) </span><span style="font-size: medium;"><span style="font-family: trebuchet;">Although each fiscal-year screening is earmarked for those turning 25 during that fiscal year, participants can take part in the screening anytime up to the year before they become eligible for the Age 30 Milestone Screening.</span><span style="font-family: trebuchet;"> </span></span></div><div><span style="font-family: trebuchet;"><div style="font-family: Times;"><span style="font-family: trebuchet;"><div><span><span style="font-size: large;"> </span></span></div></span></div></span></div></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div><div><span style="font-family: trebuchet;"><div style="font-family: Times;"><span style="font-family: trebuchet;"><div style="text-align: left;"><span style="font-size: medium;">Note: </span><span style="font-size: medium;">Transition of each FY birth cohort to the Age 25 Milestone Screening reduces a target population for the main TUE. This reduction began in the third round conducted during FY 2016-2017, which excluded the FY 1992 and 1993 cohorts in anticipation of the upcoming Age 25 Milestone Screening. With each FY birth cohort including about 22,000 individuals, this is a sizable reduction which continues as the TUE target population ages. An exception is an increase from 367,637 for the first round to 381,237 for the second round which is due to an inclusion of those who were in utero at the time of the accident). From then on, it has decreased to 336,667 for the third round, 294,228 for the fourth round, and now 252,902 for the fifth round.</span></div></span></div></span></div></div></blockquote><div><div><span style="font-family: trebuchet;"></span><span style="font-family: trebuchet;"><div style="font-family: Times;"><span style="font-family: trebuchet;"><div><span style="font-size: medium;"><br /></span></div></span></div><div style="font-family: Times;"><span style="font-family: trebuchet;"><span><div style="font-family: Times;"><span style="font-family: trebuchet;"><span><span style="font-size: large;"> </span><span style="font-size: medium;">The </span></span><span style="font-size: medium;"><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/510079.pdf" target="_blank">results reported this time</a><span> are from the data up to March 31, 2022, and this time some regional data (only for the primary examination) is reported, following the first-time appearance of age and sex distribution graphs for suspected and confirmed cancer cases in the <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/510079.pdf" target="_blank">last report</a>. FY1996 cohort began screening this fiscal year (FY2022), and their primary examination results are included this time, but this data is excluded from the secondary examination results at this time due to a limited number of participants. Moreover in FY2022, those born in FY1992 became eligible to participate in the Age 30 Milestone Screening, but no data was reported on this.</span></span></span></div><div style="font-family: Times;"><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> Since the previously reported results as of September 30</span></span></span><span style="font-size: medium;"><span><span style="font-family: trebuchet;">, 2021</span><span style="font-family: trebuchet;"><span>, target population increased to </span></span></span></span><span style="font-size: medium;">108,713 due to an addition of 21,020 born in FY1996. The primary examination participation increased by 1,678 to total participants of 9,841, but the participation rate actually decreased slightly from 9.3% to 9.1% due to a larger denominator from the target population increase.</span></div><div style="font-family: Times;"><span style="font-family: trebuchet; font-size: medium;"><span style="font-size: medium;"> An additional 90 participants received</span> "B" assessment in the primary examination, and a total of 504 qualified for the confirmatory examination. Seventy-four of 90 participants with newly assessed "B" are from FY1996 who were excluded from the report this time. Thus the confirmatory examination results covered 430 who are eligible, an increase of 16 since the last report.</span><span style="font-family: trebuchet; font-size: large;"> </span><span style="font-size: medium;">Twenty-five more participated in the confirmatory examination, making the total participants 353, and 345 (39 more than last time) have the final results. After FNAC was conducted in 6 individuals (with total FNAC cases of 31), 3 individuals (all females who were age 15 at exposure) were diagnosed with suspected thyroid cancer. Their prior screening results were 2 with A2 cysts and 1 with no prior screening. Regional data reported for the first time only includes the primary examination data, and no information is available as to residence location information of these cases.</span></div><div style="font-family: Times;"><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div style="font-family: Times;"><span style="font-family: trebuchet;"><span style="font-size: large;"> </span><span style="font-size: medium;">In summary, the number of suspected or confirmed thyroid cancer cases from the Age 25 Milestone Screening increased by 3 to 16. The results from the prior screening are: 4 with "A" (</span></span><span style="font-family: trebuchet; font-size: medium;">1 with A2 nodules, 3 with A2 cysts), 3 with "B" and 9 with no prior screening.</span></div></span></span></div></span></div><div><span style="font-family: trebuchet;"><div style="font-family: Times;"><span style="font-family: trebuchet;"><span><div style="font-family: Times;"><span style="font-family: trebuchet; font-size: medium;"> Four new surgical cases (all papillary thyroid cancer) were added, and the number of surgically confirmed thyroid cancer increased to 10, including 9 papillary thyroid cancers and 1 follicular thyroid cancer.</span></div><div style="font-family: Times;"><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div style="font-family: Times;"><span style="font-size: large;"> </span><span style="font-family: trebuchet; font-size: medium;">Note: The FNAC results this time show a minimum tumor diameter of 5.3 mm, which is 0.9 mm smaller than last reported. This means that newly detected tumors are smaller and thus potential candidates for non-surgical active surveillance. Of 16 suspected thyroid cancer cases, 10 have undergone surgery. With the cancer cases being mostly in their late 20's, there is a possibility that remaining 6 are under active surveillance. </span></div></span></span></div></span></div></div><p><span style="font-family: trebuchet; font-size: large;"><u><b>Sex ratio</b></u></span></p><p><span style="font-family: trebuchet; font-size: large;"> </span><span style="font-family: trebuchet; font-size: medium;">All 10 newly diagnosed with suspected thyroid cancer are females this time. A female to male ratio has increased significantly to 10:1 in the fifth round, and there is a mild increase to 3:1 in the Age 25 Milestone Screening. FMU suggested 3 possible explanations for this increase: </span></p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p><span style="font-family: trebuchet; font-size: medium;">1) Nodules tend to be detected more in females; </span></p><p><span style="font-family: trebuchet; font-size: medium;">2) Progress status of the fifth round up to March 2022 does not include the results of the school-based screening with younger participants in Hamadori and Aizu, which just started in April 2022; and </span></p><p><span style="font-family: trebuchet; font-size: medium;">3) There are more females than males participating in the Age 25 Milestone Screening. The primary examination results by sex in <a href=" https://www.pref.fukushima.lg.jp/uploaded/attachment/529190.pdf#page=11" target="_blank">Appendix 4 of the most recent report</a> show nearly twice as many female participants than males (6,233 vs. 3,287). This tendency was already seen in <a href="https://fhms.jp/fhms/uploads/41_5May2021.pdf#page=27" target="_blank">data up to September 2020</a> (3,884 females vs. 2,023 males) in the latest available English translation of the report from the 41st session. </span></p></blockquote><p><span style="font-family: trebuchet; font-size: medium;"> However, the fifth-round sex ratio is likely to change since it is still progressing.</span></p><div><div><div><span style="font-family: trebuchet; font-size: large;"><u><b>Expected upcoming changes in the dataset</b></u></span></div><div><span style="font-family: trebuchet;"> </span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"> There are two factors inherent to the implementation structure of the TUE, leading to a smaller dataset with each screening cycle. One is a reduced size of target population and the other is a decline in participation rates, both of which are already being observed and expected to progress.</span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"> As described above, a shift of a cohort to the Milestone Screening (Age 25, Age 30, etc.) with time reduces the target population in each successive screening cycle. Furthermore, school-based screening conducted through high school slows down with each cohort graduating from high school. It will eventually come to a natural halt when the youngest cohort born in FY2011 (between April 2, 2011 and April 1, 2012) finishes high school in 2029. It should be noted that the school-based screening is completely voluntary, no less the TUE itself.</span></span></div><div><span style="font-size: medium;"><span style="font-family: trebuchet;"> Convenience of the school-based screening contributes to a higher participation rate for ages up to 18 than past age 18. This is clearly shown in the most recent participation rates by age reported in this post: </span><span style="font-family: trebuchet;">48.1% in ages 8-11, 36.0% in ages 12-17, and 10.3% in ages over 18 in the fifth round, and 9.1% for the Age 25 Milestone Screening. </span></span></div><div><span style="font-size: medium;"><span style="font-family: trebuchet;"> It is critical to recognize these expected changes for future datasets when reviewing the TUE data because they cast doubt on reliability and integrity of the TUE data itself and any analysis conducted. Retrieval of "missing data" due to "unreported cases" at any age is being attempted by matching the TUE data with regional (up to 2015) and national (from 2016 on) cancer registry data. For instance, reconciliation with the most recently available national cancer registry data up to 2018 (</span><span style="font-family: trebuchet;"><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/524933.pdf" target="_blank">document</a> from the 19th Subcommittee session<span>)</span><span> revealed 43 cases from the cancer registry, </span></span></span><span style="font-family: trebuchet; font-size: medium;">which are not included in the official TUE count. This is an increase from 27 cases up to 2017 (<a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/488957.pdf" target="_blank">reported</a> to the 18th Subcommittee session). Nonetheless the cancer registry is far from fool-proof because patients who move their official residence registry outside Fukushima are <i>not</i> reported as Fukushima cases.</span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: large;"><b><u>UNSCEAR2020/2021 Report</u></b></span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"> <a href="https://www.unscear.org/unscear/publications/2020_2021_2.html" target="_blank">UNSCEAR Report 2020/2021</a> (<a href="https://unis.unvienna.org/unis/en/pressrels/2021/unisous419.html" target="_blank">press release</a>) concluded that future health effects, e.g. cancer directly related to radiation exposure from the 2011 Fukushima Daiichi Nuclear Accident are not likely to be discernible. Main findings of UNSCEAR 2020/2021 were introduced to the Oversight Committee 3 times this year: the 44th session in May, the 19th Subcommittee session in August, and at the 45th session in September during a report on proceedings of the 19th Subcommittee session. </span></div><div><span style="font-family: trebuchet; font-size: medium;"> This redundancy is telling and believed to reflect an ulterior motive on the part of the Ministry of the Environment (MOE) which would like to bring "closure" to the matter of radiation exposure. Some committee and subcommittee members take them at face value as words from an authoritative international agency, but some who did not fully agree with the rushed summary of the second-round results (see <a href="https://fukushimavoice-eng2.blogspot.com/2019/06/how-conclusion-transpired-on-thyroid.html" target="_blank">this post</a>) question validity of the report as well as transparency and integrity of UNSCEAR as an agency.</span></div><div><span style="font-family: trebuchet; font-size: medium;"> In particular, attention was drawn to a transfer coefficient of iodine into the thyroid gland, which is set at 30% by ICRP. For the Fukushima report this coefficient was reduced by half to 15% owing to iodine-rich diet of the Japanese population, and consequently doses would be reduced in half. Members of the public and experts have questioned how reasonable this reduction is since modern Japanese diet is not always rich in iodine. </span></div><div><span style="font-family: trebuchet; font-size: medium;"> The very question was raised at the 45th session by a committee member <a href="https://researchmap.jp/read0180749?lang=en" target="_blank">Sakae Shibusawa</a> of Tokyo University of Agriculture and Technology. It is a known fact that Subcommittee Chair Gen Suzuki leads a research team on the reconstruction of early internal doses funded by the MOE, and his team's work that reduced thyroid equivalent dose estimates (<a href="https://www.nature.com/articles/s41598-020-60453-0" target="_blank">published paper</a>, <a href="https://www.env.go.jp/content/900406511.pdf#page=45" target="_blank">2018 MOE report</a>) </span><span style="font-family: trebuchet;"><span style="font-size: medium;">contributed to updated dose estimates by UNSCEAR. Suzuki said that his team determined a thyroid accumulation rate for the Japanese to be </span><a href="https://www.env.go.jp/content/900406511.pdf#page=86" style="font-size: large;">18.6%</a><span style="font-size: medium;">, and UNSCEAR determined it to be 15%. </span><i><span style="font-size: medium;">Suzuki also stated that thyroid accumulation was not affected so much by the amount of iodine intake but more related to "genetic variations" in transport of iodine into the thyroid gland by NIS (sodium iodine symporter) and renal clearance. If the amount of iodine intake does not matter so much, why emphasize it so much? Furthermore, an assumption that the Japanese dietary habits include iodine-rich foods does not seem to be updated, failing to consider studies on modern dietary habits of the Japanese with lower iodine intake.</span><span style="font-size: x-small;"> (Added on September 19, 2022.)</span></i></span></div><div><span style="font-family: trebuchet; font-size: medium;"> It's astonishing to think someone whose research team is actively contributing to reduced dose estimates is presiding over proceedings of the TUE Subcommittee where a relationship between thyroid cancer and thyroid doses is being investigated. Suzuki has declared that the Subcommittee would not take clinical and pathological data into consideration and focus on epidemiological analyses. When Suzuki was appointed Chair, it was not too hard to imagine what would eventually happen, but what is actually happening is worse than imagined.</span></div><div><span style="font-family: trebuchet; font-size: medium;"> <i>It should not be forgotten that the third-round data is still under evaluation, and the Oversight Committee has not come to a definitive conclusion that radiation health effects are unlikely. In truth, it is going to take many years to elucidate a cause of the increase in thyroid cancer in Fukushima, whether it be a true increase due to some factors such as radiation exposure or overdiagnosis. </i></span></div><div><span style="font-family: trebuchet;"><i><span style="font-size: medium;"> The rushed summary of the second round raised many questions about transparency of data and credibility of its analysis (see </span><a href="https://fukushimavoice-eng2.blogspot.com/2019/06/" style="font-size: large;" target="_blank">this post</a><span style="font-size: medium;">). The first round was originally assumed to offer "baseline" data, to which the second round would be compared. Quietly the second round has essentially become part of the baseline in the English papers published by FMU (see </span><a href="https://fukushimavoice-eng2.blogspot.com/2019/06/pediatric-and-adolescent-thyroid-cancer.html" style="font-size: large;" target="_blank">this post</a><span style="font-size: medium;">). ("Quietly" because this is not a common perception at the Oversight Committee or the Subcommittee.) If the third-round data is too small, why not combine it with the second-round data with more thyroid cancer cases than the fourth round? This is unlikely because FMU has done everything to make any sign of dose response disappear so far. </span><span style="font-size: x-small;">(Added on September 19, 2022.)</span></i></span></div><div><span style="font-family: trebuchet;"> </span></div><div><span style="font-family: trebuchet;"><span face=""><b><span style="font-size: large;"><u>Summary of the results from the previous screen</u></span><span style="font-size: large;"><u>ing</u></span> </b></span><br /><span face=""><span><span style="font-size: large;"> </span><span style="font-size: medium;">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. </span></span></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div><span style="font-family: trebuchet; font-size: medium;"><u>Definition</u></span></div><div><span style="font-family: trebuchet; font-size: medium;">"A1": no ultrasound findings. </span></div><div><div><span style="font-family: trebuchet; font-size: medium;"><span>"A2": ultrasound findings of nodules </span><span>≤ 5.0 mm and/or cysts </span><span>≤ 20.0 mm. </span></span></div></div><div><div><span style="font-family: trebuchet; font-size: medium;"><span>"B": ultrasound findings of nodules </span><span>≥</span><span> 5.1 mm and/or cysts </span><span>≥</span><span> 20.1 mm.</span></span></div></div></blockquote><div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> </span>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.)</span></div><div><ul><li><span style="font-family: trebuchet; font-size: medium;">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</span></li><li><span style="font-family: trebuchet; font-size: medium;">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</span></li><li><span style="font-family: trebuchet; font-size: medium;">Fourth round (39 cases): 6 cases with A1, 20 cases with A2 (6 nodules, 13 cysts, and 1 nodule & cyst), 9 cases with B, 4 cases previously unexamined</span></li><li><span style="font-family: trebuchet;"><span style="font-size: medium;">Fifth round (11 cases): 3</span><span style="font-size: medium;"> case with A1, 5 cases with A2 (4 cyst and 1 nodule & cyst), 2 cases with B, 1 case previously unexamined</span></span></li><li><span style="font-family: trebuchet; font-size: medium;"><span>Age 25 Milestone Screening (16 cases): 4</span> cases with A2 (1 nodule and 3 cyst), 3 cases with B, 9 cases previously unexamined</span></li></ul></div></div></div><p><span style="font-family: trebuchet;"><span style="font-size: medium;"> </span></span></p><div><span style="font-family: trebuchet; font-size: medium;"> </span></div>@YuriHiranumahttp://www.blogger.com/profile/16819451884150838540noreply@blogger.com0tag:blogger.com,1999:blog-9200156515048577812.post-60224373907933583632022-05-27T13:42:00.004-07:002022-09-18T08:35:17.098-07:00Fukushima Thyroid Examination May 2022: 226 Surgically Confirmed as Thyroid Cancer Among 274 Cytology Suspected Cases<p> </p><p><span style="font-family: trebuchet;"><span><span style="font-size: medium;"><b style="font-size: xx-large;">Overview</b></span></span></span></p><p><span style="font-family: trebuchet;"><span><span style="font-size: medium;"><span> </span>On May 13, 2022, <a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-40.html" target="_blank">t</a></span><span style="font-size: medium;"><a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-44.html" target="_blank">he 44th session of the Oversight Committee</a> for the <a href="https://fhms.jp/en/fhms/" target="_blank">Fukushima Health Management Survey</a> (FHMS) convened online and in Fukushima City</span></span></span><span style="font-family: trebuchet; font-size: medium;">, releasing a new set of results (data up to September 30, 2021) from the</span><span style="font-size: medium;"><span style="font-family: trebuchet;"> </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/510077.pdf" style="font-family: trebuchet;" target="_blank">fourth</a><span style="font-family: trebuchet;"> and </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/510078.pdf" style="font-family: trebuchet;" target="_blank">fifth</a><span style="font-family: trebuchet;"> </span></span><span style="font-family: trebuchet; font-size: medium;">rounds as well as the </span><span style="font-size: medium;"><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/510079.pdf" style="font-family: trebuchet;" target="_blank">Age 25 Milestone Screening</a> <span style="font-family: trebuchet;">of </span><span style="font-family: trebuchet;">the <a href="https://fhms.jp/en/fhms/thyroid/" target="_blank">Thyroid Ultrasound Examination</a> (TUE). </span><span style="font-family: trebuchet;"> The fifth-round data reported this time includes more details of the confirmatory examination results, and the first age & sex distribution graph was released for the Age 25 Milestone Screening. </span></span></p><p><span style="font-family: trebuchet; font-size: medium;"><span> </span>The 44th session was the second session of the fifth term </span><span style="font-size: medium;"><span style="font-family: trebuchet;">(August 2021-July 2023)</span><span style="font-family: trebuchet;"> </span><span style="font-family: trebuchet;">of the Oversight Committee. (The first of two-year terms consisting of quarterly sessions commenced at the 11th session on June 5, 2013, after the departure of Shunich Yamashita amid controversy surrounding "secret meetings.") It was unprecedented not only in the length of time that elapsed (seven months) since the previous session, but also in an unusual turnover of committee members at merely the second session: four members resigned, including Hokuto Hoshi who served as Chair for the five consecutive terms as well as Toshiya Inaba who as a fifth-term member and Vice Chair would have been a strong candidate to as new Chair. Everyone but Inaba has been replaced by someone from respective organizations, and the <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/510290.pdf" target="_blank">member roster</a> stands at 17 for now.</span></span></p><p><span style="font-size: medium;"><span style="font-family: trebuchet;"> Hoshi's resignation was due to his political activity as a candidate in the summer 2022 election from the Fukushima electoral district for the House of Councillors (upper house) of the National Diet of Japan. His declaration for candidacy in mid-December 2021 meant the end of his reign as the Oversight Committee Chair, and it turns out he did resign as a committee member a month later. His resignation was a welcome news to some of the long-time audience faithfully following the Oversight Committee. (</span><span style="font-family: trebuchet;">Hoshi would often diverge into lengthy monologues and even occasional emotional outbursts during these sessions, in addition to expressing displeasure and irritation by questions and comments at press conferences. None of these behaviors seemed appropriate as Chair.</span><span style="font-family: trebuchet;">) </span></span></p><p><span style="font-size: medium;"><span style="font-family: trebuchet;"> Hoshi has now been replaced by Noboru Takamura of Nagasaki University who is also serving his fifth term. Takamura is a known disciple of late Shigenobu Nagataki and infamous <a href="https://www.spiegel.de/international/world/studying-the-fukushima-aftermath-people-are-suffering-from-radiophobia-a-780810.html" target="_blank">Shunichi Yamashita</a>. It should not be forgotten that shortly </span><span style="font-family: trebuchet;">after the 2011 Fukushima nuclear accident</span><span style="font-family: trebuchet;"> Fukushima Prefecture appointed </span></span><span style="font-family: trebuchet; font-size: medium;">Yamashita and Takamura </span><span style="font-family: trebuchet; font-size: medium;">to be radiation health risk management advisors. The pair went around Fukushima, downplaying potential health effects of radiation exposure in order to soothe people's fear. An excerpt below is from</span><span style="font-family: trebuchet; font-size: medium;"> a <a href="https://www.wsj.com/articles/SB10001424053111903554904576458230766485092" target="_blank">Wall Street Journal article</a> published on August 16, 2011. (The article can be read <a href="https://forgottennavajopeople.org/2011/08/23/wall-street-journal-invisible-menace-murky-science-clouded-japan-nuclear-response/" target="_blank">here</a>.)</span></p><blockquote><span style="font-family: trebuchet; font-size: medium;"><span>On March 25, 2011 Takamura told </span><span>about 600 villagers that they could continue to live
safely in Iitate if they took precautions like wearing face masks
outdoors and washing hands frequently, according to the village
newsletter. Mr. Takamura said recently that radiation readings in the
village were below 100 millisieverts — considered the threshold for health risk.</span></span></blockquote><p><span style="font-size: medium;"> <span style="font-family: trebuchet;">Takamura is also known to have told Iitate Village residents that children could safely play outside up to 10 µSv/h of the ambient radiation. Besides his involvement with fieldwork in <a href="https://www.genken.nagasaki-u.ac.jp/abdi/bases/kawauchi_e.html" target="_blank">Kawauchi Village</a> and <a href="https://www.genken.nagasaki-u.ac.jp/abdi/bases/tomioka_e.html" target="_blank">Tomioka Town</a> through respective Reconstruction Promotion Bases at Nagasaki University, Takamura is also curator of the Great Japan Earthquake and Nuclear Disaster Memorial Museum in Futaba Town, as described in <a href="https://www.jaero.or.jp/Noboru%20Takamura%20Interview.pdf" target="_blank">this interview</a>. </span></span></p><p><span style="font-family: trebuchet; font-size: medium;"> After Yamashita's well-publicized <a href="https://www.nature.com/articles/nature.2013.12463" target="_blank">departure</a> from Chair in March 2013 which coincided with the end of FY 2012, it seems that the Oversight Committee has come full circle with Takamura as Chair.</span></p><span style="font-size: medium;"></span><p></p><p><span style="font-size: medium;"><span style="font-family: trebuchet;"> On a separate note, only 3 months worth of new data as of September 30, 2021 was reported </span><span style="font-family: trebuchet;">despite the lengthy pause of 7 months since the last session. The Oversight Committee is supposed to meet quarterly according to the implementation guidelines, but only 3 sessions each were held in 2019 and 2020, gradually widening the gap between compilation dates and report dates of the data. Quarterly sessions returned in 2021, and the data reporting was finally catching up, but now it's behind about 6 months even though other non-thyroid surveys were reporting the end-of-FY data as of March 31, 2021.</span></span></p><p><span style="font-size: medium;"><span style="font-family: trebuchet;"> </span><span><span style="font-family: trebuchet;">At this time, an official English translation is still only available up to the 40th session of the Oversight Committee. T</span><span style="font-family: trebuchet;">he Radiation Medical Science Center of the Fukushima Health Management Survey (RMSC/FHMS) has rearranged its website, and the meeting materials are now available on <a href="https://fhms.jp/en/fhms/outline/materials/" target="_blank">this page</a>. </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/401325.pdf" style="font-family: trebuchet;" target="_blank">The final results of the third round</a><span style="font-family: trebuchet;">, released at the 39th session in August 2020, is<i> </i>also available in English on pages 2-20 of <a href="http://kenko-kanri.jp/en/health-survey/document/pdf/39_31Aug2020.pdf#page=2" target="_blank">this report</a>.</span></span></span></p><div style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 12px auto 6px;"><div><span style="font-weight: 700;"><span><span style="font-family: trebuchet; font-size: medium;"> </span></span></span></div><div><span style="font-weight: 700;"><span><span style="font-family: trebuchet; font-size: x-large;">Highlights</span></span></span></div><b><ul><span style="font-family: trebuchet; font-size: medium;"><li><b>The fourth round: 1 new case diagnosed as suspicious or malignant, and 3 new surgical cases. </b></li><li><b>The fifth round: 3 new cases diagnosed as suspicious or malignant, and 2 new surgical cases.</b></li><li><b>Age 25 Milestone Screening: 4 new cases diagnosed as suspicious or malignant, and no new surgical cases.</b></li><li><b>Total number of suspected/confirmed thyroid cancer has increased by 8 to</b> <span style="color: red;">274</span><b>: </b><b>116 in the first round (in<b>cluding a single case of benign tumor</b>), 71 in the second round, 31 in the third round, 37 in the fourth round, 6 in the fifth round, and 13 in Age 25 Milestone Screening.</b></li><li><b>Total number of surgically confirmed thyroid cancer cases has increased by 5 to <span style="color: red;">226</span><span style="color: red;"> </span>(101 in the first round, 55 in the second round, 29 in the third round, 32 in the fourth round, 3 in the fifth round, and 6 in Age 25 Milestone Screening,</b></li></span></ul></b><div><span><b><span style="font-family: trebuchet; font-size: x-large;"><br /></span></b></span></div><div><span><b><span style="font-family: trebuchet; font-size: x-large;">The latest overall results including the "unreported" and cancer registry cases</span></b></span></div><div><span><span style="font-family: trebuchet;"><span><span style="font-size: medium;"> Please refer to </span></span></span></span><span style="font-family: trebuchet; font-size: medium;"><span>the </span><a href="https://fukushimavoice-eng2.blogspot.com/2021/06/fukushima-thyroid-examination-may-2021.html" target="_blank">post on the May 2021 report</a> regarding the details of "unreported" cases and cancer registry data.</span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> </span>Official count, as reported in the summary document shown in the next section, is <b>274</b> suspected/confirmed and <b>226</b> 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 <b>333</b> cytologically suspected/confirmed and <b>269 surgically confirmed </b>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.</span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsvyrJHQ1TC9iEGV9XNynBblZCrLwIApMbJdRr4BXdv_CoSpbO77tRrbwamS_8AACh_HhFw7cOPAmom6ktKQX1C0ymJOomZSfktAfis3rlaLq7GoObGYtdoyRnsT__f_hYPEAxefl1QcSBpgCtwEImQpbUmUeSQu1ooKlXgHvQH9sJ5U7NVH-IKqJk5A/s1546/%2344%20Latest%20results.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1204" data-original-width="1546" height="498" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsvyrJHQ1TC9iEGV9XNynBblZCrLwIApMbJdRr4BXdv_CoSpbO77tRrbwamS_8AACh_HhFw7cOPAmom6ktKQX1C0ymJOomZSfktAfis3rlaLq7GoObGYtdoyRnsT__f_hYPEAxefl1QcSBpgCtwEImQpbUmUeSQu1ooKlXgHvQH9sJ5U7NVH-IKqJk5A/w640-h498/%2344%20Latest%20results.png" width="640" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 12px auto 6px;"><div><span style="font-family: trebuchet; font-size: x-large;"><b>Summary on the current status of the TUE</b></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> </span>A seven-page <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/510082.pdf" target="_blank">summary</a> 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. </span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><span> </span>Below is an unofficial translation of this summary which is not officially translated.</span></span></div><div><br /></div><div><span><span style="font-family: trebuchet; font-size: medium;">
<p style="-x-system-font: none; display: block; font-family: Helvetica,Arial,Sans-serif; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; font: 14px Helvetica, Arial, sans-serif; line-height: normal; margin: 12px auto 6px;"> <a href="https://www.scribd.com/document/576011875/44-Status-of-the-Thyroid-Ultrasound-Examination-Results-May-13-2022#from_embed" style="text-decoration: underline;" title="View #44 Status of the Thyroid Ultrasound Examination Results (May 13, 2022) on Scribd">#44 Status of the Thyroid Ultrasound Examination Results (May 13, 2022)</a> by <a href="https://www.scribd.com/user/233065310/Yuri-Hiranuma#from_embed" style="text-decoration: underline;" title="View Yuri Hiranuma's profile on Scribd">Yuri Hiranuma</a> on Scribd</p><iframe class="scribd_iframe_embed" data-aspect-ratio="0.7729220222793488" data-auto-height="true" frameborder="0" height="600" id="doc_54125" scrolling="no" src="https://www.scribd.com/embeds/576011875/content?start_page=1&view_mode=scroll&access_key=key-a8hp7oxB1f3GoVQxnJJB" title="#44 Status of the Thyroid Ultrasound Examination Results (May 13, 2022)" width="100%"></iframe></span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div></div></div><div><div><span style="font-family: trebuchet;"><span face=""><u><span style="font-size: large;"><b>The fourth round</b></span></u></span><br /><span face=""><span style="font-size: medium;"><span> For t</span>he still ongoing <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/510077.pdf" target="_blank">fourth round</a>, originally scheduled from April 1, 2018 through March 31, 2020, only 31 more participated in the primary examination between July 1, 2021 and September 30, 2021, with an unchanged participation rate of </span></span></span><span style="font-family: trebuchet;"><span face=""><span style="font-size: medium;">62.3%</span><span style="font-size: medium;"><span>. (Note: This is still below what the prior rounds registered (</span></span></span></span><span style="font-size: medium;"><span style="font-family: trebuchet;">81.7% for the first round, 71.0% for the second round, and 64.7% for the third round)</span><span style="font-family: trebuchet;">, although it is slowly approaching the third round.)</span></span></div><div><br /></div><div><span style="font-family: trebuchet;"><span face=""><span style="font-size: medium;"><span> </span>Only one person became newly eligible for the confirmatory examination, h</span></span></span><span style="font-size: medium;"><span style="font-family: trebuchet;">aving received the "B" assessment in the primary examination.</span><span style="font-family: trebuchet;"> Ten </span><span style="font-family: trebuchet;">newly participated in the confirmatory examination with 2 undergoing FNAC (fine-needle aspiration cytology), and one male, who was age 10 at the time of the 2011 nuclear accident, was diagnosed with suspected thyroid cancer. His third-round result was "B." He is from the FY 2018 municipality and a resident of Nakadori.</span></span></div><div><span style="font-family: trebuchet;"><span face=""><span style="font-size: medium;"><br /></span></span></span></div><div><span style="font-family: trebuchet;"><span face=""><span style="font-size: medium;"><div><span style="font-family: trebuchet; font-size: medium;"> Three (two</span><span style="font-family: trebuchet; font-size: medium;"> cases</span><span style="font-size: medium;"><span style="font-family: trebuchet;"> from the FY 2018 municipalities and one from the FY 2019 municipalities) </span><span style="font-family: trebuchet;">were newly confirmed with papillary thyroid cancer after undergoing surgery. </span></span></div><div><span style="font-size: medium;"><span style="font-family: trebuchet;"><br /></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> </span>In summary, a</span><span style="font-size: medium;"><span style="font-family: trebuchet;">s of September 30, 2021, t</span><span style="font-family: trebuchet;">he number of suspected or confirmed thyroid cancer cases f</span></span><span style="font-family: trebuchet; font-size: medium;">or the fourth round is 37, of which 32 have been surgically confirmed as papillary thyroid cancer. </span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet;"><span face="" style="font-size: medium;"><span> The</span> 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), 9 with "B," and 3 with no prior result. </span></span></div></span></span></span></div><div><br /></div><div><span style="font-family: trebuchet;"><u><span style="font-size: large;"><b>The fifth round</b></span></u></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> </span>The <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/510078.pdf" target="_blank">fifth round</a> targets 252,855 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. (It has <a href="https://fukushimavoice-eng2.blogspot.com/2021/01/fukushima-thyroid-examination-january.html" target="_blank">previously been discussed</a> how this exclusion skews age distribution graphs to the left.)</span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><br /></span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> </span>Th</span><span><span style="font-size: medium;">e 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.</span></span><span><span><span style="font-size: medium;"> [Note: </span></span><span style="font-size: medium;">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 <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/446622.pdf" target="_blank">this proposal</a>: 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.]</span></span></span></div><div><br /></div><div><span style="font-family: trebuchet; font-size: medium;"> As of September 30, 2021, 45,860 participated in the primary examination,</span><span style="font-size: medium;"><span style="font-family: trebuchet;"> including 13,456</span><span><span style="font-family: trebuchet;"> new participants,</span><span style="font-family: trebuchet;"> </span><span style="font-family: trebuchet;">and its participation rate increased from 12.8% to 18.1</span></span><span style="font-family: trebuchet;">%, still quite low. Participation rates by age group went up 30-50% at 31.3% in ages 8-11, 20.1% in ages 12-17, and 7.4% in ages over 18. The primary examination results are available for 38,136 (83.2%), and 458 (an additional 167 new cases) were assessed as "B," qualifying for the confirmatory examination. </span></span></div><div><span style="font-size: medium;"><span style="font-family: trebuchet;"><br /></span></span></div><div><span style="font-size: medium;"><span style="font-family: trebuchet;"> Sixty-three newly participated in the confirmatory examination, 10 underwent FNAC, and 3 (1 male and 2 females) were diagnosed with suspected thyroid cancer. All three are </span><span style="font-family: trebuchet;">residents of the FY 2020 municipalities. </span><span style="font-family: trebuchet;">Age and tumor diameter data for the fifth round are available for the first time, and the age range at the time of the accident is shown to be 2 to 12 years, which means someone diagnosed in the fifth round was 2 years old at the time of the accident. Also newly reported were the results of blood tests and urinary iodine.</span></span></div><div><br /></div><div><span style="font-family: trebuchet; font-size: medium;"> Two from the FY 2020 municipalities have been confirmed with papillary thyroid cancer after undergoing surgery.</span></div><div><br /></div><div><span style="font-family: trebuchet; font-size: medium;"><span style="font-family: trebuchet; font-size: medium;"> In summary, a</span><span style="font-size: medium;"><span style="font-family: trebuchet;">s of September 30, 2021, t</span><span style="font-family: trebuchet;">he number of suspected or confirmed thyroid cancer cases f</span></span><span style="font-family: trebuchet; font-size: medium;">or the fifth round is 6, of which 3 have been surgically confirmed as papillary thyroid cancer. </span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span style="font-family: trebuchet; font-size: medium;"><span> The</span> previous results from the fourth round were released for the first time: 3 with "A" (1 with A1, 1 with A2 cysts, 1 with A2 nodules), 2 with "B," and 1 with no prior result. </span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><br /></span></span></div><div><span style="font-family: trebuchet;"><span face=""><span style="font-size: large;"><u><b>Age 25 Milestone Screening</b></u></span></span><br /></span><span style="font-family: trebuchet; font-size: medium;"> </span><span style="font-family: trebuchet; font-size: medium;">In the Age 25 Milestone Screening, each screening year targets a cohort turning 25 during each fiscal year, and t<span><span face="">he results are reported every 6 months. The most recent implementation schedule available in English is from</span></span><span> September 2020, which was reported to the 41st session of the Oversight Committee and can be found <a href="https://fhms.jp/fhms/uploads/33_27Dec2018.pdf#page=37" target="_blank">here</a>. (</span></span><span style="font-family: trebuchet; font-size: medium;">No one is supposed to undergo a "regular: TUE within 2 years of becoming eligible for the Age 25 Milestone Screening.) </span><span style="font-size: medium;"><span style="font-family: trebuchet;">Although each fiscal-year screening is earmarked for those turning 25 during that fiscal year, participants can take part in the screening anytime up to the year before they become eligible for the Age 30 Milestone Screening.</span><span style="font-family: trebuchet;"> </span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet;"><div style="font-family: Times;"><span style="font-family: trebuchet;"><div><span><span style="font-size: large;"> </span><span style="font-size: medium;">Note: </span><span style="font-size: medium;">Transition of each FY birth cohort to the Age 25 Milestone Screening reduces a target population for the main TUE. This reduction began in the third round conducted during FY 2016-2017, which excluded the FY 1992 and 1993 cohorts in anticipation of the upcoming Age 25 Milestone Screening. With each FY birth cohort including about 22,000 individuals, this is a sizable reduction which continues as the TUE target population ages. For example, the target population has gone from 367,637 for the first round, to 381,237 for the second round (an increase here is due to the inclusion of those who were in utero at the time of the accident), 336,667 for the third round, 294,231 for the fourth round, and now 252,855 for the fifth round.</span></span></div><div><br /></div></span></div><div style="font-family: Times;"><span style="font-family: trebuchet;"><span><div style="font-family: Times;"><span style="font-family: trebuchet;"><span><span style="font-size: large;"> </span><span style="font-size: medium;">The </span></span><span style="font-size: medium;"><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/510079.pdf" target="_blank">results reported this time</a><span> are from the data up to September 30, 2021, and for the first time the age and sex distribution graph for suspected and confirmed cancer cases is included. Although this fiscal year cycle begins screening in those who were born in FY1996, the results from this cohort is not included here due to a limited number participants. Moreover in FY2022, those born in FY1992 became eligible to participate in the Age 30 Milestone Screening.</span></span></span></div><div style="font-family: Times;"><br /></div><div style="font-family: Times;"><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> Since the previously reported results as of </span></span></span><span style="font-size: medium;"><span><span style="font-family: trebuchet;">June 30, 2021</span><span style="font-family: trebuchet;"><span>, 542 more participated in the primary examination, with total participants being 7,612, A participation rate slightly increased by 0.6% to 9.3% which is still extremely low.</span></span></span><span style="font-family: trebuchet;"> </span></span></div><div style="font-family: Times;"><span><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div><div style="font-family: Times;"><span style="font-family: trebuchet; font-size: medium;"><span style="font-size: medium;"> With an addition of 55 participants newly receiving</span> "B" assessment in the primary examination, a total of 414 qualified for the confirmatory examination. Of 328 confirmatory examination participants including 89 added during this report period, 304 have the final results. After FNAC was conducted in 8 individuals (with a total FNAC cases of 25), 4 individuals (2 males and 2 females) were diagnosed with suspected thyroid cancer. Their prior screening results were: 1 with "A" (A2 cyst), 1 with "B," and 2 with no prior screening.</span></div><div style="font-family: Times;"><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div style="font-family: Times;"><span style="font-family: trebuchet;"><span style="font-size: large;"> </span><span style="font-size: medium;">Thus the number of suspected or confirmed thyroid cancer cases from the Age 25 Milestone Screening increased by 4 to 13. The results from the prior screening are: 2 with "A" (</span></span><span style="font-family: trebuchet; font-size: medium;">1 with A2 nodule, 1 with A2 cyst), 3 with "B" and 8 with no prior screening.</span></div></span></span></div></span></div><div><span style="font-size: medium;"><span style="font-family: trebuchet;"></span><span style="font-family: trebuchet;"></span></span><span style="font-family: trebuchet;"><div style="font-family: Times;"><span style="font-family: trebuchet;"><span><div style="font-family: Times;"><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div style="font-family: Times;"><span style="font-family: trebuchet; font-size: medium;"><span> N</span>o new surgical cases were added, and the number of surgically confirmed thyroid cancer cases remains at 6, including 5 papillary thyroid cancers and 1 follicular thyroid cancer.</span><span style="font-family: trebuchet; font-size: large;"> </span></div></span></span></div></span></div></div><p><span style="font-size: medium;"> <span style="font-family: trebuchet;">Note: The FNAC results show a minimum tumor diameter of 6.2 mm, which is 3.2 mm smaller than last reported. This means that newly detected tumors are smaller and thus potential candidates for non-surgical active surveillance. No change in the number of surgical cases seems to support this scenario. (No evidence exists for active surveillance of noninvasive thyroid papillary microcarcinomas in pediatric population, but individuals in the Age 25 Milestone Screening are mostly in their late 20's at diagnosis.)</span></span><span style="font-family: trebuchet;"> </span></p><div><div><div><span style="font-family: trebuchet;"> </span></div><div><span style="font-family: trebuchet;"><span face=""><b><span style="font-size: large;"><u>Summary of the results from the previous screen</u></span><span style="font-size: large;"><u>ing</u></span> </b></span><br /><span face=""><span><span style="font-size: large;"> </span><span style="font-size: medium;">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. </span></span></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div><span style="font-family: trebuchet; font-size: medium;"><u>Definition</u></span></div><div><span style="font-family: trebuchet; font-size: medium;">"A1": no ultrasound findings. </span></div><div><div><span style="font-family: trebuchet; font-size: medium;"><span>"A2": ultrasound findings of nodules </span><span>≤ 5.0 mm and/or cysts </span><span>≤ 20.0 mm. </span></span></div></div><div><div><span style="font-family: trebuchet; font-size: medium;"><span>"B": ultrasound findings of nodules </span><span>≥</span><span> 5.1 mm and/or cysts </span><span>≥</span><span> 20.1 mm.</span></span></div></div></blockquote><div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> </span>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.)</span></div><div><ul><li><span style="font-family: trebuchet; font-size: medium;">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</span></li><li><span style="font-family: trebuchet; font-size: medium;">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</span></li><li><span style="font-family: trebuchet; font-size: medium;">Fourth round (37 cases): 6 cases with A1, 19 cases with A2 (5 nodules, 13 cysts, and 1 nodule & cyst), 9 cases with B, 3 cases previously unexamined</span></li><li><span style="font-family: trebuchet;"><span style="font-size: medium;">Fifth round (6 cases): 1</span><span style="font-size: medium;"> case with A1, 2 cases with A2 (1 cyst and 1 nodule & cyst), 2 cases with B, 1 case previously unexamined</span></span></li><li><span style="font-family: trebuchet; font-size: medium;"><span>Age 25 Milestone Screening (13 cases): 2</span> cases with A2 (1 nodule and 1 cyst), 3 cases with B, 8 cases previously unexamined</span></li></ul></div></div></div><p><span style="font-family: trebuchet;"><span style="font-size: medium;"> </span></span></p><div><span style="font-family: trebuchet; font-size: medium;"> </span></div>@YuriHiranumahttp://www.blogger.com/profile/16819451884150838540noreply@blogger.com0tag:blogger.com,1999:blog-9200156515048577812.post-38415126033242473612021-10-15T15:14:00.006-07:002022-09-17T22:24:21.731-07:00Fukushima Thyroid Examination October 2021: 221 Surgically Confirmed as Thyroid Cancer Among 266 Cytology Suspected Cases<p><br /></p><p><span style="font-family: trebuchet;"><span><span style="font-size: medium;"><b style="font-size: xx-large;">Overview</b></span></span></span></p><p><span style="font-family: trebuchet;"><span><span style="font-size: medium;"><span> </span>On October 15, 2021, <a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-40.html" target="_blank">t</a></span><span style="font-size: medium;"><a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-43.html" target="_blank">he 43rd session of the Oversight Committee</a> for the Fukushima Health Management Survey (FHMS) convened online and in Fukushima City</span></span></span><span style="font-family: trebuchet; font-size: medium;">, releasing a new set of results (data up to June 30, 2021) from the</span><span style="font-size: medium;"><span style="font-family: trebuchet;"> </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/475143.pdf" style="font-family: trebuchet;" target="_blank">fourth</a><span style="font-family: trebuchet;"> and </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/475144.pdf" style="font-family: trebuchet;" target="_blank">fifth</a><span style="font-family: trebuchet;"> </span></span><span style="font-family: trebuchet; font-size: medium;">rounds of </span><span style="font-family: trebuchet; font-size: medium;">the Thyroid Ultrasound Examination (TUE). </span><span style="font-family: trebuchet; font-size: medium;"> The fifth-round data reported this time includes the confirmatory examination results. In addition, a corrected version of the results was released for the <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/461568.pdf" target="_blank">Age 25 Milestone Screening</a> originally reported in July 2021. </span></p><p><span style="font-family: trebuchet; font-size: medium;"><span> </span>The 43rd session was the first session of a new two-year term (August 2021-July 2023) for <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/475603.pdf#page=5" target="_blank">18 committee members</a>, 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 href="https://www.pref.fukushima.lg.jp/uploaded/attachment/475145.pdf#page=3" target="_blank">A roster for the Thyroid Examination Evaluation Subcommittee</a> 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.</span></p><p><span style="font-family: trebuchet; font-size: medium;"></span></p><p><span style="font-family: trebuchet; font-size: large;"> </span><span style="font-size: medium;"><span style="font-family: trebuchet;">At this time, an official English translation is available up to the 40th session of the Oversight Committee on the </span><a href="http://kenko-kanri.jp/en/health-survey/document/" style="font-family: trebuchet;" target="_blank">website</a><span style="font-family: trebuchet;"> (<a href="https://fhms.jp/en/fhms/outline/materials/" target="_blank">new URL</a> as of April 1, 2022) for the Radiation Medical Science Center of the Fukushima Health Management Survey (RMSC/FHMS). </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/401325.pdf" style="font-family: trebuchet;" target="_blank">The final results of the third round</a><span style="font-family: trebuchet;">, released at the 39th session in August 2020, is <i>finally</i> available in English on pages 2-20 of <a href="https://fhms.jp/fhms/uploads/39_31Aug2020.pdf#page=2" target="_blank">this report</a>.</span></span><br /></p><div style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 12px auto 6px;"><div><span style="font-weight: 700;"><span><span style="font-family: trebuchet; font-size: medium;"> </span></span></span></div><div><span style="font-weight: 700;"><span><span style="font-family: trebuchet; font-size: x-large;">Highlights</span></span></span></div><b><ul><span style="font-family: trebuchet; font-size: medium;"><li><b>The fourth round: 3 new cases diagnosed as suspicious or malignant, and 2 new surgical cases. </b></li><li><b>The fifth round: 3 new cases diagnosed as suspicious or malignant, and 1 new surgical case</b></li><li><b>Total number of suspected/confirmed thyroid cancer has increased by 6 to</b> <span style="color: red;">266</span><b>: </b><b>116 in the first round (in<b>cluding a single case of benign tumor</b>), 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.</b></li><li><b>Total number of surgically confirmed thyroid cancer cases has increased by 3 to <span style="color: red;">221</span><span style="color: red;"> </span>(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,</b></li></span></ul></b><div><span><b><span style="font-family: trebuchet; font-size: x-large;"><br /></span></b></span></div><div><span><b><span style="font-family: trebuchet; font-size: x-large;">The latest overall results including the "unreported" and cancer registry cases</span></b></span></div><div><span><span style="font-family: trebuchet;"><span><span style="font-size: medium;"> Please refer to </span></span></span></span><span style="font-family: trebuchet; font-size: medium;"><span>the </span><a href="https://fukushimavoice-eng2.blogspot.com/2021/06/fukushima-thyroid-examination-may-2021.html" target="_blank">post on the May 2021 report</a> regarding the details of "unreported" cases and cancer registry data.</span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> </span>Official count, as reported in the summary document shown in the next section, is <b>266</b> suspected/confirmed and <b>221</b> 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 <b>325</b> cytologically suspected/confirmed and <b>264 surgically confirmed </b>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.</span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUlMTeaYIGYRlzrgBe4ORJhw08wLP6ulRe7uWycoAYCeNXfmyHVDN233TGhs2dHR4TCHwGhTX4ICTAzy_ZkYYPoViX5VIXzO4FqykN10AtByKQvPot7kSEYbik5yA2RLv7SGLPCIlL7rNa/s1494/%252343+Latest+results.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1156" data-original-width="1494" height="496" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjUlMTeaYIGYRlzrgBe4ORJhw08wLP6ulRe7uWycoAYCeNXfmyHVDN233TGhs2dHR4TCHwGhTX4ICTAzy_ZkYYPoViX5VIXzO4FqykN10AtByKQvPot7kSEYbik5yA2RLv7SGLPCIlL7rNa/w640-h496/%252343+Latest+results.png" width="640" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 12px auto 6px;"><div><span style="font-family: trebuchet; font-size: x-large;"><b>Summary on the current status of the TUE</b></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> </span>A six-page <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/475149.pdf" target="_blank">summary</a> 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. </span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><span> </span>Below is an unofficial translation of this summary which is not officially translated.</span></span></div><div><br /></div><div><span><span style="font-family: trebuchet; font-size: medium;"><p style="-x-system-font: none; font-family: Helvetica, Arial, sans-serif; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-style: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant: normal; font-weight: normal; font: 14px Helvetica, Arial, sans-serif; line-height: normal; margin: 12px auto 6px;"><a href="https://www.scribd.com/document/532779641/43-Status-of-the-Thyroid-Ultrasound-Examination-Results#from_embed" title="View #43 Status of the Thyroid Ultrasound Examination Results on Scribd">#43 Status of the Thyroid Ultrasound Examination Results (October 15, 2021)</a> by <a href="https://www.scribd.com/user/233065310/Yuri-Hiranuma#from_embed" title="View Yuri Hiranuma's profile on Scribd">Yuri Hiranuma</a> on Scribd</p><iframe class="scribd_iframe_embed" data-aspect-ratio="0.75" data-auto-height="false" frameborder="0" height="600" id="doc_25460" scrolling="no" src="https://www.scribd.com/embeds/532779641/content?start_page=1&view_mode=scroll&access_key=key-eeMIVQizkQ85qTu37jNf" title="#43 Status of the Thyroid Ultrasound Examination Results" width="100%"></iframe> </span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div></div></div><div><div><span style="font-family: trebuchet;"><span face=""><u><span style="font-size: large;"><b>The fourth round</b></span></u></span><br /><span face=""><span style="font-size: medium;"><span> For t</span>he still ongoing <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/461566.pdf" target="_blank">fourth round</a>, 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 </span></span></span><span style="font-family: trebuchet;"><span face=""><span style="font-size: medium;">62.3%</span><span style="font-size: medium;"><span>. (Note: This is still below what the prior rounds registered (</span></span></span></span><span style="font-size: medium;"><span style="font-family: trebuchet;">81.7% for the first round, 71.0% for the second round, and 64.7% for the third round</span><span style="font-family: trebuchet;">), although it is slowly approaching the third round.)</span></span></div><div><span style="font-size: medium;"><span style="font-family: trebuchet;"><br /></span></span></div><div><span style="font-family: trebuchet;"><span face=""><span style="font-size: medium;"><span> </span>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. </span></span></span></div><div><span style="font-family: trebuchet;"><span face=""><span style="font-size: medium;"><br /></span></span></span></div><div><span style="font-family: trebuchet;"><span face=""><span style="font-size: medium;"><div><span style="font-family: trebuchet; font-size: medium;"> Two</span><span style="font-family: trebuchet; font-size: medium;"> more cases</span><span style="font-size: medium;"><span style="font-family: trebuchet;"> from the FY 2019 municipalities </span><span style="font-family: trebuchet;">were newly confirmed with papillary thyroid cancer after undergoing surgery. </span></span></div><div><span style="font-size: medium;"><span style="font-family: trebuchet;"><br /></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> </span>In summary, a</span><span style="font-size: medium;"><span style="font-family: trebuchet;">s of June 30, 2021, t</span><span style="font-family: trebuchet;">he number of suspected or confirmed thyroid cancer cases f</span></span><span style="font-family: trebuchet; font-size: medium;">or the fourth round is 36, of which 29 have been surgically confirmed as papillary thyroid cancer. </span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet;"><span face="" style="font-size: medium;"><span> The</span> 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. </span></span></div></span></span></span></div><div><br /></div><div><br /></div><div><span style="font-family: trebuchet;"><u><span style="font-size: large;"><b>The fifth round</b></span></u></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> </span>The <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/475144.pdf" target="_blank">fifth round</a> 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 <a href="https://fukushimavoice-eng2.blogspot.com/2021/01/fukushima-thyroid-examination-january.html" target="_blank">previous post</a> discussed how this exclusion skews age distribution graphs to the left.)</span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><br /></span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> </span>Th</span><span><span style="font-size: medium;">e 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.</span></span><span><span><span style="font-size: medium;"> [Note: </span></span><span style="font-size: medium;">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 <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/446622.pdf" target="_blank">this proposal</a>: 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.]</span></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"> As of June 30, 2021, 32,404 participated in the primary examination,</span><span style="font-family: trebuchet; font-size: medium;"> including </span><span style="font-size: medium;"><span style="font-family: trebuchet;">8,992 new participants,</span><span style="font-family: trebuchet;"> </span><span style="font-family: trebuchet;">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. </span></span></div><div><span style="font-size: medium;"><span style="font-family: trebuchet;"><br /></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"> 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. </span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"> The single case from the FY 2021 municipalities has been confirmed with papillary thyroid cancer after undergoing surgery.</span></div><div><br /></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><br /></span></span></div><div><span style="font-family: trebuchet;"><span face=""><span style="font-size: large;"><u><b>Age 25 Milestone Screening results corrected</b></u></span></span><br /></span><span style="font-family: trebuchet; font-size: medium;"><span> </span></span></div><div> <span style="font-family: trebuchet; font-size: medium;"> 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 href="https://www.pref.fukushima.lg.jp/uploaded/attachment/475148.pdf" target="_blank">a corrected version of the results</a> was released. Also, the single A2 case was confirmed to be nodule. </span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet;"><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><div><span style="font-family: trebuchet;"><span> </span><span>The results from the prior screening for 9 suspected or confirmed cases are: </span></span>1 with A2 nodule, 2 with "B," and 6 with no prior screening.</div></span></span></div></span></div></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div><span style="font-family: trebuchet;"><div style="font-family: Times;"><br /></div></span></div></blockquote><div><div><div><span style="font-family: trebuchet;"> </span></div><div><span style="font-family: trebuchet;"><span face=""><b><span style="font-size: large;"><u>Summary of the results from the previous screen</u></span><span style="font-size: large;"><u>ing</u></span> </b></span><br /><span face=""><span><span style="font-size: large;"> </span><span style="font-size: medium;">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. </span></span></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div><span style="font-family: trebuchet; font-size: medium;"><u>Definition</u></span></div><div><span style="font-family: trebuchet; font-size: medium;">"A1": no ultrasound findings. </span></div><div><div><span style="font-family: trebuchet; font-size: medium;"><span>"A2": ultrasound findings of nodules </span><span>≤ 5.0 mm and/or cysts </span><span>≤ 20.0 mm. </span></span></div></div><div><div><span style="font-family: trebuchet; font-size: medium;"><span>"B": ultrasound findings of nodules </span><span>≥</span><span> 5.1 mm and/or cysts </span><span>≥</span><span> 20.1 mm.</span></span></div></div></blockquote><div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> </span>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.)</span></div><div><ul><li><span style="font-family: trebuchet; font-size: medium;">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</span></li><li><span style="font-family: trebuchet; font-size: medium;">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</span></li><li><span style="font-family: trebuchet; font-size: medium;">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</span></li><li><span style="font-family: trebuchet; font-size: medium;"><span>Age 25 Milestone Screening (9 cases): </span>1 case with A2 (nodule), 2 cases with B, 6 cases previously unexamined</span></li></ul></div></div></div><span style="font-family: trebuchet;"><span style="font-size: medium;"> </span></span><div><span style="font-family: trebuchet; font-size: medium;"> </span></div>@YuriHiranumahttp://www.blogger.com/profile/16819451884150838540noreply@blogger.com0tag:blogger.com,1999:blog-9200156515048577812.post-2979988610880660772021-10-04T22:13:00.011-07:002022-09-18T08:46:31.917-07:00Fukushima Thyroid Examination July 2021: 218 Surgically Confirmed as Thyroid Cancer Among 260 Cytology Suspected Cases
<p><br /></p><p><span style="font-family: trebuchet;"><span><span style="font-size: medium;"><b style="font-size: xx-large;">Overview</b></span></span></span></p><p><span style="font-family: trebuchet;"><span><span style="font-size: medium;"><span> </span>On July 27, 2021, <a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-40.html" target="_blank">t</a></span><span style="font-size: medium;"><a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-42.html" target="_blank">he 42nd session of the Oversight Committee</a> for the Fukushima Health Management Survey (FHMS) convened online and in Fukushima City</span></span></span><span style="font-family: trebuchet; font-size: medium;">, releasing a new set of results (data up to March 31, 2021) from the Thyroid Ultrasound Examination (TUE). The main results reported this time are for the</span><span style="font-size: medium;"><span style="font-family: trebuchet;"> </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/461566.pdf" style="font-family: trebuchet;" target="_blank">fourth</a><span style="font-family: trebuchet;"> and </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/461567.pdf" style="font-family: trebuchet;" target="_blank">fifth</a><span style="font-family: trebuchet;"> </span></span><span style="font-family: trebuchet; font-size: medium;">rounds as well as the <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/461568.pdf" target="_blank">Age 25 Milestone Screening</a>. In addition, March 31st marks the end of fiscal year in Japan prompting a release of fiscal year-end reports, which included </span><span style="font-family: trebuchet; font-size: medium;"><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/461564.pdf" target="_blank">an updated version of the </a></span><span style="font-size: medium;"><span style="font-family: trebuchet;"><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/461564.pdf" target="_blank">second-round results</a> and <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/461565.pdf" target="_blank">a FY 2020 supplementary version for the third round</a>.</span></span></p><p><span style="font-family: trebuchet; font-size: medium;"><span> </span>The 42nd session, held only two months after the last session, was the final session for this group of committee members whose two-year term concluded on July 31, 2021. It was also held a month after the <a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-b17.html" target="_blank">17th session of the Thyroid Examination Evaluation Subcommittee</a> (herein the TUE Subcommittee), which was also the final session of the two-year term for the subcommittee members. Although the TUE Subcommittee was discussing analytical results of the third-round data, no "interim summary" has been drawn up.</span></p><p><span style="font-family: trebuchet; font-size: medium;"> The Oversight Committee sessions were only held three times during FY 2018 and 2020, rather than quarterly as specified in the <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/65129.pdf" target="_blank">implementation guidelines</a>. The data gap created during FY 2020 with 3-month worth of data reported every 4 months was "closed" this time with a report of 6-month worth of data. With the 43rd session scheduled to be held on October 15, 2021, the Oversight Committee appears to be back on regular schedule at least for the current fiscal year 2021.</span></p><p><span style="font-family: trebuchet; font-size: medium;"><span> </span>The pandemic restrictions are still hampering the progress of the fifth round: Once again, the confirmatory examination results were not reported.</span></p><p><span style="font-family: trebuchet; font-size: medium;"></span></p><p><span style="font-family: trebuchet; font-size: large;"> </span><span style="font-size: medium;"><span style="font-family: trebuchet;">At this time, an official English translation is available up to the 40th session of the Oversight Committee on the </span><a href="http://kenko-kanri.jp/en/health-survey/document/" style="font-family: trebuchet;" target="_blank">website</a><span style="font-family: trebuchet;"> for the Radiation Medical Science Center of the Fukushima Health Management Survey (RMSC/FHMS). This means that </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/401325.pdf" style="font-family: trebuchet;" target="_blank">the final results of the third round</a><span style="font-family: trebuchet;">, released at the 39th session in August 2020, is <i>finally</i> available in English on pages 2-20 of <a href="http://kenko-kanri.jp/en/health-survey/document/pdf/39_31Aug2020.pdf#page=2" target="_blank">this report</a>. (Update on September 18, 2022: English translation of the 42nd session is available <a href="https://fhms.jp/fhms/uploads/42_26Jul2021.pdf" target="_blank">here</a>.)</span></span><br /></p><div style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 12px auto 6px;"><div><span style="font-weight: 700;"><span><span style="font-family: trebuchet; font-size: medium;"> </span></span></span></div><div><span style="font-weight: 700;"><span><span style="font-family: trebuchet; font-size: x-large;">Highlights</span></span></span></div><b><ul><span style="font-family: trebuchet; font-size: medium;"><li>The second round: 1 new surgical case.</li><li>The third round: 2 new surgical cases.</li><li><b>The fourth round: 3 new cases diagnosed as suspicious or malignant, and 2 new surgical cases. </b></li><li><b>The fifth round: no report on the confirmatory examination.</b></li><li>The Age 25 Milestone Screening: 1 new case diagnosed as suspicious or malignant, and no new surgical cases.</li><li><b>Total number of suspected/confirmed thyroid cancer has increased by 4 to</b> <span style="color: red;">260</span><b>: </b><b>116 in the first round (in<b>cluding a single case of benign tumor</b>), 71 in the second round, 31 in the third round, 33 in the fourth round, and 9 in Age 25 Milestone Screening.</b></li><li><b>Total number of surgically confirmed thyroid cancer cases has increased by 5 to <span style="color: red;">218</span><span style="color: red;"> </span>(101 in the first round, 55 in the second round, 29 in the third round, 27 in the fourth round, and 6 in Age 25 Milestone Screening,</b></li></span></ul></b><div><span><b><span style="font-family: trebuchet; font-size: x-large;"><br /></span></b></span></div><div><span><b><span style="font-family: trebuchet; font-size: x-large;">The latest overall results including the "unreported" and cancer registry cases</span></b></span></div><div><span><span style="font-family: trebuchet;"><span><span style="font-size: medium;"> Please refer to </span></span></span></span><span style="font-size: medium;"><span style="font-family: trebuchet;">the </span><a href="https://fukushimavoice-eng2.blogspot.com/2021/06/fukushima-thyroid-examination-may-2021.html" style="font-family: trebuchet;" target="_blank">post on the May 2021 report</a> regarding the details of "unreported" cases and cancer registry data.</span></div><div><span style="font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> </span>Official count, as reported in the summary document shown in the next section, is <b>260</b> suspected/confirmed and <b>218</b> 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 <b>319</b> cytologically suspected/confirmed and <b>261 surgically confirmed </b>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.</span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-DrkoO-3P_faC0_itPbPTuvJS3LsLRvFHemkwYnF81bkjYvtd3ZOXbv0KqhlkMaPPF0w5JoajgMKAaCPlqji_xl-pChGdtg7UD0WdaImw8K239P3gv1Ryu6kF_OuNg2kgKkivCds9ZeVA/s1498/%252342+Latest+results+screenshot.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1172" data-original-width="1498" height="500" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-DrkoO-3P_faC0_itPbPTuvJS3LsLRvFHemkwYnF81bkjYvtd3ZOXbv0KqhlkMaPPF0w5JoajgMKAaCPlqji_xl-pChGdtg7UD0WdaImw8K239P3gv1Ryu6kF_OuNg2kgKkivCds9ZeVA/w640-h500/%252342+Latest+results+screenshot.png" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><div style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 12px auto 6px;"><div><span style="font-family: trebuchet; font-size: x-large;"><b>Summary on the current status of the TUE</b></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> </span>A six-page <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/461573.pdf" target="_blank">summary</a> 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. </span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><span> </span>Below is an unofficial translation of this summary which is not officially translated.</span></span></div><div><br /></div><div><span><span style="font-family: trebuchet; font-size: medium;"><p style="-x-system-font: none; font-family: Helvetica, Arial, sans-serif; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-style: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant: normal; font-weight: normal; font: 14px Helvetica, Arial, sans-serif; line-height: normal; margin: 12px auto 6px;"><a href="https://www.scribd.com/document/530704725/42-Status-of-The-Thyroid-Ultrasound-Examination-Results-July-27-2021#from_embed" title="View #42 Status of The Thyroid Ultrasound Examination Results (July 27, 2021) on Scribd">#42 Status of The Thyroid Ultrasound Examination Results (July 27, 2021)</a> by <a href="https://www.scribd.com/user/233065310/Yuri-Hiranuma#from_embed" title="View Yuri Hiranuma's profile on Scribd">Yuri Hiranuma</a> on Scribd</p>
<iframe class="scribd_iframe_embed" data-aspect-ratio="0.7729220222793488" data-auto-height="true" frameborder="0" height="600" scrolling="no" src="https://www.scribd.com/embeds/530704725/content?start_page=1&view_mode=scroll&access_key=key-GHn8gNCOtFBrMmfZGanh" tabindex="0" title="#42 Status of The Thyroid Ultrasound Examination Results (July 27, 2021)" width="100%"></iframe><br /></span></span></div></div></div><div><div><span style="font-family: trebuchet;"><span face=""><p style="font-family: Times;"><span style="font-family: trebuchet; font-size: large;"><span style="font-size: large;"><b style="text-decoration-line: underline;"><br /></b></span></span></p><p style="font-family: Times;"><span style="font-family: trebuchet; font-size: large;"><span style="font-size: large;"><b style="text-decoration-line: underline;">The second round</b> <span style="font-size: small;"> </span></span></span></p><p><span style="font-size: large;"> </span><span style="font-size: medium;">An <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/461564.pdf" target="_blank">updated version of the second-round results</a> was released at the end of FY 2020 reflecting slight changes in the number of participants and test results since <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/461404.pdf" target="_blank">the FY 2017 supplementary version</a>. Corrections were also made for female proportions of the primary examination participants which were erroneously reported as female proportions of the target population. Similar corrections were made for the first-round results, but its updated version was posted as a replacement for <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/461403.pdf" target="_blank">the FY 2017 condensed version</a> which is the most recent condensed version of the first-round results.</span></p><p><span style="font-size: medium;"> The number of suspected thyroid cancer remains the same at 71, but with an addition of one new surgical case which turned out to be a papillary thyroid cancer, the number of confirmed cancer cases now stands at 55 including 54 papillary thyroid cancers and 1 other cancer.</span></p><p><b style="text-decoration-line: underline;"><span style="font-size: large;">The third round</span></b></p><p><span style="font-size: medium;"> For the third-round results, a FY 2020 supplementary version of the final results was released to reflect changes in the numbers of participants and test results since the final results were reported in the summer of 2020. The number of suspected thyroid cancer cases remains the same at 31, but an addition of 2 surgical cases increases the number of confirmed thyroid cancer cases to 29, all papillary thyroid cancers.</span></p><p><span style="font-size: medium;"> An official English translation of the final results of the third round is available <a href="http://kenko-kanri.jp/en/health-survey/document/pdf/39_31Aug2020.pdf#page=2" target="_blank">here</a>.</span> </p></span></span></div><div><span style="font-family: trebuchet;"><span face=""><u><span style="font-size: large;"><b>The fourth round</b></span></u></span><br /><span face=""><span style="font-size: medium;"><span> Although t</span>he <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/461566.pdf" target="_blank">fourth round</a>, originally scheduled from April 1, 2018 through March 31, 2020, is still ongoing, only 442 participated in the primary examination between September 30, 2020 and March 31, 2021, slightly raising the current participation rate by 0.2</span></span></span><span style="font-family: trebuchet; font-size: medium;">% </span><span style="font-family: trebuchet;"><span face=""><span style="font-size: medium;">to 62.3%</span><span style="font-size: medium;"><span>. This is still below what the prior rounds registered (</span></span></span></span><span style="font-size: medium;"><span style="font-family: trebuchet;">81.7% for the first round, 71.0% for the second round, and 64.7% for the third round</span><span style="font-family: trebuchet;">), although it is slowly approaching the third round.</span></span></div><div><span style="font-size: medium;"><span style="font-family: trebuchet;"><br /></span></span></div><div><span style="font-family: trebuchet;"><span face=""><span style="font-size: medium;"><span> </span>Having received the "B" assessment in the primary examination, 9 newly became eligible for the confirmatory examination. With an additional 86 participants, the confirmatory examination increased its participation rate by 5.8% to 73.3%. Out of 8 participants newly undergoing FNAC, 3 individuals (2 males and 1 female) were diagnosed with suspected thyroid cancer. Their third-round results were A1, B, and no previous examination. Two males were ages 8 and 9 and the female was age 8 at the time of the 2011 nuclear accident. One of the males is from the FY 2018 municipalities, and the other male and the female are from the FY 2019 municipalities. One is from Nakadori and two are from Hamadori. </span></span></span></div><div><span style="font-family: trebuchet;"><span face=""><span style="font-size: medium;"><br /></span></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> </span></span><span style="font-family: trebuchet; font-size: medium;"><span> </span>Two</span><span style="font-family: trebuchet; font-size: medium;"> more cases </span><span style="font-size: medium;"><span style="font-family: trebuchet;">(one from the FY 2018 municipalities and one from the FY 2019 municipalities) </span><span style="font-family: trebuchet;">were newly confirmed with papillary thyroid cancer after undergoing surgery. </span></span></div><div><span style="font-size: medium;"><span style="font-family: trebuchet;"><br /></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> </span>In summary, a</span><span style="font-size: medium;"><span style="font-family: trebuchet;">s of March 31, 2021, t</span><span style="font-family: trebuchet;">he number of suspected or confirmed thyroid cancer cases f</span></span><span style="font-family: trebuchet; font-size: medium;">or the fourth round is 33, of which 27 have been surgically confirmed as papillary thyroid cancer. </span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet;"><span face="" style="font-size: medium;"><span> The</span> previous results from the third round are as follows: 24 with "A" (6 with A1, 12 with A2 cysts, 5 with A2 nodules, and 1 with A2 cysts and nodules), 6 with "B," and 3 with no prior result. </span></span></div><div><br /></div><div><span style="font-family: trebuchet;"><u><span style="font-size: large;"><b>The fifth round</b></span></u></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> </span>The <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/461567.pdf" target="_blank">fifth round</a> 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 <a href="https://fukushimavoice-eng2.blogspot.com/2021/01/fukushima-thyroid-examination-january.html" target="_blank">previous post</a> discussed how this exclusion skews age distribution graphs to the left.)</span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><br /></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> </span>Th</span><span style="font-family: trebuchet; font-size: medium;">e 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. </span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"> </span><span style="font-family: trebuchet; font-size: medium;">As of March 31, 2021, 23,412 participated in the primary examination, including 20,342 new participants, and its participation rate increased from 1.2% to 9.3%, still quite low. Participation rates by age group are 16.4% in ages 8-11, 9.7% in ages 12-17, and 4.2% in ages over 18, showing a slow progress of school-bases examination. The primary examination results are available for 21,624 (92.4%), and 228 were assessed as "B" qualifying for the confirmatory examination. Once again, no confirmatory examination results were reported due to a very small number of participants.</span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><br /></span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> </span>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 <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/446622.pdf" target="_blank">this proposal</a>: 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.</span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><br /></span></span></div><div><span style="font-family: trebuchet;"><span face=""><span style="font-size: large;"><u><b>Age 25 Milestone Screening</b></u></span></span><br /></span><span style="font-family: trebuchet; font-size: medium;"><span> </span>In the Age 25 Milestone Screening, each screening year targets a cohort turning 25 during each fiscal year, and t<span><span face="">he results are reported every 6 months. </span></span><span>Implementation schedule as of September 30, 2018, reported to the 33rd session of the Oversight Committee, can be found <a href="https://fhms.jp/fhms/uploads/33_27Dec2018.pdf#page=37" target="_blank">here</a>. (</span></span><span style="font-family: trebuchet; font-size: medium;">No one is supposed to undergo a regular TUE within 2 years of becoming eligible for the Age 25 Milestone Screening.)</span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet;"><div style="font-family: Times;"><span style="font-family: trebuchet;"><div><span><span style="font-size: large;"> </span><span style="font-size: medium;">Transition of each FY birth cohort to the Age 25 Milestone Screening reduces a target population for the main TUE. This reduction began in the third round conducted during FY 2016-2017, which excluded the FY 1992 and 1993 cohorts in anticipation of the upcoming Age 25 Milestone Screening. With each FY birth cohort including about 22,000 individuals, this is a sizable reduction which continues as the TUE target population ages. For example, the target population has gone from 367,637 for the first round, to 381,237 for the second round (increased because those who were in utero at the time of the accident were included), 336,667 for the third round, 294,239 for the fourth round, and now 252,842 for the fifth round.</span></span></div><div><br /></div></span></div><div style="font-family: Times;"><span style="font-family: trebuchet;"><span><div style="font-family: Times;"><span style="font-family: trebuchet;"><span><span style="font-size: large;"> </span><span style="font-size: medium;">The </span></span><span style="font-size: medium;"><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/461568.pdf" target="_blank">results reported this time</a><span> are from the data up to March 31, 2021, newly including 21,056 who were born in FY1995 in the target population. Since the previously reported results as of </span></span></span><span style="font-size: medium;"><span><span style="font-family: trebuchet;">September 30, 2020</span><span style="font-family: trebuchet;"><span>, 1,667 more participated in the primary examination, with total participants being 7,612, A participation rate actually saw a slightly decrease by 0.2% to 8.7%, due to </span></span></span><span style="font-family: trebuchet;">the increased target population of 87,694.</span><span style="font-family: trebuchet;"> </span><span style="font-family: trebuchet;">Although each fiscal-year screening is earmarked for those turning 25 during that fiscal year, participants can take part in the screening anytime up to the year before they become eligible for the Age 30 Milestone Screening. Thus p</span><span style="font-family: trebuchet;">articipation rates by FY birth cohorts might continue to change as the screening progresses. </span></span></div><div style="font-family: Times;"><span><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div><div style="font-family: Times;"><span style="font-family: trebuchet; font-size: medium;"><span style="font-size: medium;"> </span>Seventy-eight more became eligible for the confirmatory examination (a.k.a. "B" assessment in the primary examination). Of 359 qualifying for the confirmatory examination, 239 have undergone it, with 18 newly participating. Only one person newly underwent FNAC, and this person, a female, was diagnosed with suspected thyroid cancer. There was a confusion about her</span><span style="font-family: trebuchet; font-size: medium;"> prior result, which was verbally reported as no prior examination while the written report shows it was A2. Curiously, the verbal report specified one prior A2 case as nodule, whereas an existing prior A2 case never had clarification as to whether it was cyst or nodule. </span></div><div style="font-family: Times;"><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div style="font-family: Times;"><span style="font-family: trebuchet;"><span style="font-size: large;"> </span><span style="font-size: medium;">Thus the number of suspected or confirmed thyroid cancer cases from the Age 25 Milestone Screening increased by 1 to 9. The results from the prior screening have two possibilities depending on which information is accurate, verbal or written. (Note on October 15, 2021: the verbal information was accurate, and <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/475148.pdf" target="_blank">a corrected version of the report</a> was released.)</span></span></div></span></span></div></span></div></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div><span style="font-family: trebuchet;"><div style="font-family: Times;"><span style="font-family: trebuchet;"><span><div style="font-family: Times;"><span style="font-family: trebuchet; font-size: medium;">a) verbal: 1 with A2 nodule, 2 with "B," and 6 with no prior screening.</span></div></span></span></div></span></div><div><span style="font-family: trebuchet;"><div style="font-family: Times;"><strike><span style="font-family: trebuchet;"><span style="font-size: medium;">b) written: </span></span><span style="font-family: trebuchet; font-size: medium;">2</span><span style="font-family: trebuchet; font-size: medium;"> with A2 (at least one with nodule according to the verbal report), 2 with "B," and 5 with no prior screening.</span></strike></div></span></div></blockquote><div><div><div><span style="font-size: medium;"><span style="font-family: trebuchet;"></span><span style="font-family: trebuchet;"></span></span><span style="font-family: trebuchet;"><div style="font-family: Times;"><span style="font-family: trebuchet;"><span><div style="font-family: Times;"><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div style="font-family: Times;"><span style="font-family: trebuchet; font-size: medium;"><span> N</span>o new surgical cases were added, and surgically confirmed thyroid cancer cases remain as 6, including 5 papillary thyroid cancers and 1 follicular thyroid cancer.</span></div><div style="font-family: Times;"><br /></div></span></span></div></span></div><div><span style="font-family: trebuchet;"> </span></div><div><span style="font-family: trebuchet;"><span face=""><b><span style="font-size: large;"><u>Summary of the results from the previous screen</u></span><span style="font-size: large;"><u>ing</u></span> </b></span><br /><span face=""><span style="font-size: medium;"><span> </span>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. </span></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div><span style="font-family: trebuchet; font-size: medium;"><u>Definition</u></span></div><div><span style="font-family: trebuchet; font-size: medium;">"A1": no ultrasound findings. </span></div><div><div><span style="font-family: trebuchet; font-size: medium;"><span>"A2": ultrasound findings of nodules </span><span>≤ 5.0 mm and/or cysts </span><span>≤ 20.0 mm. </span></span></div></div><div><div><span style="font-family: trebuchet; font-size: medium;"><span>"B": ultrasound findings of nodules </span><span>≥</span><span> 5.1 mm and/or cysts </span><span>≥</span><span> 20.1 mm.</span></span></div></div></blockquote><div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> </span>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.)</span></div><div><ul><li><span style="font-family: trebuchet; font-size: medium;">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</span></li><li><span style="font-family: trebuchet; font-size: medium;">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</span></li><li><span style="font-family: trebuchet; font-size: medium;">Fourth round (33 cases): 6 cases with A1, 18 cases with A2 (5 nodules, 12 cysts, and 1 nodule & cyst), 6 cases with B, 3 cases previously unexamined</span></li><li><span style="font-family: trebuchet; font-size: medium;">Age 25 Milestone Screening (9 cases): Due to inconsistencies between verbal and written reports, both scenarios are listed below. </span>(Note on October 15, 2021: the verbal information was accurate, and <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/475148.pdf" style="font-family: trebuchet; font-size: large;" target="_blank">a corrected version of the report</a><span style="font-family: trebuchet; font-size: large;"> was released.)</span></li></ul></div></div></div><div style="text-align: left;"><div><div><span><span style="font-family: trebuchet;"><span style="font-size: medium;"> Verbal report: </span></span><span style="font-family: trebuchet; font-size: medium;">1 case with A2 (nodule), 2 cases with B, 6 cases previously unexamined</span></span></div></div></div><span style="font-family: trebuchet;"><span style="font-size: medium;"> <strike>Written report: 2 cases with A2 (1 nodule and 1 unknown?), 2 cases with B, 5 cases previously unexamined</strike></span></span><br /><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><br /></span></span></div></blockquote><div><span style="font-family: trebuchet; font-size: medium;"> </span></div>@YuriHiranumahttp://www.blogger.com/profile/16819451884150838540noreply@blogger.com0tag:blogger.com,1999:blog-9200156515048577812.post-77813509454951787682021-06-17T21:37:00.006-07:002022-09-18T08:48:51.473-07:00Fukushima Thyroid Examination May 2021: 213 Surgically Confirmed as Thyroid Cancer Among 256 Cytology Suspected Cases<p> </p><p><span style="font-family: trebuchet;"><span><span style="font-size: medium;"><b style="font-size: xx-large;"><br class="Apple-interchange-newline" />Overview</b></span></span></span></p><p><span style="font-family: trebuchet;"><span><span style="font-size: medium;"><span> </span>On May 17, 2021, <a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-40.html" target="_blank">t</a></span><span style="font-size: medium;"><a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-41.html" target="_blank">he 41st session of the Oversight Committee</a> for the Fukushima Health Management Survey (FHMS) convened online and in Fukushima City</span></span></span><span style="font-family: trebuchet; font-size: medium;">, releasing a new set of results (data up to September 30, 2020) from the Thyroid Ultrasound Examination (TUE). The results reported this time are for </span><span style="font-size: medium;"><span style="font-family: trebuchet;">the </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/446728.pdf" style="font-family: trebuchet;" target="_blank">fourth</a><span style="font-family: trebuchet;"> and </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/446620.pdf" style="font-family: trebuchet;" target="_blank">fifth</a><span style="font-family: trebuchet;"> </span></span><span style="font-family: trebuchet; font-size: medium;">rounds as well as the <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/446730.pdf" target="_blank">Age 25 Milestone Screening</a>. </span></p><p><span style="font-family: trebuchet; font-size: medium;"><span> </span>The 41st session was held four months after the last session, and it appears that it has become "regular" to hold the Oversight Committee sessions three times a year rather than quarterly as specified in the <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/65129.pdf" target="_blank">implementation guidelines</a>. With the data released at each session only including 3 months worth of results while sessions held every 4 months since 2019, a data gap keeps increasing. A spring session such as this used to report data up to March 31, which is the end of a fiscal year in Japan, but now we are 6 months <i>behind</i> on data release.</span></p><p><span style="font-family: trebuchet; font-size: medium;"><span> </span>The pandemic restrictions are still slowing the fifth round, and no results were reported for the confirmatory examination of the fifth round, which has only been sparsely conducted.</span></p><div style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 12px auto 6px;"><div><span style="font-weight: 700;"><span><span style="font-family: trebuchet; font-size: medium;"> </span></span></span></div><div><span style="font-weight: 700;"><span><span style="font-family: trebuchet; font-size: x-large;">Highlights</span></span></span></div><b><ul><span style="font-family: trebuchet; font-size: medium;"><li><b>The fourth round: 3 new cases diagnosed as suspicious or malignant, and 9 new surgical cases. </b></li><li><b>The fifth round: no report on the confirmatory examination.</b></li><li>The Age 25 Milestone Screening: 1 new case diagnosed as suspicious or malignant, and 2 new surgical cases.</li><li><b>Total number of suspected/confirmed thyroid cancer has increased by 4 to</b> <span style="color: red;">256</span><b>: </b><b>116 in the first round (in<b>cluding a single case of benign tumor</b>), 71 in the second round, 31 in the third round, 30 in the fourth round, and 8 in Age 25 Milestone Screening.</b></li><li><b>Total number of surgically confirmed thyroid cancer cases has increased by 11 to <span style="color: red;">213</span><span style="color: red;"> </span>(101 in the first round, 54 in the second round, 27 in the third round, 25 in the fourth round, and 6 in Age 25 Milestone Screening)</b></li></span></ul></b><ul><li><b><span style="font-family: trebuchet; font-size: medium;">Data reported is as of September 30, 2020. (Delayed reporting persists after the fourth quarterly session was skipped in 2019, 2020, and now likely 2021.)</span></b></li><li><span><span style="font-family: trebuchet; font-size: medium; font-weight: bold;">A list of official English translation of the FHMS reports including the TUE results is available on the <a href="http://kenko-kanri.jp/en/health-survey/document/" target="_blank">website</a> for the Radiation Medical Science Center of the Fukushima Health Management Survey (RMSC/FHMS). At this time, translation <i>is available</i> for the first two 2020 sessions, the 37th and 38th sessions. The <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/401325.pdf" target="_blank">final results of the third round</a>, released at the 39th session in August 2020, is not yet available in English.</span></span></li></ul><div><span><b><span style="font-family: trebuchet; font-size: x-large;"><br /></span></b></span></div><div><span><b><span style="font-family: trebuchet; font-size: x-large;">The latest overall results including the "unreported" and cancer registry cases</span></b></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><span> </span>The table below shows a new set of numbers for "unreported" cases: 35 malignant or suspicious, 35 surgical, and 19 cancer cases (previously 12, 12, and 11, respectively, as explained <a href="https://fukushimavoice-eng2.blogspot.com/2018/07/results-of-survey-on-fukushima-thyroid.html" target="_blank">here</a> and reported in <a href="https://www.jstage.jst.go.jp/article/fms/65/3/65_2019-26/_html/-char/ja" target="_blank">this paper</a>). These 35 cases are part of 180 surgical cases operated at the Fukushima Medical University (FMU) hospital as of December 31, 2018: unlike other 145, they had </span></span><span style="font-family: trebuchet; font-size: medium;">not been included in a report to the Oversight Committee,</span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><span> </span>Shinichi Suzuki, an FMU thyroid surgeon, has presented this data at various domestic and international academic meetings since 2019 including a February 3, 2020 keynote lecture </span></span><span style="font-size: medium;"><span style="font-family: trebuchet;">at the Second International Symposium by RMSC/FHMS. More than a year later, i</span><span style="font-family: trebuchet;">t finally became part of the official TUE data when it was </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/435506.pdf" style="font-family: trebuchet;" target="_blank">reported</a><span style="font-family: trebuchet;"> to the 16th TUE Subcommittee held on March 22, 2021. (Note: This report is merely an excerpt from a symposium abstract. The </span><span style="font-family: trebuchet;">English abstract can be accessed <a href="http://kenko-kanri.jp/en/img/report_2ndIntlSympo_EN.pdf#page=44" target="_blank">here</a>.) There is no way to confirm, but it is assumed that </span><i style="font-family: trebuchet;">previous</i><span style="font-family: trebuchet;"> 12 unreported malignant/suspicious cases, of which 11 are confirmed as cancer, are likely included in these 35 cases.</span></span></div><div><span style="font-family: trebuchet; font-size: large;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> </span>There is also a new row added to the table, showing 24 thyroid cancer cases which were diagnosed outside the framework of the TUE but found in Fukushima Prefecture's cancer registry from 2012 to 2017. This was also <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/435505.pdf" target="_blank">reported</a> at the 16th TUE Subcommittee.</span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> </span>Official count, as reported in the summary document shown in the next section, is <b>256</b> suspected/confirmed and <b>213</b> 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 <b>315</b> cytologically suspected/confirmed and <b>256 surgically confirmed cancer</b>. It should be noted that the actual number of cases is likely more than these.</span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj59ZGcgQOEl1rO1HAjbvSXgkdouxlypvcydN-Ck3u_Vqc3FNpbVHlCYN-7ZXWPnImsBkjuFtxx_Ck3zcd4BLdN8xAmRXHZwzsBYMuNAu-1QmQps-kau4hb5tcVHnzvZ-PRa0LM3NmAsjh1/s1500/%252341+Latest+data+in+English.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1168" data-original-width="1500" height="498" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj59ZGcgQOEl1rO1HAjbvSXgkdouxlypvcydN-Ck3u_Vqc3FNpbVHlCYN-7ZXWPnImsBkjuFtxx_Ck3zcd4BLdN8xAmRXHZwzsBYMuNAu-1QmQps-kau4hb5tcVHnzvZ-PRa0LM3NmAsjh1/w640-h498/%252341+Latest+data+in+English.png" width="640" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 12px auto 6px;"><div><span style="font-family: trebuchet; font-size: x-large;"><b>Summary on the current status of the TUE</b></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> </span>A six-page <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/446633.pdf" target="_blank">summary</a> 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. </span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><span> </span>Below is an unofficial translation of this summary which is not officially translated.</span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><a href="https://www.scribd.com/document/512184585/41-Status-of-the-Thyroid-Ultrasound-Examination-Results-May-17-2021" style="font-family: Helvetica, Arial, sans-serif; font-size: 14px;" title="View #40 Status of the Thyroid Ultrasound Examination (January 15, 2021) on Scribd">#41 Status of the Thyroid Ultrasound Examination Results</a><span face="Helvetica, Arial, sans-serif" style="font-size: 14px;"> by </span><a href="https://www.scribd.com/user/233065310/Yuri-Hiranuma#from_embed" style="font-family: Helvetica, Arial, sans-serif; font-size: 14px;" title="View Yuri Hiranuma's profile on Scribd">Yuri Hiranuma</a></span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><iframe class="scribd_iframe_embed" data-aspect-ratio="0.7729220222793488" data-auto-height="true" height="600" scrolling="no" src="https://www.scribd.com/embeds/492645595/content?start_page=1&view_mode=scroll&access_key=key-27GYFQ9EW2i1JZMJnDDB" tabindex="0" title="#40 Status of the Thyroid Ultrasound Examination (January 15, 2021)" width="100%"></iframe><p style="-x-system-font: none; font-family: Helvetica, Arial, sans-serif; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-style: normal; font-variant-east-asian: normal; font-variant-numeric: normal; font-variant: normal; font-weight: normal; font: 14px Helvetica, Arial, sans-serif; line-height: normal; margin: 12px auto 6px;"><br /></p></span></span></div></div></div><p><span style="font-family: trebuchet;"><span><span style="font-size: medium;"><b style="font-size: xx-large;"></b></span></span></span></p><div><div><div><span style="font-family: trebuchet;"><div class="separator" style="clear: both; text-align: center;"><br /></div></span></div><div><span style="font-family: trebuchet;"><span face=""><u><span style="font-size: large;"><b>The fourth round</b></span></u></span><br /><span face=""><span style="font-size: medium;"><span> </span>The <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/446728.pdf" target="_blank">fourth round</a>, originally scheduled from April 1, 2018 through March 31, 2020, is still ongoing. Between June 30, 2020 and September 30, 2020, the primary examination gained 1,851 more participants, raising the current participation rate by 0.6</span></span></span><span style="font-family: trebuchet; font-size: medium;">% </span><span style="font-family: trebuchet;"><span face=""><span style="font-size: medium;">to 62.1%</span><span style="font-size: medium;"><span>. An important reminder: This is still below what the prior rounds registered (</span></span></span></span><span style="font-size: medium;"><span style="font-family: trebuchet;">81.7% for the first round, 71.0% for the second round, and 64.7% for the third round</span><span style="font-family: trebuchet;">), although it is slowly approaching the third round.</span></span></div><div><span style="font-family: trebuchet;"><span face=""><span style="font-size: medium;"><span> </span>Having received the "B" assessment in the primary examination, 12 newly became eligible for the confirmatory examination. With an additional 109 participants, the confirmatory examination increased its participation rate by 7.4% to 67.5%. Out of 10 participants newly undergoing FNAC, 3 individuals (1 male and 2 females) were diagnosed with suspected cancer. Their third-round results were 2 with A2 (1 nodule and 1 nodule & cyst) and 1 with no previous examination. The male was age 9 and the females were age 5 and 9 at the time of the 2011 nuclear accident. All three are from the FY 2019 municipalities, and two are from Hamadori and one is from Aizu. </span></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> </span>Nine</span><span style="font-family: trebuchet; font-size: medium;"> more cases </span><span style="font-size: medium;"><span style="font-family: trebuchet;">(two from the FY 2018 municipalities and seven from the FY 2019 municipalities) </span><span style="font-family: trebuchet;">were newly confirmed with papillary thyroid cancer after undergoing surgery. </span></span></div><div><span style="font-size: medium;"><span style="font-family: trebuchet;"><br /></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> </span>In summary, a</span><span style="font-size: medium;"><span style="font-family: trebuchet;">s of September 30, 2020, t</span><span style="font-family: trebuchet;">he number of suspected or confirmed thyroid cancer cases f</span></span><span style="font-family: trebuchet; font-size: medium;">or the fourth round is 30, of which 25 have been surgically confirmed as thyroid cancer: all papillary thyroid cancer. </span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet;"><span face="" style="font-size: medium;"><span> </span>The previous results from the third round are as follows: 23 with "A" (5 with A1, 12 with A2 cysts, 5 with A2 nodules, and 1 with A2 cysts and nodules), 5 with "B," and 2 with no prior result. </span></span></div><div><br /></div><div><br /></div><div><span style="font-family: trebuchet;"><u><span style="font-size: large;"><b>The fifth round</b></span></u></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> </span>The <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/446620.pdf" target="_blank">fifth round</a> targets 252,828 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 <a href="https://fukushimavoice-eng2.blogspot.com/2021/01/fukushima-thyroid-examination-january.html" target="_blank">previous post</a> discussed how this exclusion skews age distribution graphs to the left.)</span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> </span>Th</span><span style="font-family: trebuchet; font-size: medium;">e COVID-19 restrictions significantly impacted 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. As of September 30, 2020, 3,070 participated in the primary examination, including </span><span style="font-size: medium;"><span style="font-family: trebuchet;">2,506 new participants,</span><span style="font-family: trebuchet;"> </span><span style="font-family: trebuchet;">but its participation rate remains extremely low at 1.2%. Of 2,506 new participants about half is in the age 8-17 category (571 in age 8-11 and 678 in age 12-17), and the other half in the age 18-24 category. The primary examination results are available for 2,138 (69.8%), and a total of 26 were assessed as "B."</span></span></div><div><span style="font-size: medium;"><span style="font-family: trebuchet;"><br /></span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> </span>Because very few had undergone the confirmatory examination as of September 30, 2020, the results were not reported at this time.</span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><br /></span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><span> </span>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 <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/446622.pdf" target="_blank">this proposal</a>: 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.</span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><br /></span></span></div><div><span style="font-family: trebuchet;"><span face=""><span style="font-size: large;"><u><b>Age 25 Milestone Screening</b></u></span></span><br /></span><span style="font-family: trebuchet; font-size: medium;"><span> </span>In the Age 25 Milestone Screening, each screening year targets a cohort turning 25 during each fiscal year, and t<span><span face="">he results are reported every 6 months. </span></span><span>Implementation schedule as of September 30, 2018, reported to the 33rd session of the Oversight Committee, can be found <a href="https://fhms.jp/fhms/uploads/33_27Dec2018.pdf#page=37" target="_blank">here</a>. </span></span><span style="font-family: trebuchet; font-size: medium;">No one is supposed to undergo the regular TUE within 2 years of becoming eligible for the Age 25 Milestone Screening.</span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><div style="font-family: Times;"><span style="font-family: trebuchet;"><div><span><span> </span>Transition of each FY birth cohort to the Age 25 Milestone Screening reduces a target population for the main TUE. This reduction began in the third round conducted during FY 2016-2017, which excluded the FY 1992 and 1993 cohorts in anticipation of the upcoming Age 25 Milestone Screening. With each FY birth cohort including about 22,000 individuals, this is a sizable reduction which continues as the TUE target population ages. For example, the target population has gone from 367,637 for the first round, to 381, 244 for the second round (increased because those who were in utero at the time of the accident were included), 336,670 for the third round, 294,242 for the fourth round, and now 252,828 for the fifth round.</span></div><div style="font-size: medium;"><br /></div></span></div><div style="font-family: Times;"><span style="font-family: trebuchet; font-size: medium;"><span><div style="font-family: Times;"><span style="font-family: trebuchet; font-size: medium;"><span><span> </span>The </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/446730.pdf" target="_blank">results reported this time</a><span> are from the data up to September 30, 2020. Since the previously reported results as of March 31, 2020, 376 more participated in the primary examination, but the total participants are 5,954 out of the target population of 66,637, and an overall participation rate only slightly increased by 0.5% to 8.9%,</span> c</span><span style="font-family: trebuchet;">onspicuously much lower than the main TUE. </span><span style="font-family: trebuchet;">Although each fiscal-year screening is earmarked for those turning 25 during that fiscal year, participants can take part in the screening anytime up to the year before they become eligible for the Age 30 Milestone Screening. Thus p</span><span style="font-family: trebuchet;">articipation rates by FY birth cohorts might continue to change as the screening progresses. </span></div><div style="font-family: Times; font-size: medium;"><span><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div><div style="font-family: Times; font-size: medium;"><span style="font-family: trebuchet; font-size: medium;"><span> </span>Thirty-seven more became eligible for the confirmatory examination (a.k.a. "B" assessment in the primary examination). Of 281 needing the confirmatory examination, 221 has undergone it, with 53 newly participating. Three newly underwent FNAC, and one female with a prior result of "B" was diagnosed with suspected thyroid cancer.</span></div><div style="font-family: Times; font-size: medium;"><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div style="font-family: Times;"><span style="font-family: trebuchet;"><span> </span>Thus the number of suspected or confirmed thyroid cancer cases from the Age 25 Milestone Screening increased by 1 to 8. The results from the prior screening are as follows: 1 with A2 (unclear if cyst or nodule due to lack of reporting), 2 with "B," and 5 with no prior screening.</span></div><div style="font-family: Times; font-size: medium;"><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div style="font-family: Times; font-size: medium;"><span style="font-family: trebuchet; font-size: medium;"><span> </span>With an addition of 2 new surgical cases, a total of 6 thyroid cancer cases (5 papillary thyroid cancers and 1 follicular thyroid cancer) were surgically confirmed in the Age 25 Milestone Screening.</span></div><div style="font-family: Times; font-size: medium;"><br /></div></span></span></div></span></div><div><span style="font-family: trebuchet;"> </span></div><div><span style="font-family: trebuchet;"><span face=""><b><span style="font-size: large;"><u>Summary of the results from the previous screen</u></span><span style="font-size: large;"><u>ing</u></span> </b></span><br /><span face=""><span style="font-size: medium;"><span> </span>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. </span></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div><span style="font-family: trebuchet; font-size: medium;"><u>Definition</u></span></div><div><span style="font-family: trebuchet; font-size: medium;">"A1": no ultrasound findings. </span></div><div><div><span style="font-family: trebuchet; font-size: medium;"><span>"A2": ultrasound findings of nodules </span><span>≤ 5.0 mm and/or cysts </span><span>≤ 20.0 mm. </span></span></div></div><div><div><span style="font-family: trebuchet; font-size: medium;"><span>"B": ultrasound findings of nodules </span><span>≥</span><span> 5.1 mm and/or cysts </span><span>≥</span><span> 20.1 mm.</span></span></div></div></blockquote><div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> </span>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.)</span></div><div><ul><li><span style="font-family: trebuchet; font-size: medium;">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</span></li><li><span style="font-family: trebuchet; font-size: medium;">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</span></li><li><span style="font-family: trebuchet; font-size: medium;">Fourth round (30 cases): 5 cases with A1, 18 cases with A2 (5 nodules, 12 cysts, and 1 nodule & cyst), 5 cases with B, 2 cases previously unexamined</span></li><li><span style="font-family: trebuchet; font-size: medium;">Age 25 Milestone Screening (8 cases): 1 case with A2 (it was never reported if nodule or cyst), 2 cases with B, 5 cases previously unexamined</span></li></ul><div><span style="font-family: trebuchet; font-size: medium;"> </span></div></div></div></div><p><span style="font-family: trebuchet;"><span><span style="font-size: medium;"><b style="font-size: xx-large;"><br /></b></span></span></span></p><p><span style="font-family: trebuchet;"><span><span style="font-size: medium;"><b style="font-size: xx-large;"><br /></b></span></span></span></p><p><br /></p>@YuriHiranumahttp://www.blogger.com/profile/16819451884150838540noreply@blogger.com0tag:blogger.com,1999:blog-9200156515048577812.post-89741975680448173432021-01-30T14:41:00.002-08:002021-06-17T21:28:30.948-07:00Fukushima Thyroid Examination January 2021: 202 Surgically Confirmed as Thyroid Cancer Among 252 Cytology Suspected Cases<p> </p><p><span style="font-family: trebuchet;"><span><span style="font-size: medium;"><b> </b>After a 4½-month hiatus, <a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-40.html" target="_blank">t</a></span><span style="font-size: medium;"><a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-40.html" target="_blank">he 40th session of the Oversight Committee</a> was held on </span></span></span><span style="font-family: trebuchet; font-size: medium;">January 15, 2021, releasing new data (as of June 30, 2020) from the <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/422933.pdf" target="_blank">fourth</a> and <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/422934.pdf" target="_blank">fifth</a> rounds of the Thyroid Ultrasound Examination (TUE). The pandemic restrictions have essentially stalled the school-based screening for the fifth round, and the only cancer data updated was that of the fourth round.</span></p><div style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 12px auto 6px;"><div><div><span style="font-weight: 700;"><span><span style="font-family: trebuchet; font-size: medium;"> </span></span></span></div></div><div><span style="font-weight: 700;"><span><span style="font-family: trebuchet; font-size: medium;"><b style="font-size: x-large;">Highlights</b></span></span></span></div><b><ul><span style="font-family: trebuchet; font-size: medium;"><li><b>The fourth round: 6 new cases diagnosed as suspicious or malignant, and 3 new surgical cases. </b></li><li><b>Total number of suspected/confirmed thyroid cancer has increased by 6 to</b> <span style="color: red;">252</span><b>: </b><b>116 in the first round (in<b>cluding a single case of benign tumor</b>), 71 in the second round, 31 in the third round, 27 in the fourth round, and 7 in Age 25 Milestone Screening.</b></li><li><b>Total number of surgically confirmed thyroid cancer cases has increased by 4 to <span style="color: red;">202</span><span style="color: red;"> </span>(101 in the first round, 54 in the second round, 27 in the third round, 16 in the fourth round, and 4 in Age 25 Milestone Screening)</b></li></span></ul></b><ul><li><b><span style="font-family: trebuchet; font-size: medium;">Data reported is as of June 30, 2020. (Delayed reporting persists after the fourth quarterly session was skipped in 2019 and now also in 2020.)</span></b></li><li><span><span style="font-family: trebuchet; font-size: medium; font-weight: bold;">A list of official English translation of the TUE results is available on the <a href="http://kenko-kanri.jp/en/health-survey/document/" target="_blank">website</a> for the Radiation Medical Science Center of the Fukushima Health Management Survey. No translation is available for the 2020 sessions at this time. </span></span></li></ul><div><span><b><span style="font-family: trebuchet; font-size: x-large;"><br /></span></b></span></div><div><span><b><span style="font-family: trebuchet; font-size: x-large;">The latest overall results including the "unreported" cases</span></b></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLPyq8Rk7BU3-9Yr86puAwYkeMzgF7JWi76wzlRHzosTOokZBKhECwl4LtmPPHySnRSMabp2MeOskUGeM4GXLEzzZr4z6GYhpPw3AIlh8HLTb2_72w_2KVBuj6TG0obDWnhyTe1fK92pgx/s1512/%252340+Latest+data.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="978" data-original-width="1512" height="414" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLPyq8Rk7BU3-9Yr86puAwYkeMzgF7JWi76wzlRHzosTOokZBKhECwl4LtmPPHySnRSMabp2MeOskUGeM4GXLEzzZr4z6GYhpPw3AIlh8HLTb2_72w_2KVBuj6TG0obDWnhyTe1fK92pgx/w640-h414/%252340+Latest+data.png" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><i style="font-family: trebuchet; text-align: left;"><span>(See <a href="https://fukushimavoice-eng2.blogspot.com/2018/07/results-of-survey-on-fukushima-thyroid.html" target="_blank">this post</a> for description of the "unreported" cases. </span></i></div><div class="separator" style="clear: both; text-align: center;"><i style="font-family: trebuchet; text-align: left;"><span>Histological diagnosis of the 11 unreported cancer cases was obtained from <a href="https://www.jstage.jst.go.jp/article/fms/65/3/65_2019-26/_html/-char/ja" target="_blank">this paper</a>.)</span></i></div><div style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 12px auto 6px;"><div style="margin: 0px;"><span style="font-family: trebuchet;"><br /></span><div><span style="font-family: trebuchet; font-size: x-large;"><b>Overview</b></span></div><div><span style="font-family: trebuchet;"> <span style="font-size: medium;">On January 15, 2021, <a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-40.html" target="_blank">the 40th session</a> of the Oversight Committee for the Fukushima Health Management Survey (FHMS) convened in Fukushima City, Fukushima Prefecture to release data as of June 30, 2020. As the third round results were finalized 7 months ago and the fifth round just began in April 2020, new information released on thyroid cancer was essentially from the fourth round only. </span></span></div><div><span style="font-family: trebuchet;"><br /></span></div></div></div><div style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 12px auto 6px;"><div><span style="font-family: trebuchet; font-size: x-large;"><b>Summary on the current status of the TUE</b></span></div><div><span style="font-family: trebuchet;"> <span style="font-size: medium;"> A six-page <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/422943.pdf" target="_blank">summary</a> of the first through fifth rounds as well as the Age 25 Milestone Screening, "The Status of the Thyroid Ultrasound Examination," lists key findings from the primary and confirmatory examinations as well as the surgical information. </span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"> Below is an unofficial translation of this summary which is not officially translated.</span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><a href="https://www.scribd.com/document/492645595/40-Status-of-the-Thyroid-Ultrasound-Examination-January-15-2021#from_embed" style="font-family: Helvetica, Arial, sans-serif; font-size: 14px;" title="View #40 Status of the Thyroid Ultrasound Examination (January 15, 2021) on Scribd">#40 Status of the Thyroid Ultrasound Examination</a><span face="Helvetica, Arial, sans-serif" style="font-size: 14px;"> by </span><a href="https://www.scribd.com/user/233065310/Yuri-Hiranuma#from_embed" style="font-family: Helvetica, Arial, sans-serif; font-size: 14px;" title="View Yuri Hiranuma's profile on Scribd">Yuri Hiranuma</a></span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><iframe class="scribd_iframe_embed" data-aspect-ratio="0.7729220222793488" data-auto-height="true" frameborder="0" height="600" scrolling="no" src="https://www.scribd.com/embeds/492645595/content?start_page=1&view_mode=scroll&access_key=key-27GYFQ9EW2i1JZMJnDDB" title="#40 Status of the Thyroid Ultrasound Examination (January 15, 2021)" width="100%"></iframe><p style="-x-system-font: none; display: block; font-family: Helvetica,Arial,Sans-serif; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; font: 14px Helvetica, Arial, sans-serif; line-height: normal; margin: 12px auto 6px;"><br /></p></span></span></div></div></div><div><div><div><span style="font-family: trebuchet;"><div class="separator" style="clear: both; text-align: center;"><br /></div></span></div><div><span style="font-family: trebuchet;"><span face=""><u><span style="font-size: large;"><b>The fourth round</b></span></u></span><br /><span face=""> <span style="font-size: medium;">The <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/422933.pdf" target="_blank">fourth round</a>, scheduled from April 1, 2018 through March 31, 2020, is still ongoing. Between April 1, 2020 and June 30, 2020, the primary examination gained only 435 more participants, raising the current participation rate by 0.1</span></span></span><span style="font-family: trebuchet; font-size: medium;"><span>% </span></span><span style="font-family: trebuchet;"><span face=""><span style="font-size: medium;">to 61.5%</span><span style="font-size: medium;"><span>. A reminder: This is still below what the prior rounds registered (</span></span></span></span><span style="font-size: medium;"><span style="font-family: trebuchet;">81.7% for the first round, 71.0% for the second round, and 64.7% for the third round</span><span style="font-family: trebuchet;">), although it is approaching the third round.</span></span></div><div><span style="font-family: trebuchet;"><span face=""><span style="font-size: medium;"> </span><span style="font-size: medium;">Having received the "B" assessment in the primary examination, 35 newly became eligible for the confirmatory examination. With an additional 78 actually participating, the participation rate increased by 4.3% to 60.1%. Out of 15 participants undergoing FNAC, 6 females were diagnosed with suspected cancer. Their third-round results include 2 with A1, 2 with A2 (1 cyst and 1 nodule), 1 with B, and 1 with no previous examination. Their ages at the time of the 2011 nuclear accident are 0, 2, 6, 6, 10 and 11. It is notable that this marks the first time that thyroid cancer was detected in individuals aged 0 and 2 at the time of radiation exposure. Two are from Nakadori, one is from Hamadori, and remaining three are from Aizu. One is from a FY 2018 municipality, and the rest from FY 2019 municipalities.</span></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"> </span><span style="font-size: medium;"><span style="font-family: trebuchet;">T</span><span style="font-family: trebuchet;">hree more case</span><span style="font-family: trebuchet;">s </span><span style="font-family: trebuchet;">(all from FY 2019 municipalities) </span><span style="font-family: trebuchet;">were newly confirmed with papillary thyroid cancer after undergoing surgery. </span></span><span style="font-family: trebuchet; font-size: medium;"> </span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"> </span><span style="font-family: trebuchet; font-size: medium;">In summary, a</span><span style="font-size: medium;"><span style="font-family: trebuchet;">s of June 30, 2020, t</span><span style="font-family: trebuchet;">he number of suspected or confirmed thyroid cancer cases for the fourth round is 27, and 16 have been surgically confirmed as thyroid cancer, all papillary thyroid cancer. </span></span></div><div><span style="font-family: trebuchet;"><span face="" style="font-size: medium;"> The previous results from the third round are as follows: 21 with "A" (5 with A1, 12 with A2 cysts, and 4 with A2 nodules), 5 with "B," and 1 with no prior result. </span></span></div><div><br /></div><div><br /></div><div><span style="font-family: trebuchet;"><u><span style="font-size: large;"><b>The fifth round</b></span></u></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"> The <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/422934.pdf" target="_blank">fifth round</a> targets 252,821 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. (See the next section to learn what this exclusion means for the age distribution graphs.)</span></span></div><div><span style="font-family: trebuchet; font-size: medium;"> </span><span style="font-family: trebuchet; font-size: medium;"> Although the fifth round began in April 2020, its progress has been hampered by school closures and other restrictions due to the COVID-19 pandemic. As of June 30, 2020, only 564 participated in the primary examination with 487 (86.3%) in the age 18-24 category. Due to cancellation of the school-based screening in accordance with school closures, only 77 participated in the younger age group (8-17). The primary examination results are available for only 41 out of 564, and one person was assessed as "B."</span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"> No confirmatory examination has been conducted as of June 30, 2020, and there are no suspected/confirmed cancer cases for the fifth round at this time.</span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><br /></span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"> Because of the pandemic delay, a <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/422935.pdf" target="_blank">proposal</a> was submitted by FMU to extend a two-year screening cycle to three years just for the fifth round. 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 already examined in FY 2020.</span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><br /></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><b><u>Age distribution graphs</u></b></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"> As the the target population size continues to dwindle in accordance with an exclusion of a respective FY cohort awaiting the Age 25 Milestone Examination within 2 years, the age distribution is skewed to the left, lending an "unnatural" appearance as thyroid cancer is known to increase in adulthood. This is depicted below in a succession of age distribution graphs from the first to fourth rounds taken from the <a href="http://kenko-kanri.jp/en/img/report_r1.pdf" target="_blank">FY2019 report of the Fukushima Health Management Survey</a> accessed on <a href="http://kenko-kanri.jp/en/health-survey/" target="_blank">this page</a>. </span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><br /></span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"> Graphs on the left show age-at-exposure distribution. The shaded area starts to be seen in the right area of the graph from the third round on. Ordinarily, for thyroid cancer, an upward trend is expected with age, beginning in early 20's. In the age-at-exposure distribution, that corresponds to the shaded area depicting missing data from those transitioning from the regular TUE to the Age 25 Milestone Examination. The age-at-examination distribution graphs on the right show 23 as the maximum age, totally disregarding the missing data.</span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"> One more thing to note: The age-at-examination distribution graphs here might not necessarily show an upward trend with age. This might partially be due to plummeted participation by those ≥ age 18. Participation rates by age groups for the fourth round are 85.4% for ages 6-11, 82.0% for ages 12-17, and 12.4% for ages 18-24.</span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"> As young adults transition to the Age 25 Milestone Screening, participation dips even further; the current participation rate is 8.4%. Thus data gathering becomes more difficult as they leave the regular TUE. Some might undergo cancer screening on their own, totally outside the FHMS system. </span></span><span style="font-family: trebuchet; font-size: medium;">FMU officials plan to rely on the national cancer registry data mandated in 2016 to fill the void. However, with young adults relocating outside Fukushima Prefecture as life goes on, how exhaustive and reliable the cancer registry data might be for this purpose remains to be seen. </span></div><div><br /></div><div><span style="font-family: trebuchet;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFr-v29AJdKqDUkPFY9OgfH2lLx1cgz1klFJysKwz6bMjlP8Z95Vr2AEs6kSqzFgTOWeWQdV2qxVC3DlnziC77JM4Z9DATW7ahdgJBtBh9VLF1gSKS5LCRilbEMPgUWXe4XtjQqNZ0sf7S/s1310/First+round+age+distribution+.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="378" data-original-width="1310" height="184" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFr-v29AJdKqDUkPFY9OgfH2lLx1cgz1klFJysKwz6bMjlP8Z95Vr2AEs6kSqzFgTOWeWQdV2qxVC3DlnziC77JM4Z9DATW7ahdgJBtBh9VLF1gSKS5LCRilbEMPgUWXe4XtjQqNZ0sf7S/w640-h184/First+round+age+distribution+.png" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large; text-align: left;">The first round as of March 31, 2018</span></td></tr></tbody></table><br /></span></div><div><span style="font-family: trebuchet;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJdmgOoDbMtzZ10kJgcgJ6xFVGsqMg4u-ygOgwXQzIHFK4BmOP4gKFoQ74PjOHJWDxUThRtdgkiVSdkFwPlgmWMjD5OCOFYQBBnOh3Fjyt7dqmh6g7fS9maaM8xtPYmEd1P4DiXWnbIBFS/s1284/Second+round+age+distribution+.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="402" data-original-width="1284" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgJdmgOoDbMtzZ10kJgcgJ6xFVGsqMg4u-ygOgwXQzIHFK4BmOP4gKFoQ74PjOHJWDxUThRtdgkiVSdkFwPlgmWMjD5OCOFYQBBnOh3Fjyt7dqmh6g7fS9maaM8xtPYmEd1P4DiXWnbIBFS/w640-h200/Second+round+age+distribution+.png" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: large; text-align: left;">The second round as of March 31, 2018<br /></span></td></tr></tbody></table></span><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5bvrT_uzLdwuWYWSj34Ffw2EvReWLAcJhXEe8GTEyqhWagVC4SwPdK_OtEzGN_VZS8ifJPjWeVleqwtmr4Fp_02MU2BaujmNmK6bEe0mwfP9O0L8eN8mKdQj1-Y3kWrN0vakPkd4UL8oC/s1296/Third+round+age+distribution+.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="392" data-original-width="1296" height="194" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5bvrT_uzLdwuWYWSj34Ffw2EvReWLAcJhXEe8GTEyqhWagVC4SwPdK_OtEzGN_VZS8ifJPjWeVleqwtmr4Fp_02MU2BaujmNmK6bEe0mwfP9O0L8eN8mKdQj1-Y3kWrN0vakPkd4UL8oC/w640-h194/Third+round+age+distribution+.png" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-family: trebuchet; font-size: large; text-align: left;">The third round as of June 30, 2019</span></td></tr></tbody></table></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><br /></span></span></div><div><span style="font-family: trebuchet;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRtrxL2n9qVR6G6d6FSM80Qjovg75j7SILFqkppkWUQrEqFnBl8MfZFuCRH-ShSlc46i8XVMUTkak7AwJW3qrytUY57r9brWr3_e3-GDWprDJQjwtMSNJkGtxhhilmcFQMZWMC-Vz5T8Fp/s1314/Fourth+round+age+distribution.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="402" data-original-width="1314" height="196" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRtrxL2n9qVR6G6d6FSM80Qjovg75j7SILFqkppkWUQrEqFnBl8MfZFuCRH-ShSlc46i8XVMUTkak7AwJW3qrytUY57r9brWr3_e3-GDWprDJQjwtMSNJkGtxhhilmcFQMZWMC-Vz5T8Fp/w640-h196/Fourth+round+age+distribution.png" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: medium;">The fourth round as of June 30, 2019</span></td></tr></tbody></table><br /></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhMbHlW4aVOitAt70EJv1GgWKpC-m-Nattk7m4HYVOEstBLzCfMf4cepSDNPT8l38WT6ON1YVvGRxtZiYdvoIwa3VWKz5VlE4RG12i_0SDTZD65LgkIpuxNfAs7lCYl1wz9YMwOV6m4scr9/s1218/%252340+age-at-exposure+distribution++.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="600" data-original-width="1218" height="316" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhMbHlW4aVOitAt70EJv1GgWKpC-m-Nattk7m4HYVOEstBLzCfMf4cepSDNPT8l38WT6ON1YVvGRxtZiYdvoIwa3VWKz5VlE4RG12i_0SDTZD65LgkIpuxNfAs7lCYl1wz9YMwOV6m4scr9/w640-h316/%252340+age-at-exposure+distribution++.png" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: medium;">The fourth round (age-at-exposure) as of June 30, 2020</span></td></tr></tbody></table><br /><br /></span><span face=""> </span></span></div><div><span style="font-family: trebuchet;"><span face=""><b><span style="font-size: large;"><u>Summary of the results from the previous screen</u></span><span style="font-size: large;"><u>ing</u></span> </b></span><br /><span face=""> <span style="font-size: medium;">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. </span></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div><span style="font-family: trebuchet; font-size: medium;"><u>Definition</u></span></div><div><span style="font-family: trebuchet; font-size: medium;">"A1": no ultrasound findings. </span></div><div><div><span style="font-family: trebuchet; font-size: medium;"><span>"A2": ultrasound findings of nodules </span><span>≤ 5.0 mm and/or cysts </span><span>≤ 20.0 mm. </span></span></div></div><div><div><span style="font-family: trebuchet; font-size: medium;"><span>"B": ultrasound findings of nodules </span><span>≥</span><span> 5.1 mm and/or cysts </span><span>≥</span><span> 20.1 mm.</span></span></div></div></blockquote><div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"> 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 the cancerous lesions were simply "invisible" during the previous screening.)</span></div><div><ul><li><span style="font-family: trebuchet; font-size: medium;">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</span></li><li><span style="font-family: trebuchet; font-size: medium;">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</span></li><li><span style="font-family: trebuchet; font-size: medium;">Fourth round (27 cases): 5 cases with A1, 16 cases with A2 (4 nodules and 12 cysts), 5 cases with B, 1 case previously unexamined</span></li><li><span style="font-family: trebuchet; font-size: medium;">Age 25 Milestone Screening (7 cases): 1 case with A2 (it was never reported if nodule or cyst), 1 case with B, 5 cases previously unexamined</span></li></ul><div><span style="font-family: trebuchet; font-size: medium;"> </span></div></div></div></div>@YuriHiranumahttp://www.blogger.com/profile/16819451884150838540noreply@blogger.com0tag:blogger.com,1999:blog-9200156515048577812.post-57278657070056416922021-01-11T22:44:00.005-08:002021-06-17T17:13:59.204-07:00Fukushima Thyroid Examination August 2020: 199 Surgically Confirmed as Thyroid Cancer Among 246 Cytology Suspected Cases<p><span style="font-family: trebuchet;"><br /></span></p><div style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 12px auto 6px;"><div><div><span style="font-family: trebuchet;"><span><span><span style="font-size: medium;"><b> </b>T</span><span style="font-size: medium;">he 39th session of the Oversight Committee was held on </span></span></span><span style="font-size: medium;">August 31, 2020, releasing some new data (as of March 31, 2020) from the second and the fourth rounds of the Thyroid Ultrasound Examination (TUE). Also released were the final results of the third round as well as the biennial report of the Age 25 Milestone Screening, both of which were first reported on June 15, 2020 at the 15th TUE Evaluation Subcommittee and covered in the <a href="https://fukushimavoice-eng2.blogspot.com/2020/08/fukushima-thyroid-examination-may-june.html" target="_blank">previous post</a>. </span></span></div><div><span style="font-weight: 700;"><span><span style="font-family: trebuchet; font-size: medium;"> </span></span></span></div></div><div><span style="font-weight: 700;"><span><span style="font-family: trebuchet; font-size: medium;"><b style="font-size: x-large;">Highlights</b></span></span></span></div><b><ul style="text-align: left;"><span style="font-family: trebuchet; font-size: medium;"><li><b>The second round: Two new cases surgically confirmed</b></li><li><b>The fourth round: Five new cases diagnosed as suspicious or malignant, and 2 new surgical cases. </b></li><li><b>Total number of suspected/confirmed thyroid cancer has increased by 5 to</b> <span style="color: red; font-weight: bold;">246</span><b>: </b><b>116 in the first round (<b><i>including</i> a single case of benign tumor)</b>, 71 in the second round, 31 in the third round, 21 in the fourth round, and 7 in Age 25 Milestone Screening.</b></li><li><b>Total number of surgically confirmed thyroid cancer cases has increased by 4 to <span style="color: red;">199 </span>(101 in the first round, 54 in the second round, 27 in the third round, 13 in the fourth round, and 4 in Age 25 Milestone Screening)</b></li></span></ul></b><ul><li><b><span style="font-family: trebuchet; font-size: medium;">Data reported is as of March 31, 2020. (Delayed reporting persists after the fourth quarterly session was skipped in 2019.)</span></b></li><li><span><span style="font-family: trebuchet; font-size: medium; font-weight: bold;">A list of official English translation of the results is available on the <a href="http://kenko-kanri.jp/en/health-survey/document/" target="_blank">website</a> for the Radiation Medical Science Center of the Fukushima Health Management Survey. No translation is available for the 2020 sessions at this time. </span></span></li></ul><div><span><b><span style="font-family: trebuchet; font-size: x-large;"><br /></span></b></span></div><div><span><b><span style="font-family: trebuchet; font-size: x-large;">The latest overall results including the "unreported" cases</span></b></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlVPaCrM7EhgpRkk7-u6d3ecIWaLAPndWfM_f0ZzVPgRHpb5ZCKU3sNIiBn6OE4OmYD_PYNzXWahtGUKpdUhnJGwk7SnA-9cy9Qqft3X7z8Yy5jZM2j4N-JC69WuAuZ1UyVQWE12gqkslk/s1528/%252339+Latest+data+.png" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: trebuchet;"><img border="0" data-original-height="970" data-original-width="1528" height="406" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhlVPaCrM7EhgpRkk7-u6d3ecIWaLAPndWfM_f0ZzVPgRHpb5ZCKU3sNIiBn6OE4OmYD_PYNzXWahtGUKpdUhnJGwk7SnA-9cy9Qqft3X7z8Yy5jZM2j4N-JC69WuAuZ1UyVQWE12gqkslk/w640-h406/%252339+Latest+data+.png" width="640" /></span></a></div><div class="separator" style="clear: both; text-align: center;"><span style="font-family: trebuchet;"><br /></span></div><div style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 12px auto 6px;"><div style="margin: 0px;"><span style="font-family: trebuchet;"><i><span>(See <a href="https://fukushimavoice-eng2.blogspot.com/2018/07/results-of-survey-on-fukushima-thyroid.html" target="_blank">this post</a> for description of the "unreported" cases. Histological diagnosis of the 11 unreported cancer cases was obtained from <a href="https://www.jstage.jst.go.jp/article/fms/65/3/65_2019-26/_html/-char/ja" target="_blank">this paper</a>.)</span></i><br /><br /></span><div><span style="font-family: trebuchet; font-size: x-large;"><b>Overview</b></span></div><div><span style="font-family: trebuchet;"> <span style="font-size: medium;">On August 31, 2020, the 39th session of the Oversight Committee for the Fukushima Health Management Survey (FHMS) convened in Fukushima City, Fukushima Prefecture to release the fiscal year-end data as of March 31, 2020. For the third round it was the finalized report which had already been released two months earlier at the 15th session of the TUE Evaluation Subcommittee held on June 15, 2020. The Age 25 Milestone Screening results had also been released then. New information released at this time includes the second round results which were updated for the first time in 2 years and the results for the ongoing fourth round.</span></span></div><div><span style="font-family: trebuchet;"><br /></span></div></div></div><div style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 12px auto 6px;"><div><span style="font-family: trebuchet; font-size: x-large;"><b>Summary on the current status of the TUE</b></span></div><div><span style="font-family: trebuchet;"> <span style="font-size: medium;"> A six-page <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/401334.pdf" target="_blank">summary</a> of the first through fourth rounds as well as the Age 25 Milestone Screening, "The Status of the Thyroid Ultrasound Examination," lists key findings from the primary and confirmatory examinations as well as the surgical information. </span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"> Below is an unofficial translation of this summary which is not officially translated.</span></span></div><div><span><span style="font-family: trebuchet; font-size: medium;"> </span></span></div><div><a href="https://www.scribd.com/document/490405574/39-Status-of-the-Thyroid-Ultrasound-Examination-released-on-August-31-2020#from_embed" style="font-family: Helvetica, Arial, sans-serif; font-size: 14px;" title="View #39 Status of the Thyroid Ultrasound Examination (released on August 31, 2020) on Scribd">#39 Status of the Thyroid Ultrasound Examination</a><span face="Helvetica, Arial, sans-serif" style="font-size: 14px;"> by </span><a href="https://www.scribd.com/user/233065310/Yuri-Hiranuma#from_embed" style="font-family: Helvetica, Arial, sans-serif; font-size: 14px;" title="View Yuri Hiranuma's profile on Scribd">Yuri Hiranuma</a><span style="font-family: trebuchet; font-size: large;"> </span><iframe class="scribd_iframe_embed" data-aspect-ratio="0.7729220222793488" data-auto-height="true" frameborder="0" height="600" scrolling="no" src="https://www.scribd.com/embeds/490405574/content?start_page=1&view_mode=scroll&access_key=key-QqNTXstlBIEZ1zyAMB13" title="#39 Status of the Thyroid Ultrasound Examination (released on August 31, 2020)" width="100%"></iframe></div></div></div><span style="font-family: trebuchet;"><br /><u><span style="font-size: large;"><b>The second round</b></span></u></span><div><span style="font-family: trebuchet;"> </span><span style="font-family: trebuchet; font-size: medium;">The second-round results, <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/273524.pdf" target="_blank">last updated</a> as a FY 2017 supplementary report to the final report at the 31st Oversight Committee on June 18, 2018, had an addition of two surgical cases. As mentioned in the <a href="https://fukushimavoice-eng2.blogspot.com/2020/08/fukushima-thyroid-examination-may-june.html" target="_blank">previous post</a>, there is no official translation of the final report of the second round or its supplementary version. What was <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/401324.pdf" target="_blank">released this time</a> has been reduced to mere 2 pages, and whether this is officially translated remains to be seen. </span><div><span style="font-family: trebuchet;"><p style="font-family: Times;"><span style="font-family: trebuchet; font-size: medium;"><span style="font-family: trebuchet; font-size: medium;"> As of March 31, 2020, t</span>he number of suspected or confirmed thyroid cancer cases in the second round remains unchanged at 71. Of 52 cases from the FY 2014 targeted municipalities, 2 cases were newly confirmed as papillary thyroid cancer after surgery, increasing the number of surgical cases to 54 (53 papillary thyroid cancer and 1 "other" thyroid cancer).</span></p><p style="font-family: Times;"> <span style="font-size: medium;"> <span style="font-family: trebuchet;">The previous results from the first round are as follows: 65 with "A" 33 with A1, 25 with A2 cysts, and 7 with A2 nodules), 5 with "B," and 1 with no prior screening.</span></span></p></span><div><span style="font-family: trebuchet;"><u><span style="font-size: large;"><b>The third round</b></span></u></span><span style="font-family: trebuchet;"> </span><div><div><span><span style="font-family: trebuchet;"> <span style="font-size: medium;">The <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/401325.pdf" target="_blank">final report of the third-round results</a>, released at the June 15th TUE Subcommittee, was also released at this time. This essentially means that it will (eventually) be officially translated into English unlike the final report of the second round. </span></span></span><div><span style="font-family: trebuchet; font-size: medium;"> </span></div><div><span style="font-family: trebuchet; font-size: medium;"> As the details of the final report were discussed in the <a href="https://fukushimavoice-eng2.blogspot.com/2020/08/fukushima-thyroid-examination-may-june.html" target="_blank">previous post</a>, only a summary is provided below: </span></div><div><span style="font-size: medium;"><br /></span></div><div><span style="font-size: medium;"><span style="font-family: trebuchet;"> As of March 31, 2020, t</span><span style="font-family: trebuchet;">he number of suspected or confirmed thyroid cancer cases is 31, and 27 have been surgically confirmed as thyroid cancer, </span><span style="font-family: trebuchet;">all of which being papillary thyroid cancer. </span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"><br /></span></span></div><div><span style="font-family: trebuchet;"><span style="font-size: medium;"> The previous results from the second round are as follows: 21 with "A" (7 with A1, 10 with A2 cysts, and 4 with A2 nodules), 7 with "B," and 3 with no prior screening.</span></span></div><div><div><span style="font-family: trebuchet;"><div class="separator" style="clear: both; text-align: center;"><br /></div></span></div><div><span style="font-family: trebuchet;"><span face=""><u><span style="font-size: large;"><b>The fourth round</b></span></u></span><br /><span face=""> <span style="font-size: medium;">The <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/401326.pdf" target="_blank">fourth round</a>, scheduled from April 1, 2018 through March 31, 2020, is still ongoing. Between December 31, 2019 and March 31, 2020, the primary examination gained 17,177 more participants, raising the current participation rate </span></span></span><span style="font-family: trebuchet; font-size: medium;">from </span><span style="font-family: trebuchet; font-size: medium;"><span>55.6</span><span>% </span></span><span style="font-family: trebuchet;"><span face=""><span style="font-size: medium;">to 61.4%</span><span style="font-size: medium;"><span>. This is still below what the prior rounds registered (</span></span></span></span><span style="font-size: medium;"><span style="font-family: trebuchet;">81.7% for the first round, 71.0% for the second round, and 64.7% for the third round</span><span style="font-family: trebuchet;">), although it is approaching the third round.</span></span></div><div><span style="font-family: trebuchet;"><span face=""><span style="font-size: medium;"><br /></span></span></span></div><div><span style="font-family: trebuchet;"><span face=""><span style="font-size: large;"> </span><span style="font-size: medium;">Having received the "B" assessment in the primary examination, 243 newly became eligible for the confirmatory examination with 137 actually participating. The participation rate increased by 0.1% to 55.8%. Out of 15 participants that underwent FNAC, 5 (3 males and 2 females) were newly diagnosed with suspected cancer. Their third-round results include 4 A2 (3 cysts and 1 nodule) and 1 B. Their ages at the time of the 2011 nuclear accident are 9 (male), 11 (male), 12 (male), and 8 (both females). Two are from Nakadori, and other three are from Hamadori. One of the females is from a FY 2018 targeted municipality, and the rest from FY 2019 targeted municipalities.</span></span></span></div><div><span style="font-family: trebuchet;"><span face=""><span style="font-size: medium;"><br /></span></span></span></div><div><span style="font-family: trebuchet; font-size: large;"> </span><span style="font-family: trebuchet; font-size: medium;">Two more cases were newly confirmed with papillary thyroid cancer after undergoing surgery. </span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: large;"> </span><span style="font-family: trebuchet; font-size: large;"> </span><span style="font-size: medium;"><span style="font-family: trebuchet;">As of March 31, 2020, t</span><span style="font-family: trebuchet;">he number of suspected or confirmed thyroid cancer cases for the fourth round is 21, and 13 have been surgically confirmed as thyroid cancer, all of which being papillary thyroid cancer. </span></span></div><div><span style="font-family: trebuchet;"><span face="" style="font-size: medium;"><div style="font-family: Times;"><span style="font-family: trebuchet;"> The previous results from the third round are as follows: 17 with "A" (3 with A1, 11 with A2 cysts, and 3 with A2 nodules), 4 with "B." </span></div></span></span></div><div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div></div><div><span style="font-family: trebuchet; font-size: medium;"><span> </span>With an addition of 2 new surgical cases (all from the FY 2018 municipalities), a total of 13 thyroid cancer cases, all papillary thyroid cancer, have been surgically confirmed in the fourth round.</span></div><div><span style="font-family: trebuchet;"><span><br /><span face=""><span style="font-size: large;"><u><b>Age 25 Milestone Screening</b></u></span></span><br /><span face=""> </span></span></span><span style="font-size: medium;"><span style="font-family: trebuchet;">The <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/401327.pdf" target="_blank">Age 25 Milestone Screening results</a> reported this time were also </span><span style="font-family: trebuchet;">released at the June 15th TUE Subcommittee like the final report of the third round. Although already discussed in the previous post, the content is reposted below due to a confusing nature of this particular screening.</span></span></div><div><span style="font-family: trebuchet;"><span><span face="" style="font-size: medium;"><br /></span></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span><span face=""> </span></span> In the Age 25 Milestone Screening, each screening year targets a cohort turning 25 during each fiscal year, and t<span><span face="">he results are reported every 6 months. </span></span><span>The very first results as of March 31, 2018 (reported to the 31st session of the Oversight Committee) were included in the fourth-round results and can be accessed </span><a href="http://kenko-kanri.jp/en/health-survey/document/pdf/31_18Jun2018.pdf" target="_blank">here</a><span> (pages 31-32). Implementation schedule from the first full report as of September 30, 2018 (reported to the 33rd session of the Oversight Committee; pages 37-43 in <a href="http://kenko-kanri.jp/en/health-survey/document/pdf/33_27Dec2018.pdf" target="_blank">this PDF</a>) is shown below. </span></span><span style="font-family: trebuchet; font-size: medium;">No one is supposed to undergo the regular TUE within 2 years of becoming eligible for the Age 25 Milestone Screening.</span></div><div><span><span style="font-family: trebuchet; font-size: medium;"> </span></span></div><div><span style="font-family: trebuchet;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuXuCtYlUfk0-tPK46O6YQeeKcN6a1GNhfeUR1jYiVqyDJsir5zAWX6RKLiK9Tdljo35Sg6XfV3MIishrDSFDQD5ugxyxe8gQ2Z-Za27bd4I_IKk-1rhsLKYybaOwM-SycVLmH10CUKFvV/s646/Screen+Shot+2020-08-29+at+1.39.00+PM.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="269" data-original-width="646" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuXuCtYlUfk0-tPK46O6YQeeKcN6a1GNhfeUR1jYiVqyDJsir5zAWX6RKLiK9Tdljo35Sg6XfV3MIishrDSFDQD5ugxyxe8gQ2Z-Za27bd4I_IKk-1rhsLKYybaOwM-SycVLmH10CUKFvV/s640/Screen+Shot+2020-08-29+at+1.39.00+PM.png" width="640" /></a></div><div><span><span face=""> <span style="font-size: medium;">In April 2017, 22,633 individuals born in FY 1992 (the FY 1992 cohort) kicked off the Age 25 Milestone Screening, which notably reduces the size of target population for the main TUE. This reduction began in the third round conducted during FY 2016-2017, which excluded the FY 1992 and 1993 cohorts in anticipation of an upcoming Age 25 Milestone Screening. With each FY birth cohort including about 22,000 individuals, this is a sizable reduction which continues as the TUE target population ages. For example, the target population has gone from 367,637 for the first round, to 381, 244 for the second round (increased because those who were in utero at the time of the accident were included), 336,670 for the third round, and 294,213 for the fourth round.</span></span></span></div><div><span><span face="" style="font-size: medium;"><br /></span></span></div></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span><span face=""> A fiscal year-end report for FY 2019 (<a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/389446.pdf" target="_blank">link</a>), which includes data </span></span>as of March 31, 2020, <span>adds data from 22,096 in the FY 1994 cohort. It also includes some updates on the FY 1992 and 1993 cohorts. (Note: Although each fiscal year screening is earmarked for those turning 25 during that fiscal year, participants can take part in the screening anytime up to the year before they become eligible for the Age 30 Milestone Screening. As such, the report can include updated data from all fiscal year cohorts.)</span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"> Since October 1, 2019, 1,301 participants newly underwent the primary examination, including 16 born in FY 1992, 63 in FY 1993, and 1,222 in FY 1994. An overall participation rate actually decreased from 9.6% to 8.4% due to a larger denominator from an addition of the FY 1994 cohort. A participation rate for the FY 1994 is 5.5%. It remained at 9.9% for the FY 1992 cohort and increased by 0.3% to 9.6% for the FY 1993 cohort. Because the participation is not limited to a specific screening year as explained earlier, it is likely that the FY 1994 cohort will eventually have a higher participation rate. A fiscal year-end participation rate for the FY 1993 cohort as of March 31, 20019 was 4.5%, which has now more than doubled a year later. Still, these participation rates are conspicuously much lower than the main TUE.</span></div><div><span><span style="font-family: trebuchet; font-size: medium;"><br /></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"> Eligibility for the confirmatory examination (a.k.a. "B" assessment in the primary examination) was gained for 46 more participants. Of 244 needing the confirmatory examination, 23 newly participated, and 3 newly underwent FNAC. All three, all females, were diagnosed with suspected thyroid cancer, and one had "B" in the previous screening whereas 2 never participated in the TUE.</span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"> Thus the number of suspected or confirmed thyroid cancer cases from the Age 25 Milestone Screening increased by 3 to 7. The results from the prior screening are as follows: 1 with A2 (unclear if cyst or nodule due to lack of reporting), 1 with "B," and 5 with no prior screening.</span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"> With an addition of 3 new surgical cases, a total of 4 thyroid cancer cases (3 papillary thyroid cancers and 1 follicular thyroid cancer) were surgically confirmed in the Age 25 Milestone Screening.</span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"><span> The average tumor diameter from t</span>he FNAC was <span>22.6 ± 15.6 mm (range 10.8 - 49.9 mm). Note that this is a drastic jump from what was reported last time, 14.5</span><span> ± 2.7mm (range 12.3 - 18.0 mm), with the average diameter increasing by a factor of 1.5 and the maximum diameter nearly tripling. This is likely due to a single case of follicular thyroid cancer. </span></span></div><div><span style="font-family: trebuchet;"><br /></span></div><div><span style="font-family: trebuchet;"><span face=""><br /></span><span face=""><b><span style="font-size: large;"><u>Summary of the results from the previous screen</u></span><span style="font-size: large;"><u>ing</u></span> </b></span><br /><span face=""> <span style="font-size: medium;">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. </span></span></span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div></div></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div><div><div><span style="font-family: trebuchet; font-size: medium;"><u>Definition</u></span></div></div></div><div><div><span style="font-family: trebuchet; font-size: medium;">"A1": no ultrasound findings. </span></div></div><div><div><span style="font-family: trebuchet; font-size: medium;"><span>"A2": ultrasound findings of nodules </span><span>≤ 5.0 mm and/or cysts </span><span>≤ 20.0 mm. </span></span></div></div><div><div><span style="font-family: trebuchet; font-size: medium;"><span>"B": ultrasound findings of nodules </span><span>≥</span><span> 5.1 mm and/or cysts </span><span>≥</span><span> 20.1 mm.</span></span></div></div></blockquote><div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><span style="font-family: trebuchet; font-size: medium;"> 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 the cancerous lesions were simply "invisible" during the previous screening.)</span></div><div><ul><li><span style="font-family: trebuchet; font-size: medium;">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</span></li><li><span style="font-family: trebuchet; font-size: medium;">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</span></li><li><span style="font-family: trebuchet; font-size: medium;">Fourth round (21 cases): 3 cases with A1, 14 cases with A2 (3 nodules and 11 cysts), 4 cases with B</span></li><li><span style="font-family: trebuchet; font-size: medium;">Age 25 Milestone Screening (7 cases): 1 case with A2 (it was never reported if nodule or cyst), 1 case with B, 5 cases previously unexamined</span></li></ul><div><span style="font-family: trebuchet; font-size: medium;"> *************************************</span></div><div><span style="font-family: trebuchet; font-size: medium;"><br /></span></div><div><b style="font-family: trebuchet;"><span style="font-size: large;">Addendum</span></b><span style="font-family: trebuchet; font-size: medium;"> (Note: this is for record-keeping, not an endorsement of any sort.)</span></div><div><p><b style="font-family: trebuchet; font-size: large;"> </b><span style="font-size: medium;"><span style="font-family: trebuchet;">The <a href="https://fukushimavoice-eng2.blogspot.com/2020/08/fukushima-thyroid-examination-may-june.html" target="_blank">previous post</a> covered </span><span style="font-family: trebuchet;">a group </span><span style="font-family: trebuchet;">promoting an overdiagnosis theory, </span><span style="font-family: trebuchet;">"<a href="http://www.med.osaka-u.ac.jp/pub/labo/JCJTC/index-E.html" target="_blank">Japan Consortium for Juvenile Thyroid Cancer</a> (JTJTC)," which was spearheaded by Toru Takano of Osaka University, a</span><span style="font-family: trebuchet;"> former controversial member of the Oversight Committee and the TUE Subcommittee. </span><span style="font-family: trebuchet;"> The member roster includes those who were aggressively attributing Fukushima's thyroid cancer to overdiagnosis: Akira Otsuru, Tomotaka Sobue, Toru Takano, Shoichiro Tsugane, and Sanae Midorikawa.</span></span></p><p><span style="font-family: trebuchet; font-size: medium;"> As explained in the previous post, objectives of the group might not be totally obvious from the website. Rather, their beliefs and claims are explained by Midorikawa on the website of Miyagi Gakuin Women's University (<a href="https://web.mgu-ac.work/essay/2072.html?_ga=2.101965633.1755230660.1593068385-619948751.1593068385" target="_blank">link</a>). Excerpts are translated below:</span></p><p></p><ul><li><span style="font-family: trebuchet; font-size: medium;">It is not that radiation exposure led to an increase in thyroid cancer in Fukushima.</span></li><li><span style="font-family: trebuchet; font-size: medium;">Many thyroid cancers happen to be "discovered" because of the Thyroid Ultrasound Examination (TUE).</span></li><li><span style="font-family: trebuchet; font-size: medium;">Further, majority of those thyroid cancer cases would not have been diagnosed if it weren't for the TUE: They are harmless cancers which probably would have remained undetected for life. (This is called overdiagnosis.)</span></li><li><span style="font-family: trebuchet; font-size: medium;">Even Fukushima residents and their families are unaware of this fact, and they continue to participate in the TUE.</span></li></ul><p><span style="font-family: trebuchet; font-size: medium;"> The JTJTC even boasts several international advisory members, as described on their <a href="http://www.med.osaka-u.ac.jp/pub/labo/JCJTC/about-E.html" target="_blank">website</a>. There is also a <a href="https://twitter.com/MKoujyo" target="_blank">Japanese Twitter account</a> called "Save Children from Overdiagnosis (SCO)" affiliated with JTJTC, clearly intended to inform the public of their agenda, often tweeting video clips by Takano, Midorikawa, and Ohtsuru.</span></p><p><span style="font-family: trebuchet; font-size: medium;"> Midorikawa, a former director of the school screening, and Ohtsuru, a former director of the TUE, have publicly turned against their former colleagues at Fukushima Medical University (FMU) in their <a href="https://www.jstage.jst.go.jp/article/endocrj/67/12/67_EJ20-0604/_html/-char/en" target="_blank">letter to the editor</a> regarding a recent <a href="https://www.blogger.com/blog/post/edit/1454638076449607880/9104004845603545047?hl=en#" target="_blank">FMU paper</a> on the non-malignant cytological examination results from the first and second rounds. Criticizing that FMU's use of the term "overtreatment" is misleading, Midorikawa and Ohtsuru ultimately recommends halting the school screening based on various pieces of "evidence" which are meant to rationalize their claim of overdiagnosis. Their discourse, built on an unproven assumption of overdiagnosis, is illogical at times.</span></p><p></p><p><span style="font-family: trebuchet; font-size: medium;"> Takano has done his share of pushing the group's biased view of overdiagnosis, actively publishing papers in various academic journals. In a <a href="https://meridian.allenpress.com/aplm/article/143/6/660/420734/Overdiagnosis-of-Thyroid-Cancer-The-Children-in" target="_blank">letter to the editor</a> published in the June 2019 issue of the Archives of Pathology and Laboratory Medicine, Takano even claimed that overdiagnosis has put Fukushima's children in danger, prompting a <a href="https://meridian.allenpress.com/aplm/article/144/7/797/441893/An-Accurate-Picture-of-Fukushima-s-Thyroid" target="_blank">reply</a> from FMU officials describing "an accurate picture" of the TUE.</span></p><p><span style="font-family: trebuchet; font-size: medium;"> Albeit a common thread of denying radiation effects due to "lower doses in Fukushima than in Chernobyl," JTJTC's activities deviate from FMU's work by emphasizing harm (mostly psychosocial) originating in the TUE, posing constant hindrance to FMU's plan to continue the TUE. Their garbled views might<i> </i>make <a href="https://fukushimavoice-eng2.blogspot.com/2019/06/how-conclusion-transpired-on-thyroid.html" target="_blank">FMU's claims</a> appear reasonable, but they are actually a good match when it comes to garbling.</span></p><p><span style="font-family: trebuchet; font-size: medium;"><br /></span></p><p><span style="font-family: trebuchet;"> </span></p></div></div></div></div></div></div></div>@YuriHiranumahttp://www.blogger.com/profile/16819451884150838540noreply@blogger.com0tag:blogger.com,1999:blog-9200156515048577812.post-68656055254275384562020-08-30T20:01:00.009-07:002021-01-28T15:17:08.763-08:00Fukushima Thyroid Examination May-June 2020: 195 Surgically Confirmed as Thyroid Cancer Among 241 Cytology Suspected Cases<p><span style="font-family: inherit;"> </span></p><div style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 12px auto 6px;"><div><div><span style="font-family: inherit;"><span style="font-size: medium;"><span face="" style="font-size: large;"><b>Highlights</b></span></span><b> </b></span></div><div><span style="font-weight: 700;"><span style="font-family: inherit; font-size: medium;"><br /></span></span></div><div><span style="font-weight: 700;"><span style="font-family: inherit;"><span style="font-size: medium;"> In May and June 2020, two sessions were held <span>within </span></span><span style="font-size: medium;">3 weeks of each other, releasing the thyroid cancer data. Due to the COVID-19 pandemic, both sessions were held in a web conference format. First was the 38th session of the Oversight Committee held on May 25, 2020. Then on June 15, 2020, the 15th session of the Thyroid Ultrasound Examination Evaluation Subcommittee (TUE Subcommittee) convened, updating some of the data released 3 weeks earlier. </span></span></span></div><div><span style="font-weight: 700;"><span style="font-family: inherit;"><span style="font-size: medium;"> This post will cover the June 15 data, which is inclusive of the May 25 data, and the development since the last session of the Oversight Committee on February 13, 2020.</span></span></span></div></div><b><ul style="text-align: left;"><span style="font-family: inherit;"><li><b>The third round: 1 case newly diagnosed as suspicious or malignant, and 1 new cases surgically confirmed. Final report released on June 15, 20.</b></li><li><b>The fourth round: No new cases diagnosed as suspicious or malignant, and 3 new surgical cases. </b></li><li><b>Age 25 Milestone Screening: 3 cases newly diagnosed as suspicious or malignant, and 3 new surgical cases. </b></li><li><b>Total number of suspected/confirmed thyroid cancer has increased by 4 to</b> <span style="color: red; font-weight: bold;">240 </span><b><i>excluding</i> a single case of benign tumor: </b><b>115 in the first round, 71 in the second round, 31 in the third round, 16 in the fourth round, and 7 in Age 25 Milestone Screening.</b></li><li><b>Total number of surgically confirmed thyroid cancer cases has increased by 9 to <span style="color: red;">195 </span>(101 in the first round, 52 in the second round, 27 in the third round, 11 in the fourth round, and 4 in Age 25 Milestone Screening)</b></li></span></ul></b><ul><li><b><span style="font-family: inherit;">Data reported is as of December 31, 2019 for the fourth round and March 31, 2020 (the end of Fiscal Year 2019) for the third round and the Age 25 Milestone Screening. (Reporting this year has been delayed in general due to the December 2019 session never being held.)</span></b></li><li><span style="font-family: inherit;"><span face="" style="font-weight: bold;">A list of official English translation of the results has finally been updated on the <a href="http://kenko-kanri.jp/en/health-survey/document/" target="_blank">new website</a> for the Radiation Medical Science Center of the Fukushima Health Management Survey. It now includes the three 2019 sessions up to the 36th Oversight Committee held on October 2019. (There were only three sessions in 2019.) The catch is, the agenda materials are only </span><b><span face="">downloadable as one large file per session, so it takes a bit of time to look for the TUE results. </span><span face="">Unfortunately, the <a href="http://fmu-global.jp/our-activities/prefectural-oversight-committee-meeting/" target="_blank">old website</a> which used to show individual reports for each session no longer exists, and the URLs for translations in the previous posts are no longer valid. Time permitting, those URLs will be updated.</span></b></span></li></ul><div><span style="font-family: inherit;"><b><span style="font-size: large;"><br /></span></b><b><span style="font-size: large;">The latest overall results including the "unreported" cases</span></b></span></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAeZ0SuB7rLCag9DTjlfxKHZo1XFzv8Ey3at0MHCAqvGQjO3ZKctvCZKyEX3QPso5PzHE9jQDl_bk-2tWXRIkz7VT9Zts4AfAqtHAXGjcJSenWy8CpltZlt0_xrp0wRTG4C1KiKCmB4-xG/s828/Latest+data+as+of+%252338+%2528May+25+2020%2529+and+%252315+%2528June+15+2020%2529.png" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: inherit;"><img border="0" data-original-height="597" data-original-width="828" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhAeZ0SuB7rLCag9DTjlfxKHZo1XFzv8Ey3at0MHCAqvGQjO3ZKctvCZKyEX3QPso5PzHE9jQDl_bk-2tWXRIkz7VT9Zts4AfAqtHAXGjcJSenWy8CpltZlt0_xrp0wRTG4C1KiKCmB4-xG/s640/Latest+data+as+of+%252338+%2528May+25+2020%2529+and+%252315+%2528June+15+2020%2529.png" width="640" /></span></a></div><div style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 12px auto 6px;"><div style="margin: 0px;"><span style="font-family: inherit;"><i><span style="font-family: inherit;">(See <a href="https://fukushimavoice-eng2.blogspot.com/2018/07/results-of-survey-on-fukushima-thyroid.html" target="_blank">this post</a> for description of the "unreported" cases. Histological diagnosis of the 11 unreported cancer cases was obtained from <a href="https://www.jstage.jst.go.jp/article/fms/65/3/65_2019-26/_html/-char/ja" target="_blank">this paper</a>.)</span></i><br /><i><br /></i><br /></span><div><span style="font-family: inherit; font-size: large;"><b>Overview</b></span></div><div><span style="font-family: inherit;"> On May 25, 2020, the 38th session of the Oversight Committee for the Fukushima Health Management Survey (FHMS) convened in Fukushima City, Fukushima Prefecture to release the third- and fourth-round data as of December 31, 2019. Then, merely 3 weeks later, the 15th session of the Thyroid Ultrasound Examination (TUE) Evaluation Subcommittee ("TUE Subcommittee") was held on June 15, 2020, this time releasing the final version of the third-round results as well as the results of the Age 25 Milestone Screening, both as of March 31, 2020, which is the end of the Fiscal Year 2019.</span></div><div><span style="font-family: inherit;"><br /></span></div><div><span style="font-family: inherit;"> The fourth-round results is anticipated to be updated to data as of March 31, 2020 at the 39th session of the Oversight Committee scheduled for August 31, 2020. </span></div><div><span style="font-family: inherit;"><br /></span></div><div><span style="font-family: inherit;"> The screening has slowed down due to the COVID-19 pandemic. In particular, temporary school closures from March through May interrupted the TUE conducted in school settings, which accounts for a big chunk of the data. Most affected by this slow down would be the fourth-round results, and the next set of data as of March 31 might begin to reflect it.</span></div><div><span style="font-family: inherit;"><span face=""> </span><br /><span face=""> It is expected that the official English translation will eventually become available <a href="http://kenko-kanri.jp/en/health-survey/document/" target="_blank">on the website of the Radiation Medical Science Center for the Fukushima Health Management Survey</a>. This website has finally been updated with the official English translation of the excerpted agenda materials from the three 2019 Oversight Committee sessions.</span></span></div><div><span style="font-family: inherit;"><br /></span></div></div></div><div style="font-stretch: normal; font-variant-east-asian: normal; font-variant-numeric: normal; line-height: normal; margin: 12px auto 6px;"><div style="font-size: medium;"><span style="font-family: inherit; font-size: large;"><b>Summary on the current status of the TUE</b></span></div><div><span style="font-family: inherit;"> A six-page <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/386032.pdf" target="_blank">summary</a> of the first through fourth rounds as well as the Age 25 Milestone Screening, "The Status of the Thyroid Ultrasound Examination," lists key findings from the primary and confirmatory examinations as well as the surgical information. </span></div><div><span style="font-family: inherit;"><span face=""> In the past, the same version released at the Oversight Committee session was distributed at the subsequent TUE Subcommittee. However, this time, the version released at the May 25th Oversight Committee session was updated for the June 15th TUE Subcommittee session. </span>Here, the more updated and complete June 15th version is unofficially translated. (There is no official translation of this summary.)</span></div><div><br /></div><div><span style="font-family: inherit;"><a href="https://www.scribd.com/document/474215687/38-Status-of-the-Thyroid-Ultrasound-Examination#from_embed" style="font-family: Helvetica, Arial, sans-serif; font-size: 14px;" title="View #38 Status of the Thyroid Ultrasound Examination on Scribd">#38 Status of the Thyroid Ultrasound Examination</a><span style="font-family: Helvetica, Arial, sans-serif; font-size: 14px;"> by </span><a href="https://www.scribd.com/user/233065310/Yuri-Hiranuma#from_embed" style="font-family: Helvetica, Arial, sans-serif; font-size: 14px;" title="View Yuri Hiranuma's profile on Scribd">Yuri Hiranuma</a><br />
<iframe class="scribd_iframe_embed" data-aspect-ratio="0.7729220222793488" data-auto-height="true" frameborder="0" height="600" scrolling="no" src="https://www.scribd.com/embeds/474215687/content?start_page=1&view_mode=scroll&access_key=key-VdSwumbEXYcj4I8EvlMw" title="#38 Status of the Thyroid Ultrasound Examination" width="100%"></iframe><p style="-x-system-font: none; display: block; font-family: Helvetica,Arial,Sans-serif; font-size-adjust: none; font-size: 14px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; font: 14px Helvetica, Arial, sans-serif; line-height: normal; margin: 12px auto 6px;"><br /></p></span></div><div><div><span style="font-family: inherit;"><span face=""><u><span style="font-size: large;">The third round</span></u></span><br /><span face=""> The final report of the third-round results was released at the June 15th TUE Subcommittee. It includes fiscal year-end data as of March 31, 2020. Any further supplemental information, such as an additional surgical cases, is expected to be released at the end of the next fiscal year.</span></span><div> Curiously, when the third-round data as of December 31, 2019 was released at the Mary 25 Oversight Committee session, Hiroki Shimura, director of the TUE, stated that he did not have the final report yet because the confirmatory examination was still progressing. Then 3 weeks later the results were finalized. Perhaps the confirmatory examination was indeed concluded <i>after</i> May 25, but regardless it seems that the intention was to release the final report at the TUE Subcommittee which is tasked with analyzing the third-round data.</div><div> One significant drawback of the final report being released to the TUE Subcommittee is that it will <i>not</i> be officially translated into English. This is what happened to the final report of the second round, <i>including</i> the FY 2017 supplementary version of the final report of the second round, released at the 31st Oversight Committee session on June 18, 2018. (Note: The final report was actually released at the 39th session of the Oversight Committee on August 31, 2020. It remains to be seen if an official translation materializes.)</div><div><br /></div><div> Between October 1, 2019 and March 31, 2020, 17 more participated in the primary examination. The final participation rate remained at 64.7%. Three took part in the confirmatory examination, and four underwent fine-needle aspiration cytology (FNAC) which detected one new case of suspected thyroid cancer in a 12-year-old male (age 5 at the time of the 2011 nuclear accident) from the 13 evacuated municipalities. His previous result from the second round was A1, meaning he had no detectible lesion on ultrasound.</div><div><br /></div><div> The number of suspected or confirmed thyroid cancer cases from the third round increased by 1 to 31. The previous results from the second round are as follows: 21 with "A" (7 with A1, 10 with A2 cysts, and 4 with A2 nodules), 7 with "B," and 3 with no prior screening.</div><div><br /><div><span style="font-family: inherit;"><span face=""> With an addition of 3 new surgical cases (1 from the FY 2016 municipalities and 2 from the FY 2017 municipalities), a total of 27 thyroid cancer cases, all papillary thyroid cancer, were surgically confirmed in the third round.</span></span></div><div><span style="font-family: inherit;"><span face=""><br /></span></span></div><div><span style="font-family: inherit;"><span face="" style="font-size: medium;"><b>Regional analysis</b></span></span></div><div><span style="font-family: inherit;"><span face=""><br /></span></span></div><div><span style="font-family: inherit;"><span face=""> Customary with the first two rounds, the final report of the third round includes a table showing proportions of B/C test results and suspicious/malignant cases by region.</span></span></div><div><span style="font-family: inherit;"><span face=""> Attention was focused on why Nakadori's cancer rate per 100,000 is so much lower than other 3 regions at 6.6. No clear explanation was given.</span></span></div><div><span style="font-family: inherit;"><span face=""><br /></span></span></div><div><span style="font-family: inherit;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_wKqC-au7NJaX8PJYXyNzfHKwjbqkVGbuuzPb6ej61unKS6yYq3yQUZAtHIqKG1cKIihx1IdDgL5bwePKlFSoEva3NIPSFLI-A7uU-dANfsRe3T2kcv6UmoSh5SdR7CqY8BfAUyv-A-3z/s877/Table+11+Third+round.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="632" data-original-width="877" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_wKqC-au7NJaX8PJYXyNzfHKwjbqkVGbuuzPb6ej61unKS6yYq3yQUZAtHIqKG1cKIihx1IdDgL5bwePKlFSoEva3NIPSFLI-A7uU-dANfsRe3T2kcv6UmoSh5SdR7CqY8BfAUyv-A-3z/s640/Table+11+Third+round.png" width="640" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div></span></div><div><span style="font-family: inherit;"><span face=""><u><span style="font-size: large;">The fourth round</span></u></span><br /><span face=""> The fourth round, scheduled from April 1, 2018 through March 31, 2020, is still ongoing. Between September 30, 2019 and December 31, 2019, the primary examination gained 26,511 more participants, raising the current participation rate to 55.6%, up from 46.5%. 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.</span></span></div><div><span style="font-family: inherit;"><br /><span face=""> Having received the "B" assessment in the primary examination, 255 became eligible for the confirmatory examination and 120 newly participated. The participation rate actually dipped slightly from 59.8% to 55.7%. Out of five participants that underwent FNAC, none was diagnosed with suspected cancer. </span></span></div><div><span style="font-family: inherit;"><span face=""><br /></span></span></div><div><div> The number of suspected or confirmed thyroid cancer cases from the fourth round remained unchanged at 16. The previous results from the third round also remain the same: 13 with "A" (3 with A1, 8 with A2 cysts, and 2 with A2 nodules) and 3 with "B." </div><div><br /></div></div><div><span style="font-family: inherit;"> </span>With an addition of 3 new surgical cases (all from the FY 2018 municipalities), a total of 11 thyroid cancer cases, all papillary thyroid cancer, were surgically confirmed in the fourth round.</div><div><span style="font-family: inherit;"><br /><span face=""><span style="font-size: large;"><u>Age 25 Milestone Screening</u></span></span><br /><span face=""> </span></span> In the Age 25 Milestone Screening, each screening year targets a cohort turning 25 during each fiscal year, and t<span style="font-family: inherit;"><span face="">he results are reported every 6 months. </span></span><span style="font-family: inherit;">The very first results as of March 31, 2018 (reported to the 31st session of the Oversight Committee) were included in the fourth-round results and can be accessed </span><a href="http://kenko-kanri.jp/en/health-survey/document/pdf/31_18Jun2018.pdf" style="font-family: inherit;" target="_blank">here</a><span style="font-family: inherit;"> (pages 31-32). Implementation schedule from the first full report as of September 30, 2018 (reported to the 33rd session of the Oversight Committee; pages 37-43 in <a href="http://kenko-kanri.jp/en/health-survey/document/pdf/33_27Dec2018.pdf" target="_blank">this PDF</a>) is shown below.</span></div><div><span style="font-family: inherit;"><span face=""> </span></span></div><div><span style="font-family: inherit;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuXuCtYlUfk0-tPK46O6YQeeKcN6a1GNhfeUR1jYiVqyDJsir5zAWX6RKLiK9Tdljo35Sg6XfV3MIishrDSFDQD5ugxyxe8gQ2Z-Za27bd4I_IKk-1rhsLKYybaOwM-SycVLmH10CUKFvV/s646/Screen+Shot+2020-08-29+at+1.39.00+PM.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="269" data-original-width="646" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuXuCtYlUfk0-tPK46O6YQeeKcN6a1GNhfeUR1jYiVqyDJsir5zAWX6RKLiK9Tdljo35Sg6XfV3MIishrDSFDQD5ugxyxe8gQ2Z-Za27bd4I_IKk-1rhsLKYybaOwM-SycVLmH10CUKFvV/s640/Screen+Shot+2020-08-29+at+1.39.00+PM.png" width="640" /></a></div><div><span style="font-family: inherit;"><span face=""> In April 2017, 22,633 individuals born in FY 1992 (the FY 1992 cohort) kicked off the Age 25 Milestone Screening, which notably reduces the size of target population for the main TUE. This reduction began in the third round conducted during FY 2016-2017, which excluded the FY 1992 and 1993 cohorts in anticipation of an upcoming Age 25 Milestone Screening. With each FY birth cohort including about 22,000 individuals, this is a sizable reduction which continues as the TUE target population ages. For example, the target population has gone from 367,637 for the first round, to 381, 244 for the second round (increased because those who were in utero at the time of the accident were included), 336,670 for the third round, and 294,213 for the fourth round.</span></span></div><div><span style="font-family: inherit;"><span face=""><br /></span></span></div></span></div><div><span style="font-family: inherit;"><span face=""> A fiscal year-end report for FY 2019 (<a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/389446.pdf" target="_blank">link</a>), which includes data </span></span>as of March 31, 2020, <span style="font-family: inherit;">adds data from 22,096 in the FY 1994 cohort. It also includes some updates on the FY 1992 and 1993 cohorts. (Note: Although each fiscal year screening is earmarked for those turning 25 during that fiscal year, participants can take part in the screening anytime up to the year before they become eligible for the Age 30 Milestone Screening. As such, the report can include updated data from all fiscal year cohorts.)</span></div><div><span style="font-family: inherit;"><br /></span></div><div><span style="font-family: inherit;"> On a side note, the fact that the Age 25 Milestone Screening results were reported to the TUE Subcommittee means that it may never be officially translated, just like the final reports of the second and third rounds as explained above. That is, unless the results are also reported to the next Oversight Committee meeting scheduled for August 31, 2020. </span>(Note: The results were also reported to the 39th session of the Oversight Committee on August 31, 2020.)</div><div><span style="font-family: inherit;"><br /></span></div><div> Since October 1, 2019, 1,301 participants newly underwent the primary examination, including 16 born in FY 1992, 63 in FY 1993, and 1,222 in FY 1994. An overall participation rate actually decreased from 9.6% to 8.4% due to a larger denominator from an addition of the FY 1994 cohort. A participation rate for the FY 1994 is 5.5%. It remained at 9.9% for the FY 1992 cohort and increased by 0.3% to 9.6% for the FY 1993 cohort. Because the participation is not limited to a specific screening year as explained earlier, it is likely that the FY 1994 cohort will eventually have a higher participation rate. A fiscal year-end participation rate for the FY 1993 cohort as of March 31, 20019 was 4.5%, which has now more than doubled a year later. Still, these participation rates are conspicuously much lower than the main TUE.</div><div><span style="font-family: inherit;"><span face=""><br /></span></span></div><div> Eligibility for the confirmatory examination (a.k.a. "B" assessment in the primary examination) was gained for 46 more participants. Of 244 needing the confirmatory examination, 23 newly participated, and 3 newly underwent FNAC. All three, all females, were diagnosed with suspected thyroid cancer, and one had "B" in the previous screening whereas 2 never participated in the TUE.</div><div><br /></div><div> Thus the number of suspected or confirmed thyroid cancer cases from the Age 25 Milestone Screening increased by 3 to 7. The results from the prior screening are as follows: 1 with A2 (unclear if cyst or nodule due to lack of reporting), 1 with "B," and 5 with no prior screening.</div><div><br /></div><div><span style="font-family: inherit;"> With an addition of 3 new surgical cases, a total of 4 thyroid cancer cases, 2 papillary thyroid cancers and 1 follicular thyroid cancer, were surgically confirmed in the Age 25 Milestone Screening.</span></div><div><span style="font-family: inherit;"><br /></span></div><div><span style="font-family: inherit;"> The average tumor diameter from t</span>he FNAC was <span style="font-family: Cambria, serif;">22.6 ± 15.6 mm (range 10.8 - 49.9 mm). Note that this is a drastic jump from what was reported last time, 14.5</span><span style="font-family: Cambria, serif;"> ± 2.7mm (range 12.3 - 18.0 mm), with the average diameter increasing by a factor of 1.5 and the maximum diameter nearly tripling. This is likely due to a single case of follicular thyroid cancer. </span></div><div><br /></div><div><span style="font-family: inherit;"><span face=""><br /></span><span face=""><span style="font-size: large;"><u>Summary of the results from the previous screen</u></span><span style="font-size: large;"><u>ing</u></span> </span><br /><span face=""> 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. </span></span></div><div><span style="font-family: inherit;"><br /></span></div></div></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div><div><div><span style="font-family: inherit;">Definition</span></div></div></div><div><div><span style="font-family: inherit;">"A1": no ultrasound findings. </span></div></div><div><div><span style="font-family: inherit;">"A2": ultrasound findings of nodules </span><span style="font-family: inherit;">≤ 5.0 mm and/or cysts </span><span style="font-family: inherit;">≤ 20.0 mm. </span></div></div><div><div><span style="font-family: inherit;">"B": ultrasound findings of nodules </span><span style="font-family: inherit;">≥</span><span style="font-family: inherit;"> 5.1 mm and/or cysts </span><span style="font-family: inherit;">≥</span><span style="font-family: inherit;"> 20.1 mm.</span></div></div></blockquote><div><div><span style="font-family: inherit;"><br /></span></div><div><span style="font-family: inherit;"> 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 the cancerous lesions were simply "invisible" during the previous screening.)</span></div><div><ul><li><span style="font-family: inherit;">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</span></li><li><span style="font-family: inherit;">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</span></li><li><span style="font-family: inherit;">Fourth round (16 cases): 3 cases with A1, 10 cases with A2 (2 nodules and 8 cysts), 3 cases with B</span></li><li><span style="font-family: inherit;">Age 25 Milestone Screening (7 cases): 1 case with A2 (it was never reported if nodule or cyst), 1 case with B, 5 cases previously unexamined</span></li></ul><div><br /></div><div><p><span style="font-size: large;"><u>The analysis and paper using the UNSCEAR doses </u></span></p><p> There was a development during the TUE Subcommittee that warrants a mention. It was as simple as a release of supplementary data and a report of a published paper, but it requires some background information for context, as explained below.</p><p><span style="font-family: inherit;"><span style="font-size: medium;"><b>A belated release of the supplementary data </b></span></span></p><p><span style="font-family: inherit;"><span> During the 15th session of the TUE Subcommittee, previously undisclosed supplementary data was released. It relates to "Document 1-2" reported to the 13th TUE Subcommittee held on June 3, 2019. (An unofficial translation of Document 1-2 can be found in <a href="https://fukushimavoice-eng2.blogspot.com/2019/06/how-conclusion-transpired-on-thyroid.html" target="_blank">this post</a>.)</span></span></p><p><span style="font-family: inherit;"><span> Document 1-2, titled "</span></span>Associations between absorbed doses to the thyroid by municipality estimated by UNSCEAR and detection rates of confirmed or suspected cancer," was one of the three documents released by Fukushima Medical University (FMU) that led the TUE Subcommittee to conclude (not unanimously), "Thus, at this time, no association is seen between thyroid cancer detected in the second round and radiation exposure." </p></div></div></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div><div><div><p style="text-align: left;">(*UNSCEAR is the United Nations Scientific Committee on the Effects of Atomic Radiation.) </p></div></div></div></blockquote><div><p> It shows an analysis in which the second-round participants ≥ age 6 are divided into four groups based on four dose ranges according to the thyroid absorbed doses by municipality estimated in the UNSCEAR 2013 report. This involves grouping Fukushima Prefecture's 59 municipalities into 4 dose ranges based on the UNSCEAR absorbed thyroid doses. </p><p> An ideal dose-response analysis would be based on individual doses, but without sufficient individual dose data (only 1080 out of over 360,000 children in Fukushima had their thyroid doses directly measured after the accident), FMU was directed by none other than Subcommittee Chair Gen Suzuki to use "the best officially available doses" as a surrogate. </p><p> However, reliability of the UNSCEAR estimation itself is in question, potentially amplifying uncertainties inherent in the results from a regional dose-response analysis. Furthermore, throughout the Subcommittee sessions, members Tomotaka Sobue of Osaka University and Kota Katanoda of National Cancer Center cautioned that the use of regional doses could create unsolvable biases and the results could be difficult to interpret. </p><p> Yet such a dose-response analysis in evaluating the second-round results was encouraged by Subcommittee Chair Suzuki who was tasked with advancing the analysis. (Suzuki himself leads a research team reconstructing the doses and reported on a <a href="https://www.nature.com/articles/s41598-020-60453-0" target="_blank">paper</a> published by his team, which effectively <i>reduced </i>the estimated thyroid doses. This is not at all surprising given Suzuki's track record as a government-patronized researcher who is known to have successfully denied radiation effects multiple times in the past.)</p><p> The aforementioned conclusion of the TUE Subcommittee, "no association is seen between thyroid cancer detected in the second round and radiation exposure," was not reached un-opposed. Some of the subcommittee members, including even Subcommittee Chair Suzuki, repeatedly requested FMU to provide actual numerical data in the analyses submitted throughout the Subcommittee sessions, so that they could fully grasp how FMU was "adjusting" the various data. This request was never fulfilled, and all that the Subcommittee members could do was take whatever came out of FMU at face value. </p><p> Eventually a draft summary prepared by Suzuki was hastily presented at the 13th TUE Subcommittee, in June 2019, which was the final session of the previous term of the TUE Subcommittee. This was also when Document 1-2 was first presented to the Subcommittee, which meant that there was hardly any time for the Subcommittee members to discuss the analysis in detail before the draft summary was prepared. Background information surrounding the controversial draft summary (unofficial translation <a href="https://fukushimavoice-eng2.blogspot.com/2019/06/english-translation-of-draft-summary-on.html" target="_blank">here</a>) is covered in <a href="https://fukushimavoice-eng2.blogspot.com/2019/06/how-conclusion-transpired-on-thyroid.html" target="_blank">this post</a>. </p><p> Upon initial presentation, Document 1-2 lacked the numbers of subjects for each dose range, preventing a full understanding of the analysis by the Subcommittee members. Apparently this was intentional on the part of FMU: Ohira later <a href="https://t.co/3GPBTgzTrM" target="_blank">admitted</a> that the decision to withhold some numerical data was made by Subcommittee Chair Suzuki for fear of "misinterpretation." </p><p> Suzuki later explained that releasing the provisional data to the Subcommittee might mean high transparency to some, but such release might compromise originality of the data and actually prevent the data from being published in academic journals, because no peer-reviewed journals would accept a manuscript lacking originality. If that were to happen, the data would not be shared with the academic community, and that is what Suzuki was afraid of. </p><p> However, withholding the data from the Subcommittee members who are tasked with evaluating the data is flatly pointless. How can the Subcommittee conduct proper evaluation? (It couldn't.) Further, reading between lines, what Suzuki was probably insinuating was that they wanted to prevent a third party analysis and publication of the data before FMU published it. </p><p> In the past, Suzuki has blurted out that FMU was hesitant on releasing too much data because "some journal would conduct an independent analysis and come to a different conclusion." No specific journal was named, but it is presumed that he was referring to a Japanese science journal <i>Kagaku</i> by Iwanami Publishers, which at the time had been publishing a series of critical analyses by Junichiro Makino on FMU's data, including previous analyses led by Ohira on regional differences (i.e. dose-response) of thyroid cancer detection.</p><p> Suzuki reasoned that it would be best for Ohira to publish his analysis in an academic journal as soon as possible, and the data can be released to the Subcommittee at a later data. That is exactly what happened here. With the analysis safely published, Document 1-2, finally (and belatedly) complete with the numbers of subjects for each dose range, was released again (<a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/389447.pdf" target="_blank">link to PDF in Japanese</a>). </p><p><span style="font-size: medium;"><b>Problems with the published paper</b></span></p><p><span style="font-family: inherit;"> The paper, for which Ohira is a corresponding author, was published in the February 2020 issue of the Journal of Radiation Research, an official journal of the Japanese Radiation Research Society (JRRS) and the Japanese Society for Radiation Oncology (JASTRO) (<a href="https://academic.oup.com/jrr/article/61/2/243/5728656" target="_blank">link to the paper</a>). </span></p></div><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px;"><div><p style="text-align: left;"><span style="font-family: inherit;">*Incidentally, JRRS is the organization that originally recommended Gen Suzuki to become a member of the TUE Subcommittee in 2017. JRRS was also commissioned by the Ministry of the Environment to create official Japanese translation of the reports by the International Agency Research on Cancer (IARC) international expert group on Thyroid Monitoring after Nuclear Accidents (TM-NUC). (See <a href="https://fukushimavoice-eng2.blogspot.com/2017/11/circumstances-regarding-japan-sponsored.html" target="_blank">this post</a> for details on TM-NUC.)</span></p></div></blockquote><div><p><span style="font-family: inherit;"> After Ohira presented a summary of the paper <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/389448.pdf" target="_blank">in Japanese</a>, Sobue called out an issue that the paper did not exactly follow the same method of the original analysis as in Document 1-2. Sobue demanded to know how the two—the paper and Document 1-2—were related. </span></p><p><span style="font-family: inherit;"> Ohira explained that Document 2-1 included <i>all</i> participants ≥ age 6 in the second-round screening, regardless of whether they participated in the first round or what their first-round results were. Participants who were 5 years of age or younger were excluded because there was only 1 case of thyroid cancer (age 5) in that age group. </span></p><p><span style="font-family: inherit;"> On the other hand, t</span>he paper included subjects ≥ age 6 who participated in both of the first- and second-round screenings, excluding those who were diagnosed with thyroid cancer in the first round. This is because <span style="font-family: inherit;">the paper was written in accordance with the original design of the TUE which defined the first round as a baseline screening and any subsequent screenings as follow-ups. </span></p><p><span style="font-family: inherit;"> As such, the total number of the subjects differed between Document 1-2 and the paper. Although they both included the TUE participants who were age 6 or older, Document 1-2 included 175,268 subjects (calculated by this author thanks to the newly released information), whereas the paper covered 164,299 subjects, 7% less than included in Document 1-2.</span></p><p><span style="font-family: inherit;"> This did not sit well with Sobue. It turns out that he and Katanoda, unbeknownst to them, were named in Acknowledgments "for their valuable advice on the manuscript." Both Sobue and Katanoda appeared astounded, not realizing that they were included in Acknowledgements until the day of the TUE Subcommittee session. Sobue exasperatedly stated that he wished he had been notified of any changes in the analytical methods before his name was included. </span></p><p><span style="font-family: inherit;"> Ohira's reply was incredulous: Because Sobue and Katanoda had been advising FMU on using the thyroid absorbed doses estimated by UNSCEAR in the analysis, it was assumed that they would approve any similar analysis by extension and thus they were mentioned in Acknowledgements.</span></p><p><span style="font-family: inherit;"> This seems to be an utterly convenient assumption and a disregard for what is surely a standard scientific protocol on multiple fronts. Flatly, lack of common courtesy is appalling. In fact, Katanota had to explain that the current guidelines of the publishing ethics dictate that anyone whose name is included as having contributed to the manuscript, including Acknowledgements, should have been notified for reviewing the manuscript. </span></p><p> Even Subcommittee Chair Suzuki, who "approved" withholding the release of data until after the analysis is published, was at a loss for words on Ohira's reply. Ultimately Suzuki said that the Subcommittee members and the audience had a general idea of who the subjects were in Document 1-2, but altering the data for publication essentially means such alteration can be conducted at FMU's discretion. </p><p> Truly, that was the pattern seen throughout the Subcommittee sessions. Without complete data, no fair discussion can ensue. It's as if it doesn't even matter what is discussed in the TUE Subcommittee or even at the Oversight Committee. By now, those of us who have been following Fukushima's thyroid cancer saga are well aware that these committee and subcommittee sessions are just a charade. We knew this the minute Suzuki was selected to chair the TUE Subcommittee 3 years ago, as described in <a href="https://fukushimavoice-eng2.blogspot.com/2018/01/fukushima-thyroid-examination-december.html" target="_blank">this post</a>.</p><p><span style="font-family: inherit;"><span> During this Subcommittee session, Ohira also presented a <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/389719.pdf" target="_blank">cross-sectional analysis</a> using the UNSCEAR estimated thyroid doses. Any further analysis based on a flawed assumption only propagates FMU's biased conclusion, especially with various adjustments conducted at their discretion. Refusing to contribute to such propagation, this blog will no longer offer unofficial translation of their biased analyses. </span></span></p><p><span style="font-family: inherit;"> Rest assured, basic information on the original TUE data and other pertinent developments will continue to be offered as before.</span></p><p><br /></p><p><span><b style="font-size: large;">Addendum</b> (Note: this is by no means an endorsement but meant as record-keeping)</span></p><p> A former member of the Oversight Committee and the TUE Subcommittee, Toru Takano, apparently spearheaded formation of a group called "Japan Consortium for Juvenile Thyroid Cancer." It's website, accessed <a href="http://www.med.osaka-u.ac.jp/pub/labo/JCJTC/index-E.html" target="_blank">here</a>, is located on the website of Graduate School of Medicine and Faculty of Medicine at Osaka University. </p><p> This group's member roster includes those who were aggressively claiming that Fukushima's thyroid cancer was due to overdiagnosis: Akira Otsuru, Tomotaka Sobue, Toru Takano, Shoichiro Tsugane, and Sanae Midorikawa.</p><p> It's astonishing that even current members of the Subcommittee (Sobue) and the Oversight Committee (Tsugane) are part of this group. Notably, Ohtsuru, Takano and Midorikawa have been vocally against the school-based screening. (Midorikawa was actually in charge of the school screening, but she is no longer with FMU.) With the COVID-19 pandemic slowing down the screening process, it is feared that this group might push towards ending the school screening or even the TUE itself.</p><p> Objectives of the group might not be totally obvious from the website. Their beliefs and claims are explained by Midorikawa on the website of her new work place, Miyagi Gakuin Women's University (<a href="https://web.mgu-ac.work/essay/2072.html?_ga=2.101965633.1755230660.1593068385-619948751.1593068385" target="_blank">link</a>). Excerpts are translated below:</p><p></p><ul style="text-align: left;"><li>It is not that radiation exposure led to an increase in thyroid cancer in Fukushima.</li><li>Many thyroid cancers happen to be "discovered" because of the Thyroid Ultrasound Examination (TUE).</li><li>Further, majority of those thyroid cancer cases would not have been diagnosed if it weren't for the TUE: They are harmless cancers which probably would have remained undetected for life. (This is called overdiagnosis.)</li><li>Even Fukushima residents and their families are unaware of this fact, and they continue to participate in the TUE.</li></ul><p></p><p><br /></p></div></div></div></div>@YuriHiranumahttp://www.blogger.com/profile/16819451884150838540noreply@blogger.com0tag:blogger.com,1999:blog-9200156515048577812.post-54540333563973742392020-02-13T01:22:00.000-08:002020-02-13T02:14:27.823-08:00Fukushima Thyroid Examination February 2020: 186 Surgically Confirmed as Thyroid Cancer Among 237 Cytology Suspected Cases<div style="display: block; font-stretch: normal; font-style: normal; font-variant: normal; line-height: normal; margin: 12px auto 6px;">
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<span style="font-size: medium;"><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>Highlights</b></span></span><b style="font-family: "trebuchet ms", sans-serif;"> </b></div>
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<li style="font-family: times; font-weight: normal;"><b style="font-family: "Trebuchet MS", sans-serif;">The third round: 1 case newly diagnosed as suspicious or malignant, and 5 new cases surgically confirmed. </b></li>
<li style="font-family: times; font-weight: normal;"><b style="font-family: "Trebuchet MS", sans-serif;">The fourth round: 3 cases newly diagnosed as suspicious or malignant, and 7 new surgical cases. </b></li>
<li style="font-family: times; font-weight: normal;"><b style="font-family: "Trebuchet MS", sans-serif;">Age 25 Milestone Screening: 2 cases newly diagnosed as suspicious or malignant, no new surgical case. Age and tumor diameter data revealed for the first time.</b></li>
<li style="font-family: times; font-weight: normal;"><span style="font-family: "trebuchet ms" , sans-serif;"><b>Total number of suspected/confirmed thyroid cancer is now</b> <span style="color: red; font-weight: bold;">236 </span><b style="font-family: "trebuchet ms", sans-serif; font-weight: bold;"><i>excluding</i> a single case of benign tumor: </b><b>115 in the first round, 71 in the second round, 30 in the third round, 16 in the fourth round, and 4 in Age 25 Milestone Screening.</b></span></li>
<li style="font-family: times; font-weight: normal;"><b style="font-family: "Trebuchet MS", sans-serif;">Total number of surgically confirmed thyroid cancer cases has increased by 12 to <span style="color: red;">186 </span>(101 in the first round, 52 in the second round,24 in the third round, 8 in the fourth round, and 1 in Age 25 Milestone Screening).</b></li>
<li style="font-family: times; font-weight: normal;"><b style="font-family: "Trebuchet MS", sans-serif;">This session reported data as of September 30, 2019. September data is usually released in late December, but for some unclear reason the December session was never held in 2019. </b></li>
<li><span style="font-family: "trebuchet ms" , sans-serif; font-weight: bold;">No official English translation of the results have been released since the December 2018 meeting. It is unclear if it will ever resume. </span><b><span style="font-family: "trebuchet ms" , sans-serif;">The <a href="http://kenko-kanri.jp/en/health-survey/document/" target="_blank">materials page on the new website</a> has a list of previous translations, downloadable as one file per session</span><span style="font-family: "trebuchet ms" , sans-serif;">. The <a href="http://fmu-global.jp/our-activities/prefectural-oversight-committee-meeting/" target="_blank">old website</a> shows individual reports for each session.</span></b></li>
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<b><span style="font-size: large;"><span style="font-family: "trebuchet ms" , sans-serif;">The latest overall results including "unreported" cases</span></span></b></div>
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<i style="font-family: "trebuchet ms", sans-serif;">(See <a href="https://fukushimavoice-eng2.blogspot.com/2018/07/results-of-survey-on-fukushima-thyroid.html" target="_blank">this post</a> for description of the "unreported" cases. Histological diagnosis of the 11 unreported cancer cases obtained from <a href="https://www.jstage.jst.go.jp/article/fms/65/3/65_2019-26/_html/-char/ja" target="_blank">this paper</a>.)</i><br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>Overview</b></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"> On February 13, 2020, the 37th session of the Oversight Committee for the Fukushima Health Management Survey (FHMS) convened in Fukushima City, Fukushima Prefecture. It has been 4 months since the last session on October 7, 2019, skipping a regularly scheduled December session for an unknown reason. It seems that Fukushima Prefecture might be moving towards holding 3 sessions a year rather than quarterly sessions.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-style: normal;"> T</span><span style="font-family: "trebuchet ms" , sans-serif; font-style: normal;">he latest results of the <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/369439.pdf" target="_blank">third</a> and <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/369440.pdf" target="_blank">fourth</a> rounds of the </span><span style="font-family: "trebuchet ms" , sans-serif; font-style: normal;">Thyroid Ultrasound Examination (TUE) </span><span style="font-family: "trebuchet ms" , sans-serif;">(as of September 30, 2019) </span><span style="font-family: "trebuchet ms" , sans-serif; font-style: normal;">were released as well as the results of the Age 25 Milestone Screening to be reported every 6 months.</span><span style="font-family: "trebuchet ms" , sans-serif;"> </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Official English translation, ordinarily available <a href="http://fmu-global.jp/our-activities/prefectural-oversight-committee-meeting/" target="_blank">on the website of Office for International Cooperation at the Radiation Medical Science Center for the Fukushima Health Management Survey</a>, has not been released since the 33rd session on December 27, 2018. According to the most recent entry in <a href="http://fmu-global.jp/" target="_blank">Announcements</a>, this </span><span style="font-family: "trebuchet ms" , sans-serif;">translation was posted online on April 5, 2019, </span><span style="font-family: "trebuchet ms" , sans-serif;">over 3 months after the 33rd session was held. It doesn't seem like Fukushima Medical University (FMU) is keen on providing translations. If it resumes, it's probably going to be posted on the new Radiation Medical Science Center website (<a href="http://kenko-kanri.jp/en/health-survey/document/" target="_blank">link</a>).</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>Summary on the current status of the TUE</b></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"> A six-page <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/369448.pdf" target="_blank">summary</a> of the first through fourth rounds as well as the Age 25 Milestone Screening, "The Status of the Thyroid Ultrasound Examination," lists key findings from the primary and confirmatory examinations as well as the surgical information. </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/369448.pdf" style="font-family: "trebuchet ms", sans-serif;" target="_blank">This summary</a> <span style="font-family: "trebuchet ms" , sans-serif;">is <i>not</i> translated into English officially,</span><span style="font-family: "trebuchet ms" , sans-serif;"> but here's an unofficial translation which hopefully helps make up for the unavailability of the entire results in English. </span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"><u><span style="font-size: large;">The third round</span></u></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> The third-round results between April 1, 2019 and June 30, 2019 show that the primary examination participation rate remained at 64.7% with an additional 25 undergoing the examination. Two more participants, assessed "B," became eligible for the confirmatory examination. These numbers are small but the examinations are still ongoing and the results are not finalized just yet.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Eight participants underwent the confirmatory examination and two</span><span style="font-family: "trebuchet ms" , sans-serif;"> underwent FNAC. One person, a female from Hamadori was diagnosed with suspected thyroid cancer.</span><span style="font-family: "trebuchet ms" , sans-serif;"> She was age 9 at exposure. Her second-round result was A2 nodule. This makes "30" the total number of suspected thyroid cancer cases in the third round.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> There was five new surgical cases from the third round, with the total of 24 surgically confirmed thyroid cancer cases, all papillary thyroid cancer. </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;"><u><span style="font-size: large;">The fourth round</span></u></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> The fourth round, scheduled from April 1, 2018 through March 31, 2020, is actively ongoing. The current participation rate for the primary examination is 46.5%, up from the previous 40.1% but still lower than the prior rounds (81.7% for the first round, 71.0% for the second round, and 64.7% for the third round).</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Ninety-two participants newly underwent the confirmatory examination with a participation rate to 59.8%. Six participants newly underwent FNAC, and 3 of them were diagnosed with suspected thyroid cancer, making "16" the total number of suspected thyroid cancer cases in the fourth round.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> The 3 suspected thyroid cancer cases are all from Nakadori, consisting of 2 males (ages-at-exposure 10, 10) and 1 female (age-at-exposure 7). Their third-round results were one case with A1 and two cases with A2 cyst.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> There was one new surgical case for the fourth round, with the total of 8 surgically confirmed thyroid cancer cases, all papillary thyroid cancer.</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;"><span style="font-size: large;"><u>Age 25 Milestone Screening</u></span></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> The participation rate for Age 25 Milestone Screening remains low at 9.6%, although it's up by 2.5%. Sixty-two participants newly underwent the confirmatory examination with a participation rate of 73.2%. Four more underwent FNAC and two (1 male and 1 female) were diagnosed with suspected thyroid cancer.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> This is the first time details of the FNAC results such as average age and tumor diameter were released. There is no additional surgical case this time, leaving one surgically confirmed thyroid cancer case (papillary thyroid cancer) for this group.</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;"><span style="font-size: large;"><u>Results from the previous screen</u></span><span style="font-size: large;"><u>ing</u></span> </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Below is information on previous assessments of the suspected/confirmed thyroid cancer cases. In the second round, 33 of 71 cases were assessed as "A1" meaning there were no ultrasound findings. Thirty-two were assessed as "A2" with ultrasound findings of nodules </span><span style="font-family: "trebuchet ms" , sans-serif;">≤ 5.0 mm and/or cysts </span><span style="font-family: "trebuchet ms" , sans-serif;">≤ 20.0 mm, 5 were assessed as "B" with nodules </span><span style="font-family: "trebuchet ms" , sans-serif;">≥</span><span style="font-family: "trebuchet ms" , sans-serif;"> 5.1 mm and/or cysts </span><span style="font-family: "trebuchet ms" , sans-serif;">≥</span><span style="font-family: "trebuchet ms" , sans-serif;"> 20.1 mm. Of 32 cases with A2, </span><span style="font-family: "trebuchet ms" , sans-serif;">25 cases had cysts. Having previous assessments of "A1" or "A2 cysts" means there was no precancerous lesion during the prior TUE, i.e., cancer supposedly appeared since the prior TUE. (Note: FMU claims the cancerous lesions were simply "invisible" during the prior TUE.)</span><br />
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<li><span style="font-family: "trebuchet ms" , sans-serif;">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</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;">Third round (30 cases): 6 cases with A1, 14 cases with A2 (4 nodules and 10 cysts), 7 cases with B, 3 cases previously unexamined</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;">Fourth round (16 cases): 3 cases with A1, 10 cases with A2 (2 nodules and 8 cysts), 3 cases with B</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;">Age 25 Milestone Screening (4 cases): 1 case with A2, 3 cases previously unexamined</span></li>
</ul>
<br style="font-family: helvetica, arial, sans-serif; font-size: 14px;" />@YuriHiranumahttp://www.blogger.com/profile/16819451884150838540noreply@blogger.com0tag:blogger.com,1999:blog-9200156515048577812.post-10976431763455552052019-11-13T00:42:00.000-08:002020-02-12T23:59:58.813-08:00Fukushima Thyroid Examination October 2019: 174 Surgically Confirmed as Thyroid Cancer Among 231 Cytology Suspected Cases<div style="display: block; font-family: "helvetica" , "arial" , sans-serif; font-size: 14px; font-stretch: normal; font-style: normal; font-variant: normal; font-weight: normal; line-height: normal; margin: 12px auto 6px auto;">
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<span style="font-size: medium;"><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>Highlights</b></span></span><b style="font-family: "trebuchet ms", sans-serif;"> </b></div>
<ul style="font-family: times; font-size: medium; font-weight: normal;">
<li><b style="font-family: "Trebuchet MS", sans-serif;">The third round: 5 cases newly diagnosed as suspicious or malignant, and 1 new case surgically confirmed.</b></li>
<li><b style="font-family: "Trebuchet MS", sans-serif;">The fourth round: 8 cases diagnosed as suspicious or malignant, and no surgical case. Age/sex distribution reported for the first time.</b></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><b>Total number of suspected/confirmed thyroid cancer is now</b> <span style="color: red; font-weight: bold;">230 </span><b style="font-family: "trebuchet ms", sans-serif; font-weight: bold;"><i>excluding</i> a single case of benign tumor: </b><b>115 in the first round, 71 in the second round, 29 in the third round, 13 in the fourth round, and 2 in Age 25 Milestone Screening.</b></span></li>
<li><b style="font-family: "Trebuchet MS", sans-serif;">Total number of surgically confirmed thyroid cancer cases has increased by 1 to <span style="color: red;">174 </span>(101 in the first round, 52 in the second round,19 in the third round, 1 in the fourth round, and 1 in Age 25 Milestone Screening).</b></li>
<li><b style="font-family: "Trebuchet MS", sans-serif;">This is the first session of the 2019-2021 term for new and returning committee members. </b></li>
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<b><span style="font-size: large;"><span style="font-family: "trebuchet ms" , sans-serif;">The latest overall results including "unreported" cases</span></span></b></div>
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<i style="font-family: "trebuchet ms", sans-serif;">(See <a href="https://fukushimavoice-eng2.blogspot.com/2018/07/results-of-survey-on-fukushima-thyroid.html" target="_blank">this post</a> for details of the "unreported" cases.)</i></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>Overview</b></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"> On October 7, 2019, the 36th session of the Oversight Committee for the Fukushima Health Management Survey (FHMS) convened in Fukushima City, Fukushima Prefecture. This was the first session of the 5th term, and the agenda centered on the Thyroid Ultrasound Examination (TUE) in order to familiarize the new members with the scheme and current status of the TUE. The I<a href="https://fukushimavoice-eng2.blogspot.com/2019/06/english-translation-of-draft-summary-on.html" target="_blank">nterim Summary for the second-round results</a> was presented along with a <a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/351385.pdf" target="_blank">summary of discussion</a> from the 35th session.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-style: normal;"> T</span><span style="font-family: "trebuchet ms" , sans-serif; font-style: normal;">he latest results of the <a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/351389.pdf" target="_blank">third</a> and <a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/351390.pdf" target="_blank">fourth</a> rounds of the </span><span style="font-family: "trebuchet ms" , sans-serif; font-style: normal;">Thyroid Ultrasound Examination (TUE) </span><span style="font-family: "trebuchet ms" , sans-serif;">(as of June 30, 2019) </span><span style="font-family: "trebuchet ms" , sans-serif; font-style: normal;">were also released.</span><span style="font-family: "trebuchet ms" , sans-serif;"> Official English translation, ordinarily available <a href="http://fmu-global.jp/our-activities/prefectural-oversight-committee-meeting/" target="_blank">on the website of Office for International Cooperation at the Radiation Medical Science Center for the Fukushima Health Management Survey</a>, has not been released since the 33rd session on December 27, 2018. According to the most recent entry in <a href="http://fmu-global.jp/" target="_blank">Announcements</a>, this </span><span style="font-family: "trebuchet ms" , sans-serif;">translation was posted online on April 5, 2019, </span><span style="font-family: "trebuchet ms" , sans-serif;">over 3 months after the 33rd session was held. This is a lot longer than the previous turnaround time of 3-4 weeks up to the 31st session. Now that the official translation is 3 sessions behind, it remains to be seen whether FMU is even going to continue to provide it.</span></div>
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<b><span style="font-size: large;"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></b><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>Summary on the current status of the TUE</b></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"> A six-page <a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/351396.pdf" target="_blank">summary</a> of the first through fourth rounds as well as the Age 25 Milestone Screening, "The Status of the Thyroid Ultrasound Examination," lists key findings from the primary and confirmatory examinations as well as the surgical information. </span><a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/351396.pdf" style="font-family: "trebuchet ms", sans-serif;" target="_blank">This summary</a> <span style="font-family: "trebuchet ms" , sans-serif;">is <i>not</i> translated into English officially,</span><span style="font-family: "trebuchet ms" , sans-serif;"> but here's an unofficial translation which hopefully helps make up for the unavailability of the entire results in English. </span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"><span style="font-size: large;"><b>Key points from the Oversight Committee</b></span></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span><span style="font-family: "trebuchet ms" , sans-serif;"><span style="font-size: large;"><u>New and returning member list</u></span></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> The 2019-2021 term (the fifth term) of the Oversight Committee consists of 18 members including 6 new faces, with an addition of one more member than the previous term. The new roster is available <a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/349726.pdf" target="_blank">here</a> (only in Japanese).</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> No immediate plan has been announced</span><span style="font-family: "trebuchet ms" , sans-serif;"> </span><span style="font-family: "trebuchet ms" , sans-serif;">to convene the third term of the Thyroid Examination Evaluation Subcommittee whose purpose to analyze the third-round results. But the </span><a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/352276.pdf" style="font-family: "trebuchet ms", sans-serif;" target="_blank">new roster</a><span style="font-family: "trebuchet ms" , sans-serif;"> </span><span style="font-family: "trebuchet ms" , sans-serif;">has already been released. </span><br />
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"> Notably, Toru Takano of Osaka University, </span><span style="font-family: "trebuchet ms" , sans-serif;">a controversial figure </span><span style="font-family: "trebuchet ms" , sans-serif;">who held dual positions in the Oversight Committee and the Thyroid Examination Evaluation Subcommittee during the last term, is out the door.</span></div>
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;"><b><span style="font-size: large;">Oversight Committee members</span> </b>(August 1, 2019 to July 31, 2021) </span><br />
<br />
<ul>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><b>Ikuko Abe </b>(new member replacing Kanae Narui; clinical psychologist), President, <a href="http://fsccp.jp/" target="_blank">Fukushima Society of Certified Clinical Psychologists</a>.</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><a href="http://seeds.office.hiroshima-u.ac.jp/profile/en.1e597bcbcf537f05520e17560c007669.html" target="_blank"><b>Toshiya Inaba, M.D., Ph.D.</b></a> (returning member; researcher), Professor, <a href="https://www.hiroshima-u.ac.jp/en/rbm/research/lab/Molecular_Oncology" target="_blank">Department of Molecular Oncology</a>, Research Center for Radiation Genome Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University.</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><a href="https://medicalnote.jp/doctors/180829-002-JK" target="_blank"><b>Hitoshi Inoue, M.D.</b></a> (returning member; gastrointestinal surgeon), President, Fukushima Hospital Association.</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><a href="https://www.rerf.or.jp/en/about/organization-en/chart-e/staff/ozasa_e/" target="_blank"><b>Kotaro Ozasa, M.D., Ph.D</b></a> (returning member who urgently replaced Makoto Akashi at the last session in July 2019; radiation epidemiologist), Chief, Department of Epidemiology, Radiation Effects Research Foundation.</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><a href="https://www.nies.go.jp/researchers-e/300903.html" target="_blank"><b>Fumiko Kasuga, Ph.D., D.V.M.</b></a> (returning member; researcher), Senior Fellow, National Institute for Environmental Studies (recommended by the <a href="http://www.scj.go.jp/en/" target="_blank">Science Council of Japan</a>).</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><a href="http://www.j-hits.org/english/director/index.html" target="_blank"><b>HIroshi Kato, M.D., Ph.D.</b></a> (returning member; psychiatrist), Director, <a href="http://www.j-hits.org/english/index.html" target="_blank">Hyogo Institute for Traumatic Stress</a> (recommended by the <a href="http://www.jstss.org/english/about/" target="_blank">Japanese Society for Traumatic Stress Studies</a>).</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><a href="https://www-sdc.med.nagasaki-u.ac.jp/radepi/message/profile_e.html" target="_blank"><b>Noboru Takamura, M.D., Ph.D.</b></a> (returning member; researcher), Professor, Department of Global Health, Medicine and Welfare, Atomic Bomb Disease Institute, Nagasaki University.</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><b>Hideo Tatsuzaki, M.D., Ph.D.</b> (new member occupying a newly created position; radiation emergency medicine specialist), Deputy Director General, <a href="https://www.qst.go.jp/site/carem/" target="_blank">Center for Advanced Radiation Emergency Medicine</a>, Quantum Medical Science Directorate, National Institutes for Quantum and Radiological Science and Technology (QST).</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><a href="https://www.med.or.jp/doctor-ase/vol4/4page_16.html" target="_blank"><b>Katsushi Tahara, M.D.</b></a> (new member replacing Tamami Umeda; government official), Director, Department of Environmental Health, Ministry of the Environment.</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><a href="https://researchmap.jp/read0004043/?lang=english" target="_blank"><b>Shoichiro Tsugane, M.D., D.M.Sc</b></a> (returning member; epidemiologist), Director, <a href="https://www.ncc.go.jp/en/cpub/about/greeting/index.html" target="_blank">Center for Public Health Sciences</a>, National Cancer Center.</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><a href="http://kojingyoseki.adb.fukushima-u.ac.jp/top/details/111" target="_blank"><b>Tetsu Tomita, M.L.</b></a> (returning member; civil lawyer), Professor, <a href="http://english.adb.fukushima-u.ac.jp/program/undergraduate/administration-social-sciences.html" target="_blank">Faculty of Administration and Social Sciences</a>, Fukushima University.</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><a href="https://ifcc-cstft.org/akira-hishinuma" target="_blank"><b>Akira Hishinuma, M.D., Ph.D.</b></a> (new member replacing Toru Takano; endocrinologist, clinical laboratory medicine specialist), Professor, Department of Infection Control and Clinical Laboratory Medicine, School of Medicine, Dokkyo Medical University (recommended by the Japan Thyroid Association).</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><a href="http://www.hoshipital.jp/hojin.html" target="_blank"><b>Hokuto Hoshi, M.D.</b></a> (returning member; chairperson of the Oversight Committee since June 2013; </span><span style="font-family: "trebuchet ms" , sans-serif;">medical administrator</span><span style="font-family: "trebuchet ms" , sans-serif;">), Vice President, Fukushima Medical Association.</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;">Akihito Horikawa, M.D. (returning member; internist), President, Soma Medical Association</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><a href="http://hue2.jm.hirosaki-u.ac.jp/html/423_en.html" target="_blank"><b>Tomisato Miura, Ph.D.</b></a> (new member replacing Ikuo Kashiwakura; dosimetry researcher), Associate Professor, <a href="https://www.hs.hirosaki-u.ac.jp/en/daigakuin/course_list07.html" target="_blank">Department of Bioscience and Laboratory Medicine</a>, Graduate School of Health Sciences, Hirosaki University.</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><a href="https://www.med.tohoku.ac.jp/english/about/laboratory/209.html" target="_blank"><b>Jun Murotsuki, M.D., Ph.D.</b></a> (returning member; obstetrician), Chair, Department of Obstetrics, Miyagi Children's Hospital (recommended by the Japanese Society of Obstetrics and Gynecology.</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><a href="https://www.achmc.pref.aichi.jp/department/hokenka/doctor.html" target="_blank"><b>Yoshihisa Yamazaki, M.D., Ph.D.</b></a> (returning member, pediatrician), Vice Director, and also Director of Health Center, Aichi Children's Health and Medical Center (recommended by the Japan Pediatric Association).</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><b>Akira Yoshida, M.D.</b> (new member replacing Kazuo Shimizu; a former TUE Subcommittee member; </span><span style="font-family: "trebuchet ms" , sans-serif;">thyroid surgeon</span><span style="font-family: "trebuchet ms" , sans-serif;">), Chair, Department of Gynecological Examination, Kanagawa Preventive Medicine Association (recommended by the Japan Association of Endocrine Surgery; Founding Chair of the Preparation Committee for the 2010 Guidelines for Management of Thyroid Tumors)</span></li>
</ul>
<br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">*** Special note ***</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Hideo Tatsuzaki warrants a special mention. He occupies the 18th position on the roster which was newly added this term. An addition of this position </span><span style="font-family: "trebuchet ms" , sans-serif;">was never brought up or discussed publicly during the last term and </span><span style="font-family: "trebuchet ms" , sans-serif;">appears to be at the discretion of an unknown party, perhaps the prefectural government. In view of the fact that his immediate superior at QST is <a href="https://www.qst.go.jp/site/carem/" target="_blank">Shunichi Yamashita</a>, who is </span><span style="font-family: "trebuchet ms" , sans-serif;">Director General at the </span><a href="https://www.qst.go.jp/site/carem/" style="font-family: "trebuchet ms", sans-serif;" target="_blank">Center for Advanced Radiation Emergency Medicine</a><span style="font-family: "trebuchet ms" , sans-serif;">, Tatsuzaki could effectively be considered Yamashita's surrogate.</span><span style="font-family: "trebuchet ms" , sans-serif;"> </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> A <a href="https://www.tokyo-np.co.jp/article/national/list/201901/CK2019012802000122.html" target="_blank">Tokyo Shimbun article</a> published in the morning edition on January 28, 2019 states that Tatsuzaki was a leader of the medical team at the Offsite Center, an emergency response measures base facility established in Fukushima Prefecture during the immediate post-accidental period. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Also, according to the <a href="https://www.pref.niigata.lg.jp/uploaded/attachment/147517.pdf" target="_blank">self-declaration form</a> submitted to the Technical Committee on Nuclear Power Safety Management in </span><span style="font-family: "trebuchet ms" , sans-serif;">Niigata Prefecture</span><span style="font-family: "trebuchet ms" , sans-serif;">, Tatsuzaki was affiliated as a radiation oncologist with IAEA from 1997 to 2001 as First Officer in the section of Applied Radiation Biology and Radiotherapy, Department of Human Health, IAEA. Tatsuzaki was also a member of the Ministry of Foreign Affairs domestic committee for IAEA/RCA lead country in the field of health and medicine in FY2018-2019. (<a href="https://www.iaea.org/about/partnerships/regional/cooperative-agreements/regional-cooperative-agreement-for-research-development-and-training-related-to-nuclear-science-and-technology-for-asia-and-the-pacific-rca" target="_blank">RCA</a> stands for </span><span style="font-family: "trebuchet ms" , sans-serif;"><b>R</b>egional <b>C</b>ooperative <b>A</b>greement for Research, Development and Training
Related to Nuclear Science and Technology for Asia and the Pacific.)</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> His ties with Yamashita and IAEA could put Tatsuzaki in a position to ascertain "dismissal" of any radiation effects potentially observable in the third and fourth rounds, complementing FMU's ongoing efforts to withhold data needed for meaningful and transparent analysis. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;"> </span><br />
<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>Thyroid Examination Evaluation Subcommittee (TUE Subcommittee) membe</b></span><span style="font-family: "trebuchet ms" , sans-serif;"><b><span style="font-size: large;">rs</span></b> (August 1, 2019 to July 31, 2021)</span><br />
<br />
<ul>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><a href="https://www.onchikai.jp/departments/surgery/surgeon" target="_blank"><b>Shuji Asahi, M.D.</b></a> (new member replacing Hirofumi Ami; thyroid and breast surgeon), Chief, Department of Endocrine and Breast Surgery, Aizu Chuo Hospital (recommended by the Fukushima Hospital Association)</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><a href="https://higashinagoya.hosp.go.jp/about/affiliation-doctor.html#breast-surgery" target="_blank"><b>Tsuneo Imai, M.D.</b></a> (new member replacing Akira Yoshida; endocrine and breast surgeon), Director, Higashinagoya National Hospital (recommended by the Japan Association of Endocrine Surgery)</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><b>Kota Katanoda, Ph.D.</b> (returning member; statistician), Chief, <a href="https://www.ncc.go.jp/en/cis/divisions/stat_int/index.html" target="_blank">Division of Cancer Statistics Integration</a>, Center for Cancer Control and Information Services, National Cancer Center</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><a href="https://www.med.yamanashi.ac.jp/clinical_basic/pathol02/index_en.html" target="_blank"><b>Tetsuo Kondo, M.D., Ph.D.</b></a> (new member replacing Ryohei Kato; pathologist), Associate Professor, Department of Human Pathology, Yamanashi University</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><b>Gen Suzuki, M.D., Ph.D.</b> (returning member; former chairperson of the TUE Subcommittee; radiation researcher), Director, International University of Health and Welfare Clinic (recommended by the Japanese Radiation Research Center)</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><a href="https://researchmap.jp/read0159567/" target="_blank"><b>Tomotaka Sobue, M.D., M.P.H.</b></a> (returning member; cancer epidemiologist), Professor, <a href="http://www2.med.osaka-u.ac.jp/envi/message-e/" target="_blank">Department of Social and Environmental Medicine</a>, Division of Environmental Medicine and Population Sciences, Graduate School of Medicine, Osaka University (recommended by the Japan Epidemiological Association)</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><a href="https://researchmap.jp/read0142543/" target="_blank"><b>Kanshi Minamitani, M.D., Ph.D.</b></a> (returning member; pediatric endocrinologist), Clinical Professor, Department of Pediatrics, Teikyo University Medical Center (recommended by the Japanese Society for Pediatric Endocrinology)</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><a href="http://www.noguchi-med.or.jp/about/career" target="_blank"><b>Tsukasa Murakami, M.D.</b></a> (new member replacing Toru Takano; endocrinologist), Director, Noguchi Thyroid Clinic and Hospital Foundation (recommended by the Japan Thyroid Association)</span></li>
</ul>
<br />
<br />
<span style="font-family: "trebuchet ms" , sans-serif;"><u><span style="font-size: large;">The third round</span></u></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> The third-round results between April 1, 2019 and June 30, 2019 show that the primary examination participation rate remained at 64.7% with an additional 177 undergoing the examination. Nine more participants, assessed "B," became eligible for the confirmatory examination. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Nine participants (not necessarily the same nine previously mentioned) underwent the confirmatory examination and f</span><span style="font-family: "trebuchet ms" , sans-serif;">ive that newly underwent FNAC were all diagnosed with suspected thyroid cancer.</span><span style="font-family: "trebuchet ms" , sans-serif;"> This makes "29" the total number of suspected thyroid cancer cases in the third round.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> The 5 new suspected thyroid cancer cases consist of 3 males (ages-at-exposure: 6, 6, and 8) and 2 females (ages-at-exposure: 10 and 11), with 2 from Hamadori and 3 from Aizu. The second-round results for these five cases were 1 case with A1, 2 cases with A2 cyst, and 2 cases with B, meaning 3 of 5 had no previous sign of cancerous lesion 2 years ago.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> There was only one new surgical case from the third round, with the total of 19 surgically confirmed thyroid cancer cases. Because the Japanese summer break for elementary through high schools is usually from late July through August (longer for colleges), the next set of data as of September 30, 2019 (to be released in late December) is likely to include more cytology and surgery results.</span><br />
<br />
<span style="font-family: "trebuchet ms" , sans-serif;"><u><span style="font-size: large;">The fourth round</span></u></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> The fourth round, scheduled from April 1, 2018 through March 31, 2020, is actively ongoing. The current participation rate for the primary examination of 40.1%, lower than the previous rounds (81.7% for the first round, 71.0% for the second round, and 64.7% for the third round), is expected to increase especially with the progress of the school examination in the FY 2019 municipalities. Nonetheless, just how high it will get remains to be seen.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Eighty-one participants newly underwent the confirmatory examination which raised a participation rate to 59.8%. Twelve participants, all from the FY2018 municipalities, newly underwent FNAC, and 8 of them were diagnosed with suspected thyroid cancer, making "13" the total number of suspected thyroid cancer cases in the fourth round.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> The 8 suspected thyroid cancer cases are all from Nakadori, consisting of 4 males and 4 females. Because this is the first time that the age and sex distribution graph for the fourth round was released, it is not possible to specify ages-at-exposure for the 8 new suspected thyroid cancer cases. However, it <i>is</i> possible to identify age and sex for the entire 13 suspected cancer cases in the fourth round which include 6 males (ages-at-exposure: 5, 5, 7, 7, 12, and 12) and 7 females (ages-at-exposure: 4, 6, 8, 9, 10, 10, and 10). </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> As can be seen, there are more patients who were aged 5 years or younger at exposure. There might be more thyroid cancer cases detected in those who were aged 5 years or younger from now on, but declining participation rates with successive screening rounds are likely to dampen the reliability of the data. Moreover, once patients are placed on the clinical follow-up track, which can happen when potential thyroid cancer risk is identified but no immediate diagnosis is made for various reasons directly during the confirmatory examination, they essentially disappear into a "black box": any cancer cases diagnosed in the black box become "unreported cases" which are not included in the official tally. Although some of the "unreported" cases have been revealed as described in <a href="https://fukushimavoice-eng2.blogspot.com/2018/07/results-of-survey-on-fukushima-thyroid.html" target="_blank">this post</a>, publicly available data is far from a true and complete picture of the situation.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> In addition, there is no way to identify which cancer occurred as a result of radiation exposure, but their previous results from the earlier rounds might give some hint. The third-round results for the 8 newly diagnosed suspected cases were 2 cases with A1, 2 cases with A2 cyst, 2 cases with A2 nodule, and 2 cases with B. However, their results in the first and second rounds are not publicly available. (No doubt that FMU has such information.)</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> There was no new surgical case for the fourth round at this time. As mentioned in the previous section, the next set of data as of September 30, 2019, to be released in late December, will probably include more surgeries because the patients might defer surgery until the summer break so as not to interfere with school work.</span><br />
<br />
<span style="font-family: "trebuchet ms" , sans-serif;"><span style="font-size: large;"><u>Results from the previous screen</u></span><span style="font-size: large;"><u>ing</u></span> </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Below is information on previous assessments of the suspected/confirmed thyroid cancer cases. In the second round, 33 of 71 cases were assessed as "A1" meaning there were no ultrasound findings. Thirty-two were assessed as "A2" with ultrasound findings of nodules </span><span style="font-family: "trebuchet ms" , sans-serif;">≤ 5.0 mm and/or cysts </span><span style="font-family: "trebuchet ms" , sans-serif;">≤ 20.0 mm, 5 were assessed as "B" with nodules </span><span style="font-family: "trebuchet ms" , sans-serif;">≥</span><span style="font-family: "trebuchet ms" , sans-serif;"> 5.1 mm and/or cysts </span><span style="font-family: "trebuchet ms" , sans-serif;">≥</span><span style="font-family: "trebuchet ms" , sans-serif;"> 20.1 mm. Of 32 cases with A2, </span><span style="font-family: "trebuchet ms" , sans-serif;">25 cases had cysts. Having previous assessments of "A1" or "A2 cysts" means there was no precancerous lesion during the prior TUE, i.e., cancer supposedly appeared since the prior TUE. (Note: FMU claims the cancerous lesions were simply "invisible" during the prior TUE.)</span><br />
<ul>
<li><span style="font-family: "trebuchet ms" , sans-serif;">Second round (71 cases): 33 cases with A1, 32 cases with A2 (7 nodules and 25 cysts), 5 cases with B, 1 case unexamined</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;">Third round (29 cases): 6 cases with A1, 13 cases with A2 (3 nodules and 10 cysts), 7 cases with B, 3 cases unexamined</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;">Fourth round (13 cases): 2 cases with A1, 8 cases with A2 (6 nodules and 2 cysts), 3 cases with B</span></li>
</ul>
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@YuriHiranumahttp://www.blogger.com/profile/16819451884150838540noreply@blogger.com0tag:blogger.com,1999:blog-9200156515048577812.post-37230873997610870152019-09-27T15:52:00.000-07:002019-11-12T20:53:06.754-08:00Fukushima Thyroid Examination July 2019: 173 Surgically Confirmed as Thyroid Cancer Among 218 Cytology Suspected Cases<span style="font-size: small;"><span style="font-family: "trebuchet ms" , sans-serif;">*See <a href="https://fukushimavoice-eng2.blogspot.com/2019/06/pediatric-and-adolescent-thyroid-cancer.html" target="_blank">this post</a> for various issues surrounding Fukushima's Thyroid Ultrasound Examination (TUE) data.</span></span><br />
<span style="font-size: small;"><span style="font-family: "trebuchet ms" , sans-serif;">**Made corrections and clarifications in description of "FY" in the Age 25 Milestone Screening section. (September 28, 2019)</span></span><br />
<span style="font-size: small;"><span style="font-family: "trebuchet ms" , sans-serif;"><span style="font-size: small;">***Table for The latest overall results including "unreported" cases was replaced with a corrected version showing that Age 25 Milestone Examination was conducted in FY2017-8, not FY2016 as stated in the original version. (September 28, 2019)</span></span></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;">****Status of the Thyroid Ultrasound Examination PDF was updated to reflect the correct number of surgical cases (18, <i>not</i> 15 as previously shown) for the third round. (October 9, 2019)</span><br />
<br />
<span style="font-size: medium;"><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>Highlights</b></span></span><b style="font-family: "trebuchet ms", sans-serif;"> </b><br />
<ul>
<li><b style="font-family: "Trebuchet MS", sans-serif;">The third round: 3 cases newly diagnosed as suspicious or malignant, and 3 new cases surgically confirmed.</b></li>
<li><b style="font-family: "Trebuchet MS", sans-serif;">The fourth round: 3 cases diagnosed as suspicious or malignant, and 1 new case surgically confirmed.</b></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><b>Total number of suspected/confirmed thyroid cancer is now</b> <span style="color: red; font-weight: bold;">217 </span><b style="font-family: "trebuchet ms", sans-serif; font-weight: bold;"><i>excluding</i> a single case of benign tumor: </b><b>115 in the first round, 71 in the second round, 24 in the third round, 5 in the fourth round, and 2 in Age 25 Milestone Screening.</b></span></li>
<li><b style="font-family: "Trebuchet MS", sans-serif;">Total number of surgically confirmed thyroid cancer cases has increased by 5 to <span style="color: red;">173 </span>(101 in the first round, 52 in the second round,18 in the third round, 1 in the fourth round, and 1 in Age 25 Milestone Screening).</b></li>
<li><b style="font-family: "Trebuchet MS", sans-serif;">This is the last session of the 2017-2019 term. </b></li>
</ul>
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<b><span style="font-size: large;"><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></span></b>
<b><span style="font-size: large;"><span style="font-family: "trebuchet ms" , sans-serif;">The latest overall results including "unreported" cases</span></span></b><br />
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<i style="font-family: "trebuchet ms", sans-serif;">(See <a href="https://fukushimavoice-eng2.blogspot.com/2018/07/results-of-survey-on-fukushima-thyroid.html" target="_blank">this post</a> for details of the "unreported" cases.)</i><br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>Overview</b></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> On July 8, 2019, the 35th Oversight Committee for Fukushima Health Management Survey (FHMS) convened in Fukushima City, Fukushima Prefecture. Agenda included various fiscal reports from FY2018 (April 1, 2018 to March 31, 2019).</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Among other information, </span><span style="font-family: "trebuchet ms" , sans-serif;">the Oversight Committee released the latest results (as of March 31, 2019) of the <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/336451.pdf" target="_blank">third</a> and <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/336452.pdf" target="_blank">fourth</a> rounds of the </span><span style="font-family: "trebuchet ms" , sans-serif;">Thyroid Ultrasound Examination (TUE).</span><span style="font-family: "trebuchet ms" , sans-serif;"> Also released were the biannual results of <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/336453.pdf" target="_blank">Age 25 Milestone Screening</a>. Official English translation should eventually be available <a href="http://fmu-global.jp/our-activities/prefectural-oversight-committee-meeting/" target="_blank">here</a>. <i>(Note: English translation for the December 27, 2018 meeting was posted online on April 5, 2019, over 3 months later.)</i></span><br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>Summary on the current status of the TUE</b></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> A five-page <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/336460.pdf" target="_blank">summary</a> of the first through fourth rounds as well as the Age 25 Milestone Screening, "The Status of the Thyroid Ultrasound Examination," lists key findings from the primary and confirmatory examinations as well as the surgical information. </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/336460.pdf" style="font-family: "trebuchet ms", sans-serif;" target="_blank">This summary</a> <span style="font-family: "trebuchet ms" , sans-serif;">is <i>not</i> translated into English officially,</span><span style="font-family: "trebuchet ms" , sans-serif;"> but here's an unofficial translation. (Note: This translation has an additional pieces of information—the average age and tumor diameter for the FNAC results of the fourth round—which were not included in the original Japanese version.)</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"><span style="font-size: large;"><b>Key points from the Oversight Committee</b></span></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"><span style="font-size: large;"><u>The interim report on the second round results</u></span></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"> <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/339634.pdf" target="_blank">The interim report</a>, finalized at the 13th Thyroid Examination Assessment Subcommittee held on June 3, 2019, was presented and discussed. (See the <a href="https://fukushimavoice-eng2.blogspot.com/2019/06/english-translation-of-draft-summary-on.html" target="_blank">previous post</a> for unofficial translation of the draft version.) The final version varies very little from the draft version, with an addition of "and prospective" to the second to the last sentence as follows:</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"><i>Further, in the future, estimated thyroid exposure doses should be used in case control <span style="color: #cc0000;">and prospective</span> studies with confounding factors adjusted, in order to evaluate an association between doses and thyroid cancer incidence rates.</i></span></blockquote>
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<span style="font-family: "trebuchet ms" , sans-serif;"> Discussion mainly revolved around the decisive nature of the phrase, "</span><span style="font-family: "trebuchet ms" , sans-serif;">Thus, at this time, no association is seen between thyroid cancer detected in the second round and radiation exposure," which was considered too premature by multiple committee members. Their opinions were complied in a <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/339633.pdf" target="_blank">supplementary document</a>, </span><span style="font-family: "trebuchet ms" , sans-serif;">but not reflected in the final version of the interim report.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"><u><span style="font-size: large;">Age 25 Milestone Screening</span></u></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"> The results released at this time include those born in FY1993 <strike>(April 1993 to March 1992)</strike> (April 2, 1993 to April 1, 1994) in addition to the <a href="https://fukushimavoice-eng2.blogspot.com/2018/07/fukushima-thyroid-examination-in-june.html" target="_blank">previously reported results</a> from those born in FY1992 (April 2, 1992 to April 1, 1993). (Note: "FY" here is "academic FY" that applies to students in a particular school grade: students born during a particular academic FY belong to the same grade.)</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"> The participation rate remains low at 7.1%. Many might be either forgoing the TUE altogether or undergoing it at their local medical facilities rather than returning to Fukushima. Fukushima Medical University (FMU) does have affiliation agreements with 120 non-Fukushima medical facilities nationwide (see the <a href="http://fukushima-mimamori.jp/thyroid-examination/schedule-outside/media/inspection-list-outside-the-prefecture.pdf" target="_blank">list</a> in Japanese), but these young adults with busy schedule might choose more convenient locations outside the list.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"> Officials intend to rely on cancer registry data to supplement data, but it may not be easy or adequate as described below.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"><b>Cancer registry in Japan</b></span> </blockquote>
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<span style="font-family: "trebuchet ms" , sans-serif;">The 2016 National Cancer Act mandates collection of cancer data nationwide. Hospitals (≥ 20 beds) are required to report cancer data, but clinics (≤ 19 beds) need to be <i>voluntarily</i> "designated" by prefectures in order to report cancer data. This loophole implies that the cancer registry data might not to be as exhaustive as it should be. (See <a href="https://www.ncc.go.jp/en/cis/divisions/stat/index.html" target="_blank">the National Cancer Center website</a> for more information in English.) It is also conceivable that some "clinics" could function as a shelter for unreported cancer cases.</span></blockquote>
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<span style="font-family: "trebuchet ms" , sans-serif;"><span style="font-size: large;"><u>Results from the previous screen</u></span><span style="font-size: large;"><u>ing</u></span> </span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"> Below is information on previous assessments of the suspected/confirmed thyroid cancer cases. In the second round, 33 of 71 cases were assessed as "A1" meaning there were no ultrasound findings. Thirty-two were assessed as "A2" with ultrasound findings of nodules </span><span style="font-family: "trebuchet ms" , sans-serif;">≤ 5.0 mm and/or cysts </span><span style="font-family: "trebuchet ms" , sans-serif;">≤ 20.0 mm, 5 were assessed as "B" with nodules </span><span style="font-family: "trebuchet ms" , sans-serif;">≥</span><span style="font-family: "trebuchet ms" , sans-serif;"> 5.1 mm and/or cysts </span><span style="font-family: "trebuchet ms" , sans-serif;">≥</span><span style="font-family: "trebuchet ms" , sans-serif;"> 20.1 mm. Of 32 with A2, </span><span style="font-family: "trebuchet ms" , sans-serif;">25 had cysts. Having previous assessments of "A1" or "A2 cysts" means there was no precancerous lesion during the prior TUE, i.e., cancer supposedly appeared since the prior TUE. (Note: FMU claims the cancerous lesions were simply "invisible" during the prior TUE.)</span></div>
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<li><span style="font-family: "trebuchet ms" , sans-serif;">Second round (71 cases): 33 with A1, 32 with A2 (7 nodules and 25 cysts), 5 with B, 1 unexamined</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;">Third round (24 cases): 5 with A1, 11 with A2 (3 nodules and 8 cysts), 5 with B, <strike>2</strike> 3* unexamined</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;">Fourth round (5 cases): 4 with A2 (4 cysts), 1 with B</span></li>
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<span style="font-family: "trebuchet ms" , sans-serif;">*Corrected on November 12, 2019. </span></div>
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@YuriHiranumahttp://www.blogger.com/profile/16819451884150838540noreply@blogger.com0tag:blogger.com,1999:blog-9200156515048577812.post-62217613591834343772019-06-11T01:45:00.001-07:002022-09-18T22:10:21.692-07:00How the "Conclusion" Transpired on Thyroid Cancer in the Second Round in Fukushima<span face=""trebuchet ms" , sans-serif"><i>Note: In translation of the official documents, "detection rate(s)" is used instead of "incidence rate" or "prevalence rate" <span style="font-family: trebuchet;">i</span></i></span><i><span style="font-family: trebuchet;">n accordance with the original Japanese terminology.</span></i><br />
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<span face=""trebuchet ms" , sans-serif" style="font-size: large;"><b>Leaked "conclusion"</b></span><br />
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<span face=""trebuchet ms" , sans-serif"> On May 31, 2019, a Kyodo News article titled, "A Link Denied Between the Nuclear Power Plant Accident and Cancer in the Full-Scale Thyroid Screening in Children," appeared on the websites of <a href="https://www.tokyo-np.co.jp/s/article/2019053101002263.html" target="_blank">Tokyo Shimbun</a> and <a href="https://www.okinawatimes.co.jp/articles/-/427032" target="_blank">Okinawa Times</a>. Below is an unofficial translation.</span><br />
<blockquote class="tr_bq">
<span face=""trebuchet ms" , sans-serif"> An interview with an official on May 31 revealed that the expert subcommittee summarized an interim report reporting no link between cancer detected during the second round of the Thyroid Ultrasound Examination (TUE) and radiation exposure. The TUE covers all children in Fukushima Prefecture who were aged ≤ 18 years when the Tokyo Electric Power Company Fukushima Daiichi Nuclear Power Plant accident occurred, and the second round screening was conducted during FY 2014–2015. The reason for reporting no link is because there was no correlation showing an increased cancer rate at a higher exposure dose.<br /> </span><span face=""trebuchet ms" , sans-serif"> As opposed to the first round that was intended to collect the baseline data, the second round is considered "Full-Scale Screening" which investigates effects of the accident on cancer. Now that opinions on the second round have been summarized for the first time, the future of the TUE might be impacted.</span></blockquote>
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<span face=""trebuchet ms" , sans-serif"> This report came as a surprise to many of us who have been following the development of the Oversight Committee for the Fukushima Health Management Survey (FHMS) and one of its subcommittees, the Thyroid Examination Evaluation Subcommittee (herein, the TUE Subcommittee), for a simple reason that the analyses and deliberations conducted so far did not seem adequate to draw such a hasty conclusion. D</span><span face=""trebuchet ms" , sans-serif">iscussions at the Subcommittee sessions have mostly been dominated by benefits and harm of the TUE itself, leading to an ongoing revision of the informed consent form. </span><br />
<span face=""trebuchet ms" , sans-serif"> It is true that an "interim report" <i>was</i> expected, as </span><span face=""trebuchet ms" , sans-serif">customary with any government committee, </span><span face=""trebuchet ms" , sans-serif">with the two-year term for the current TUE Subcommittee roster coming to a close as of the 13th TUE Subcommittee meeting held on June 3, 2019. What was <i>not</i> expected was that it would be such a hasty conclusion with a decisive tone.</span><br />
<span face=""trebuchet ms" , sans-serif"><br /></span>
<span face=""trebuchet ms" , sans-serif"><b><span style="font-size: large;">"Draft" summary</span></b></span><br />
<span face=""trebuchet ms" , sans-serif"><br /></span><span face=""trebuchet ms" , sans-serif"> Chairperson Gen Suzuki started the meeting off complaining that the "scoop" headlines would take on a life of its own without conveying the process of discussion that led to the conclusion. T</span><span face=""trebuchet ms" , sans-serif">he actual "interim report" released at the 13th Subcommittee meeting turned out to be only a "draft summary," and the conclusion was considered provisional.</span><br />
<span face=""trebuchet ms" , sans-serif"> Accuracy of media reports released after the meeting seemed to depend on how well the writers have been informed of this complicated issue. Unfortunately, the only English <a href="https://mainichi.jp/english/articles/20190604/p2a/00m/0na/017000c" target="_blank">article by Mainichi</a>, "</span><span face=""trebuchet ms" , sans-serif">Thyroid cancer diagnoses in Fukushima youth not linked to nuke disaster: panel"</span><span face=""trebuchet ms" , sans-serif"> did not accurately convey the <a href="https://mainichi.jp/articles/20190603/k00/00m/040/222000c" target="_blank">original Japanese</a> title "Thyroid cancer in Fukushima youth and radiation exposure 'not linked at this time': subcommittee" </span><span face=""trebuchet ms" , sans-serif">that emphasized the temporary nature of the conclusion. (Also the phrase in t</span><span face=""trebuchet ms" , sans-serif">he Mainichi English article, "</span><span face=""trebuchet ms" , sans-serif">there is no data on those who have yet to be examined," is mistranslation of the original Japanese text that refers to lack of data on those who were examined outside the TUE system, explained as <i>missing data</i> in the <a href="https://fukushimavoice-eng2.blogspot.com/2019/06/pediatric-and-adolescent-thyroid-cancer.html" target="_blank">previous post</a>.</span><br />
<span face=""trebuchet ms" , sans-serif"><br /></span>
<span face=""trebuchet ms" , sans-serif"> Granted, the draft summary presented is only a draft. But the conclusion seems too decisive despite </span><span face=""trebuchet ms" , sans-serif">"provisional,"</span><span face=""trebuchet ms" , sans-serif"> considering the quality of analyses and discussions conducted so far. </span><span face=""trebuchet ms" , sans-serif">Some of the subcommittee members were not happy about the decisive tone of the draft summary, making suggestions to tone it down.</span><br />
<span face=""trebuchet ms" , sans-serif"> In honor of Suzuki's wish to "</span><span face=""trebuchet ms" , sans-serif">convey the process of discussion that led to the conclusion," </span><span face=""trebuchet ms" , sans-serif">relevant documents have been translated into English. </span><span face=""trebuchet ms" , sans-serif">Translation of the draft summary is posted </span><a href="https://fukushimavoice-eng2.blogspot.com/2019/06/english-translation-of-draft-summary-on.html" style="font-family: "Trebuchet MS", sans-serif;" target="_blank">here</a><span face=""trebuchet ms" , sans-serif">, and translation of FMU's analyses used to draw the "provisional conclusion" will follow in the latter part of this post. </span><br />
<span face=""trebuchet ms" , sans-serif"><br /></span>
<span face=""trebuchet ms" , sans-serif"> First, some background information is offered to characterize this TUE Subcommittee and "convey the process of discussion."</span><br />
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<span face=""trebuchet ms" , sans-serif"><span style="font-size: large;"><b>Analyses dominated by FMU</b></span></span><br />
<span face=""trebuchet ms" , sans-serif"> </span><br />
<span face=""trebuchet ms" , sans-serif"> When the TUE Subcommittee was reconvened after nearly a three-year hiatus in order to analyze the second-round data, there was an expectation that the analysis would be conducted by the subcommittee members which included experts in thyroid surgery, pediatrics, pathology, cancer statistics, epidemiology, and thyroid cancer research. However, the Subcommittee</span><span face=""trebuchet ms" , sans-serif"> has been able to do little more than listening to Fukushima Medical University (FMU) officials </span><span face=""trebuchet ms" , sans-serif">presenting their own analyses of the data, mostly consisting of </span><span face=""trebuchet ms" , sans-serif">proportions without actual numerical results. </span><br />
<span face=""trebuchet ms" , sans-serif"> T</span><span face=""trebuchet ms" , sans-serif">he subcommittee members have had to repeatedly ask for the actual data to no avail. When FMU officials said that after confounding factors were adjusted </span><span face=""trebuchet ms" , sans-serif">some results of analyses</span><span face=""trebuchet ms" , sans-serif"> </span><span face=""trebuchet ms" , sans-serif">yielded a very small number, 1 or 2 cases, from very small municipalities that might make them identifiable, the members even offered, more than once, </span><span face=""trebuchet ms" , sans-serif">to hold a closed session to secure privacy of data. When FMU officials shared their hesitation to share raw data because it should not be looked at without removing confounding factors, </span><span face=""trebuchet ms" , sans-serif">chairperson Suzuki suggested that FMU share data at least with experts in statistics and epidemiology, if not the entire subcommittee, to help them sort through issues. </span><br />
<span face=""trebuchet ms" , sans-serif"> None of the advices or suggestions were taken up by FMU. Instead, they would submit analyses after analyses with their own interpretations. The subcommittee members would listen, ask question, </span><span face=""trebuchet ms" , sans-serif">offer some opinions and advises. Never once were the subcommittee members involved in analyzing the actual data simply because of the lack of opportunity. </span><br />
<span face=""trebuchet ms" , sans-serif"><br /></span><span face=""trebuchet ms" , sans-serif"> (Note: During an informal interview immediately after the 13th Subcommittee press conference, chairperson Suzuki allegedly said that FMU withheld the actual raw data so as not to let a "certain magazine" publish its own analysis which would then take on a life of its own. Most certainly that magazine is <i>Kagaku</i> by Iwanami Publishers.)</span><br />
<span face=""trebuchet ms" , sans-serif"><br /></span>
<span face=""trebuchet ms" , sans-serif"><b><span style="font-size: large;">Other futile discussions</span></b></span><br />
<span face=""trebuchet ms" , sans-serif"> </span><br />
<span face=""trebuchet ms" , sans-serif"> For some reason, when the TUE Subcommittee resumed, its members were <i>still</i> debating benefits and harm of the TUE itself even when the third round was fully under way. Recognition of the TUE as typical cancer screening, rather than health monitoring a</span><span face=""trebuchet ms" , sans-serif">s described in the </span><a href="https://fukushimavoice-eng2.blogspot.com/2019/06/pediatric-and-adolescent-thyroid-cancer.html" style="font-family: "Trebuchet MS", sans-serif;" target="_blank">previous post</a><span face=""trebuchet ms" , sans-serif">, set the tone for the </span><span face=""trebuchet ms" , sans-serif">never-ending debate throughout the term of this TUE Subcommittee. The debate even intensified after the IARC expert group <a href="http://tmnuc.iarc.fr/en/" target="_blank">TM-NUC</a> (<u>T</u>hyroid <u>M</u>onitoring after <u>Nuc</u>lear Accident) released its <a href="http://publications.iarc.fr/571" target="_blank">report</a>, <a href="http://tmnuc.iarc.fr/public/docs/TM-NUC_lay_summary_final2.pdf" target="_blank">recommending against</a> systematic thyroid screening for fear of overdiagnosis. (See <a href="https://fukushimavoice-eng2.blogspot.com/2017/11/circumstances-regarding-japan-sponsored.html" target="_blank">this 2017 post</a> or <a href="https://fukushimavoice-eng2.blogspot.com/2019/06/pediatric-and-adolescent-thyroid-cancer.html" target="_blank">previous post</a> for more on TM-NUC.) </span><br />
<span face=""trebuchet ms" , sans-serif"> Further, Toru Takano, a thyroid cancer researcher from Osaka University and the only subcommittee member doubly appointed to the Oversight Committee, kept insisting that the TUE administered in school-settings (in elementary and junior high schools) constituted an ethical and human rights violation because students were "forced" into it. (The truth is that the school-based TUE, approved by FMU's ethics committee, had been requested by municipal education commissions to prevent missed school days and extra load on families from taking children to a specified TUE location. Only students with signed consent forms are examined.) </span><br />
<span face=""trebuchet ms" , sans-serif"> According to Takano's own <a href="http://www.med.osaka-u.ac.jp/pub/labo/www/CRT/EN.html" target="_blank">hypothesis</a> of fetal cell carcinogenesis, all children have "self-limiting thyroid cancer." Hence all thyroid cancer cases detected in Fukushima comprise overdiagnosis, so the TUE should immediately be stopped and replaced by palpation of the neck. Why Japan Thyroid Association appointed Takano to the double positions is unclear. If the intention was to create disturbance and muddle the debate, their choice certainly nailed it.</span><br />
<br />
<span face=""trebuchet ms" , sans-serif" style="font-size: large;"><b>Disappearing regional differences</b></span><br />
<span face=""trebuchet ms" , sans-serif"><br /></span>
<span face=""trebuchet ms" , sans-serif"> As described in the </span><a href="https://fukushimavoice-eng2.blogspot.com/2019/06/pediatric-and-adolescent-thyroid-cancer.html" style="font-family: "Trebuchet MS", sans-serif;" target="_blank">previous post</a>,<span face=""trebuchet ms" , sans-serif"> the TUE data has numerous transparency and reliability issues</span><span face=""trebuchet ms" , sans-serif">. Still, some meaningful analysis on the official data could be of use. </span><br />
<span face=""trebuchet ms" , sans-serif"> The </span><a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/250523.pdf" style="font-family: "Trebuchet MS", sans-serif;" target="_blank">final report of the second round</a><span face=""trebuchet ms" , sans-serif"> has never been translated into English because it was first presented to the <a href="http://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-b8.html" target="_blank">8th TUE Subcommittee</a> as <a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/250523.pdf" target="_blank">Document 2-1</a>. (Documents from subcommittee are never officially translated.) Included in the final report is Table 11 for a regional analysis which, </span><span face=""trebuchet ms" , sans-serif">unlike in the first round (see </span><a href="http://fmu-global.jp/download/thyroid-ultrasound-examination-supplemental-report-of-the-fy-2016-surveypreliminary-baseline-screening/?wpdmdl=2690" style="font-family: "Trebuchet MS", sans-serif;" target="_blank">Table 9</a>), <span face=""trebuchet ms" , sans-serif">appears to show regional differences in detection rates of thyroid cancer in the second round (shown in the bottom rows). (See the comparison between Tables 11 and 9 in <a href="https://fukushimavoice-eng2.blogspot.com/2018/01/fukushima-thyroid-examination-december.html" target="_blank">this post</a>.)</span><br />
<span face=""trebuchet ms" , sans-serif"> Also presented at the 8th TUE Subcommittee meeting </span><span face=""trebuchet ms" , sans-serif">as <a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/244313.pdf" target="_blank">Document 2-3</a> </span><span face=""trebuchet ms" , sans-serif">was another set of the regional analysis adjusted with screening interval, the length of time between primary examinations of the first and second rounds. This analysis only includes 246,687 subjects who participated in <u>both of the first and second rounds</u>, eliminating 23,829 or nearly 9% of 270,516 participants. </span><br />
<span face=""trebuchet ms" , sans-serif"> Table 11 and the version adjusted for screening interval is shown below.</span><br />
<span face=""trebuchet ms" , sans-serif"><br /></span>
<a href="https://www.scribd.com/document/413009000/The-second-round-results-by-region-original-Table-11-and-adjusted-for-screening-interval#from_embed" style="font-family: helvetica, arial, sans-serif; font-size: 14px;" target="_blank" title="View The second-round results by region: original Table 11 and adjusted for screening interval on Scribd">The second-round results by region: original Table 11 and adjusted for screening interval</a><span face=""helvetica" , "arial" , sans-serif" style="font-size: 14px;"> by </span><a href="https://www.blogger.com/undefined#from_embed" style="font-family: helvetica, arial, sans-serif; font-size: 14px; text-decoration-line: underline;" title="View 's profile on Scribd"></a><span face=""helvetica" , "arial" , sans-serif" style="font-size: 14px;"> on Scribd</span><br />
<iframe class="scribd_iframe_embed" data-aspect-ratio="null" data-auto-height="true" frameborder="0" height="600" scrolling="no" src="https://www.scribd.com/embeds/413009000/content?start_page=1&view_mode=scroll&show_recommendations=true&access_key=key-P10P8qpuK6JKN2bQ0nSa" title="The second-round results by region: original Table 11 and adjusted for screening interval" width="100%"></iframe>
<span face=""trebuchet ms" , sans-serif"><br /></span>
<span face=""trebuchet ms" , sans-serif"> </span><br />
<span face=""trebuchet ms" , sans-serif"> Other than this adjustment for screening interval, </span><span face=""trebuchet ms" , sans-serif">FMU has compared the first- and second-round data (see <a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/278761.pdf" target="_blank">Document 2</a> from the <a href="http://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-b10.html" target="_blank">10th Subcommittee</a>) and done just about everything seemingly possible to "adjust" detection rates of confirmed or suspected cancer for various factors which can affect the second-round data (see <a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/295101.pdf" target="_blank">Document 1</a> from the <a href="http://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-b11.html" target="_blank">11th Subcommittee</a>).</span><span face=""trebuchet ms" , sans-serif"> Excerpts fro these 2 documents were presented as Document 1-1 at the 13th Subcommittee meeting.</span><br />
<span face=""trebuchet ms" , sans-serif"><br /></span>
<span face=""trebuchet ms" , sans-serif"><b><span style="font-size: large;">Dose-response analysis with UNSCEAR doses</span></b></span><br />
<span face=""trebuchet ms" , sans-serif"><br /></span>
<span face=""trebuchet ms" , sans-serif"> Their effort culminated in a <a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/311587.pdf" target="_blank">dose-response analysis</a> using absorbed doses to the thyroid by municipality estimated by UNSCEAR. Presented as <a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/311587.pdf" target="_blank">Document 1-2</a> at the <a href="http://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-b12.html" target="_blank">12th Subcommittee meeting</a> on February 22, 2019, it claimed no dose-response in confirmed or suspected cancer cases from the second round. Of course, the best doses to be used are individual thyroid doses, but only 1080 children from 3 municipalities had their thyroids directly measured (and these measurements are likely <a href="https://www.iwanami.co.jp/kagaku/eKagaku_201709_Hiranuma-rev2.pdf" target="_blank">underestimated</a>). UNSCEAR estimated doses by municipality were considered by chairperson Suzuki the only "authorized" doses available at present to be used in a dose-response analysis, despite reservations about its use as expressed by experts from National Cancer Center Japan.</span><br />
<span face=""trebuchet ms" , sans-serif"> This dose-response analysis has been severely criticized by Junichiro Makino, an astromist/physicist at Kobe University, for questionable methods in a Japanese science journal </span><i style="font-family: "Trebuchet MS", sans-serif;">Kagaku</i><span face=""trebuchet ms" , sans-serif"> (only available in Japanese).</span><span face=""trebuchet ms" , sans-serif"> Makino has previously pointed out in his 2015 book "Assessment of radiation exposure and scientific methods" that thyroid absorption doses estimated by UNSCEAR have a significant amount of uncertainties because they are essentially based on deposition of radioactive cesium 134/137. </span><br />
<span face=""trebuchet ms" , sans-serif"> I</span><span face=""trebuchet ms" , sans-serif">t is not radioactive cesium but radioactive iodine that affects the thyroid gland. However, due to a very short half-life (8 days) of radioactive iodine 131 and even shorter half-life (2.3 hours) of iodine 132 existing in equilibrium with tellurium 132 (half-life 3.2 days), it is extremely difficult to conduct actual measurements of radiological contamination due to short-lived iodine isotopes. Thus UNSCEAR-estimated thyroid absorption doses were calculated from radioactive cesium levels based on a theoretically-derived cesium-to-iodine ratio which in reality may not remain the same under different circumstances.</span><br />
<span face=""trebuchet ms" , sans-serif"> In short, results from the dose-response analysis using UNSCEAR estimated doses would not be considered very reliable due to </span><span face=""trebuchet ms" , sans-serif">a significant amount of inherent uncertainties</span><span face=""trebuchet ms" , sans-serif">. </span><br />
<span face=""trebuchet ms" , sans-serif"><br /></span>
<span face=""trebuchet ms" , sans-serif" style="font-size: large;"><b>Underestimation due to an error </b></span><br />
<br />
<span face=""trebuchet ms" , sans-serif"> At the June 3, 2019 TUE Subcommittee meeting, FMU admitted that an error made while entering data in analytical program of statistical software had produced odds ratios which were smaller than actual values. </span><span face=""trebuchet ms" , sans-serif">A </span><a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/330584.pdf" style="font-family: "Trebuchet MS", sans-serif;" target="_blank">correction</a><span face=""trebuchet ms" , sans-serif"> (Document 1-3, translation shown below) was issued that showed bigger odds ratios and wider 95% confidence intervals. Insisting that the error does not change the results of significant testing, FMU upholds their conclusion of no</span><span face=""trebuchet ms" , sans-serif"> dose-response. </span><br />
<span face=""trebuchet ms" , sans-serif"> As to preventing future errors, FMU formed an investigative committee to look into the matter and decided to establish a system where two individuals would conduct the same analysis and compare results. With their competency in question, a better option might be a third-party analysis and oversight.</span><br />
<span face=""trebuchet ms" , sans-serif"><br /></span>
<span face=""trebuchet ms" , sans-serif"><span style="font-size: large;"><b>New analysis</b></span></span><span face=""trebuchet ms" , sans-serif"> </span><br />
<br />
<span face=""trebuchet ms" , sans-serif"> As if to back up their "no dose-response" claim, FMU</span><span face=""trebuchet ms" , sans-serif" style="background-color: transparent;"> also released <a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/330129.pdf" target="_blank">further odds ratio analyses</a> (Document 1-2, translation shown below) with an adjustment of various factors</span><span face=""trebuchet ms" , sans-serif">. The "new" analysis released at the same time as the draft summary was bizarre. </span><br />
<span face=""trebuchet ms" , sans-serif"> The subcommittee members appeared literally at a loss. In fact, some stated that it was difficult to interpret the results without seeing the number of cases in each dose group. Others seemed to be having difficulty digesting FMU's own analyses and interpretation in a short time. </span><br />
<span face=""trebuchet ms" , sans-serif"> In particular, some of the graphs actually show a <i>negative</i> trend, with odds ratios falling below 1. Testuya Ohira, an FMU official, explains, "a negative trend seen is an unlikely item in general, so for now we are calling it no dose-response."</span><br />
<span face=""trebuchet ms" , sans-serif"><br /></span><span face=""trebuchet ms" , sans-serif">⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨⬨</span><br />
<span face=""trebuchet ms" , sans-serif"><br class="Apple-interchange-newline" /><span face=""trebuchet ms" , sans-serif"> At the 12th Subcommittee meeting in February 2019, it was becoming clear that the TUE Subcommittee was running out of time to make a proper assessment before the two-year term was up, but in our naivety, some of us anticipated that discussion might be carried onto the next term without drawing any definitive conclusion. </span></span><br />
<span face=""trebuchet ms" , sans-serif"> However, what actually took place at the very last meeting of the current term was beyond words: Based on FMU's analysis criticized for lack of transparency or comprehensibility from start to finish, chairperson Suzuki put together a draft summary with a provisional conclusion of <i>no radiation effects for thyroid cancer detected in the second round</i>. </span><br />
<span face=""trebuchet ms" , sans-serif"> When asked to "grade" the conclusion at the press conference, Tomotaka Sobue, a cancer epidemiologist, gave 60 out of 100, and Kota Katanoda, a cancer statistician, gave 50. They both pointed to 2 things that account for the tentative nature of the conclusion, 1) lack of individual doses and 2) missing data on cancer cases diagnosed during the clinical follow-up or outside the TUE.</span><span face=""trebuchet ms" , sans-serif"> </span><br />
<span face=""trebuchet ms" , sans-serif"> </span><span face=""trebuchet ms" , sans-serif">Suzuki says the provisional conclusion is to be treated with caution because the second-round data will eventually be re-analyzed. Unfortunately, once it hits a headline, the provisional conclusion is likely to skip whatever nuance is intended and take on a life of its own. </span><br />
<span face=""trebuchet ms" , sans-serif"><br /></span>
<span face=""trebuchet ms" , sans-serif"><span style="font-size: large;"><b>Translation of the FMU analyses</b></span></span><br />
<span face=""trebuchet ms" , sans-serif"><br /></span>
<span face=""trebuchet ms" , sans-serif"> Below is the translation of 3 documents </span><span face=""trebuchet ms" , sans-serif">presented to the 13th TUE Subcommittee on June 3, 2019. Showing analyses by FMU, these documents comprise the basis for the "provisional conclusion" that denies radiation effects for the second round of the TUE.</span><span face=""trebuchet ms" , sans-serif"> </span>
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<a href="https://www.scribd.com/document/413006362/Document-1-1-Regarding-factors-related-to-the-results-of-the-Full-Scale-Thyroid-Ultrasound-Examination-the-second-round#from_embed" style="text-decoration: underline;" target="_blank" title="View Document 1-1 : Regarding factors related to the results of the Full-Scale Thyroid Ultrasound Examination (the second round) on Scribd">Document 1-1: Regarding factors related to the results of the Full-Scale Thyroid Ultrasound Examination (the second round)</a> by <a href="https://www.blogger.com/undefined#from_embed" style="text-decoration: underline;" title="View 's profile on Scribd"></a> on Scribd</div>
<iframe class="scribd_iframe_embed" data-aspect-ratio="null" data-auto-height="true" frameborder="0" height="600" scrolling="no" src="https://www.scribd.com/embeds/413006362/content?start_page=1&view_mode=scroll&show_recommendations=true&access_key=key-Foh7ssRrVAteLiCvDY5I" title="Document 1-1 : Regarding factors related to the results of the Full-Scale Thyroid Ultrasound Examination (the second round)" width="100%"></iframe>
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<a href="https://www.scribd.com/document/413006581/Document-1-2-Associations-between-absorbed-doses-to-the-thyroid-by-municipality-estimated-by-UNSCEAR-and-detection-rates-of-confirmed-or-suspected-ca#from_embed" style="text-decoration: underline;" target="_blank" title="View Document 1-2: Associations between absorbed doses to the thyroid by municipality estimated by UNSCEAR and detection rates of confirmed or suspected cancer on Scribd">Document 1-2: Associations between absorbed doses to the thyroid by municipality estimated by UNSCEAR and detection rates of confirmed or suspected cancer</a> by <a href="https://www.blogger.com/undefined#from_embed" style="text-decoration: underline;" title="View 's profile on Scribd"></a> on Scribd</div>
<iframe class="scribd_iframe_embed" data-aspect-ratio="null" data-auto-height="true" frameborder="0" height="600" scrolling="no" src="https://www.scribd.com/embeds/413006581/content?start_page=1&view_mode=scroll&show_recommendations=true&access_key=key-99GR8nbaJdfOzHW38scF" title="Document 1-2: Associations between absorbed doses to the thyroid by municipality estimated by UNSCEAR and detection rates of confirmed or suspected cancer" width="100%"></iframe>
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<a href="https://www.scribd.com/document/413008814/Document-1-3-Regarding-corrections-on-graphs-presented-to-the-12th-Thyroid-Examination-Evaluation-Subcommittee#from_embed" style="text-decoration: underline;" target="_blank" title="View Document 1-3: Regarding corrections on graphs presented to the 12th Thyroid Examination Evaluation Subcommittee on Scribd">Document 1-3: Regarding corrections on graphs presented to the 12th TUE Subcommittee</a> by <a href="https://www.blogger.com/undefined#from_embed" style="text-decoration: underline;" title="View 's profile on Scribd"></a> on Scribd</div>
<iframe class="scribd_iframe_embed" data-aspect-ratio="null" data-auto-height="true" frameborder="0" height="600" scrolling="no" src="https://www.scribd.com/embeds/413008814/content?start_page=1&view_mode=scroll&show_recommendations=true&access_key=key-ghOEuyaES59z6ZAyeJYK" title="Document 1-3: Regarding corrections on graphs presented to the 12th Thyroid Examination Evaluation Subcommittee" width="100%"></iframe>@YuriHiranumahttp://www.blogger.com/profile/16819451884150838540noreply@blogger.com0tag:blogger.com,1999:blog-9200156515048577812.post-50677515049845511762019-06-06T16:50:00.000-07:002019-11-10T11:36:05.666-08:00English Translation of a Draft Summary on Fukushima's Thyroid Cancer Found in the Second-Round Screening <span style="font-family: "trebuchet ms" , sans-serif;">⁂ <i>This is an unofficial English translation of the <b>draft version</b> of the official summary on the second-round results.</i></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;">⁂ </span><span style="font-family: "trebuchet ms" , sans-serif;">Update on November 10, 2019: The final version submitted to the 35th meeting of the Oversight Committee on July 8, 2019 had an addition of "and prospective" in the second to the last sentence as shown below.</span><br />
<blockquote class="tr_bq">
<i style="font-family: "trebuchet ms", sans-serif;"> Further, in the future, estimated thyroid exposure doses should be used in case control <span style="color: #cc0000;">and prospective</span> studies with confounding factors adjusted, in order to evaluate an association between doses and thyroid cancer incidence rates.</i></blockquote>
*********<span style="font-family: "trebuchet ms" , sans-serif;"> </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> On June 3, 2019, the <a href="http://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-b13.html" target="_blank">13th </a></span><span style="font-family: "trebuchet ms" , sans-serif;"><a href="http://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-b13.html" target="_blank">Thyroid Examination Evaluation Subcommittee</a> (herein, the TUE Subcommittee) was held, marking the end of a two-year term for the members. As it is customary for committees to produce a report at the end of the term, <a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/330479.pdf" target="_blank">a draft version of the "interim report"</a> was submitted by Gen Suzuki, chair to the TUE Subcommittee, concluding, "</span><span style="font-family: "trebuchet ms" , sans-serif;">at this time, no association is seen between thyroid cancer detected in the second round and radiation exposure."</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> The conclusion, albeit provisional, came as a surprise to many, because it did not seem like the TUE Subcommittee had spent enough time analyzing the second-round data. On the contrary, most of discussions have revolved around the topic of benefits and harm of the TUE itself.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> When this "provisional" conclusion became known to English speakers via a <a href="https://mainichi.jp/english/articles/20190604/p2a/00m/0na/017000c" target="_blank">online newspaper article on the Mainichi website</a>, confusion ensued. </span><span style="font-family: "trebuchet ms" , sans-serif;">English translation of the <a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/330479.pdf" target="_blank">"interim report"</a> is offered below so everyone can see the "basis" for the conclusion by the TUE Subcommittee. </span><span style="font-family: "trebuchet ms" , sans-serif;">Translation of some of the analyses mentioned is to be posted separately.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇</span><span style="font-family: "trebuchet ms" , sans-serif;">◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇◇</span><br />
Note: This is a draft version. The final version is expected to have slightly different wording. (See the update at top.)<br />
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<div class="WordSection1">
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;"> A summary of the subcommittee regarding the results of the Full-Scale
Screening of the Thyroid Ultrasound Examination (the second round)</span></div>
<div class="MsoNormal">
<br /></div>
<div align="right" class="MsoNormal" style="text-align: right;">
<span style="font-family: "trebuchet ms" , sans-serif;">June 3, 2019<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">Thyroid Ultrasound Examination Evaluation
Subcommittee by the <o:p></o:p></span></div>
<div align="right" class="MsoNormal" style="text-align: right;">
<span style="font-family: "trebuchet ms" , sans-serif;">Oversight Committee for Fukushima
Health Management Survey<o:p></o:p></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"><span style="mso-spacerun: yes;"> </span>The Thyroid Ultrasound Examination
(herein, TUE) Evaluation Subcommittee by the Oversight Committee for Fukushima
Health Management Survey (herein, the Subcommittee) released an “Interim Summary
on the TUE” (herein, the Interim Summary) in March 2015 to report on the
results of the Initial Screening of the TUE (the first round) conducted from FY
2011 to FY 2013. The Interim Summary concluded that the results of the first
round “were unlikely to be the effects of radiation.”<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;"><span style="mso-spacerun: yes;"> </span>At the 26<sup>th</sup>
Oversight Committee for Fukushima Health Management Survey (herein, the
Oversight Committee) held on February 20, 2017, a proposal was made to convene
the Subcommittee in order to summarize and evaluate the results of the Full-Scale
Screening of the TUE (the second round, FY 2014-2015). In response to this
proposal, the 7<sup>th</sup> Subcommittee was convened in conjunction with the
27<sup>th</sup> Oversight Committee on June 5, 2017, followed by the 8<sup>th</sup>
Subcommittee held with a new set of members on November 30, 2017. The
Subcommittee engaged in repeated deliberations over a total of 7 sessions, up
to the 13<sup>th</sup> Subcommittee held on June 3, 2019.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;"><span style="mso-spacerun: yes;"> </span>Based on the contents
of the deliberations, the Subcommittee summarized below the results of the second
round, opinions of the Subcommittee on the results, and issues for future consideration.
<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">1<span style="mso-spacerun: yes;"> </span>Results of the Full-Scale
Screening of the TUE (the second round)<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;"><span style="mso-spacerun: yes;"> </span>The
second round that began in April 2014 covered approximately 380,000 Fukushima
residents, adding subjects born between April 2, 2011 and April 1, 2012 to the
first-round subjects born between April 2, 1992 and April 1, 2011. About 270,000
have participated as of June 30, 2017 (participation rates of 71% overall, 86.4%
in ages ≤ 17, 25.7% in ages ≥ 18), and 2227 (0.8%) were assessed the B test
results requiring a confirmatory examination and no one had the C test result (note:
requiring an immediate confirmatory examination). After undergoing fine-needle
aspiration cytology (FNAC) during the confirmatory examination, 71 were diagnosed
with confirmed or suspected malignancy (26.2/100,000; 32 males and 39 females;
average age 16.9 ± 3.2 years, age range 9-23 years; average age at the time of
the accident 12.6 ± 3.2 years, age range 5-18; average tumor diameter 11.1 ±
5.6 mm). (Note: 52 underwent surgery, revealing 51 papillary thyroid cancer and
1 other cancer.)<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;"><span style="mso-spacerun: yes;"> </span>The detection
rate of thyroid cancer during the first round was several <strike>orders tens of times</strike> multiples of ten higher than
prevalence rate/proportion estimated from the Japanese cancer statistics data based on the
regional cancer registry. The thyroid cancer detection rate in the second round
was somewhat smaller than that in the first round but still several <strike>orders</strike> multiples of ten higher (than the cancer statistics data).<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;"> Detection rates of confirmed or suspected cancer showed no regional
difference in the first round. In the second round, a simple comparison without
adjusting for sex and age showed the highest detection rate in the 13 evacuated
municipalities, followed by Nakadori, Hamadori, and Aizu.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;"> However,
detection rates of confirmed or suspected cancer are likely influenced by many
factors. When some of the factors were considered, the following tendencies
were observed.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst">
</div>
<ul>
<li><span style="font-family: "trebuchet ms" , sans-serif;">The detection rate of nodules with diameter of 5.1–10 mm was low in the 13 evacuated municipalities in the first round. Also, among subjects with the B test results in the second round, the proportion of the subjects whose first-round results were also B was low in the 13 evacuated municipalities. This suggests that the second-round results are affected by the first-round results. </span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;">The longer the interval between the first and second rounds, the higher the FNAC rate and the detection rate of confirmed or suspected cancer. The longest average interval was observed in the 13 evacuated municipalities. </span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;">FNAC rates have declined in successive years even in the first round. The second-round FNAC rate declined in the order of the 13 evacuated municipalities, Nakadori, Hamadori, and Aizu. </span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;">When FNAC was conducted in the first round, FNAC rates and detection rates of confirmed or suspected cancer tended to be lower in comparison with the subjects who underwent no FNAC in the first round.</span> </li>
</ul>
<br />
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">2<span style="mso-spacerun: yes;"> </span>Regarding the preliminary
analysis on an association between thyroid cancer detection rates in the second
round and radiation doses<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;"><span style="mso-spacerun: yes;"> </span>The above analysis has
shown that detection rates of confirmed or suspected cancer are influenced by many
factors other than sex and age at screening, such as screening year, FNAC
rates, screening interval since the first round, and whether FNAC was conducted
in the first round. Therefore, an evaluation of an association between thyroid
cancer detection rates and radiation doses calls for analyses that control these
factors.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;"><span style="mso-spacerun: yes;"> </span>For radiation doses, an
analysis was tentatively conducted with absorbed doses to the thyroid estimated
in different age groups and municipalities by United Nations Scientific
Committee on Effects of Atomic Radiation (UNSCEAR), which incorporate internal
exposure.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;"><span style="mso-spacerun: yes;"> </span>The analysis showed no
clear association between doses and thyroid cancer detection rates. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">3<span style="mso-spacerun: yes;"> </span>Findings<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;"> Proportions of the B test
results in the primary examination, recommended to advance to the confirmatory
examination, were larger with an older age at the time of the accident, and detection
rates of confirmed or suspected cancer were higher with an older age at the
time of the confirmatory examination. This is dissimilar to detection of many more
thyroid cancer in a younger age group after the Chernobyl accident. Detection
of more cancer with an increasing age is similar to cancer in general.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;"><span style="mso-spacerun: yes;"> </span>The male-to-female
ratio is close to 1:1, which is different from what tends to be observed in a
clinical setting (about 1:6). It has been reported that the male-to-female
ratio tends to be smaller in latent cancer and younger ages. Evaluation of an
association between the male-to-female ratio and radiation remains as a future
task.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;"><span style="mso-spacerun: yes;"> </span>A simple comparison of detection
rates of confirmed or suspected cancer in four regions appears to show differences,
but it is influenced by many factors such as screening year and screening
interval since the first round. Any analysis needs to take these factors into
consideration.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;"><span style="mso-spacerun: yes;"> </span>When factors that can
influence detection rates were adjusted as much as possible, analyses of an
association between doses and thyroid cancer detection rates, tentatively using
the absorbed doses to the thyroid estimated by UNSCEAR by age group and
municipality, revealed no consistent relationship between increasing doses and
increasing detection rates (dose-effect relationship).<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;"><span style="mso-spacerun: yes;"> </span>Thus, at this time, no
association is seen between thyroid cancer detected in the second round and
radiation exposure.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">4<span style="mso-spacerun: yes;"> </span>Explanation to residents
covered by the TUE <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;"><span style="mso-spacerun: yes;"> </span>The Subcommittee has advanced
discussion on contents of the explanation to residents covered by the TUE. It
is important to continue careful explanation of merits and demerits of the TUE,
so their understanding and consent may be gained before the TUE is administered.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;">5<span style="mso-spacerun: yes;"> </span>Viewpoints for future
evaluation<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;"><span style="mso-spacerun: yes;"> </span>The third round started
in FY 2016 and the fourth round in FY 2018, and their results need to be
incorporated into further analyses.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;"><span style="mso-spacerun: yes;"> </span>Also, participation
rates of the TUE are declining every year. In particular, a participation rate after
high school graduation is low with continuing decline expected in the future.
Moreover, it is possible that more cancer cases might be discovered outside the
TUE conducted as part of the Fukushima Health Management Survey. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;"><span style="mso-spacerun: yes;"> </span>This leads to the use
of regional and national cancer registries in order to identify cancer
incidence among residents covered by the TUE so an analysis could be conducted.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;"><span style="mso-spacerun: yes;"> </span>Further, in the future,
estimated thyroid exposure doses should be used in case control studies with
confounding factors adjusted, in order to evaluate an association between doses
and thyroid cancer incidence rates.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;"><span style="mso-spacerun: yes;"> </span>These are the
viewpoints that should be considered in advancing discussion at the
Subcommittee and the Oversight Committee in the future.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "trebuchet ms" , sans-serif;"><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span></span></div>
</div>
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<a href="https://www.scribd.com/document/413008908/Document-3-A-draft-summary-of-the-subcommittee-regarding-the-results-of-the-Full-Scale-Screening-of-the-Thyroid-Ultrasound-Examination-the-second-ro#from_embed" style="text-decoration: underline;" target="_blank" title="View Document 3: A draft summary of the subcommittee regarding the results of the Full-Scale Screening of the Thyroid Ultrasound Examination (the second round) on Scribd">A draft summary of the subcommittee regarding the results of the Full-Scale Screening of the Thyroid Ultrasound Examination (the second round)</a> by <a href="https://www.blogger.com/undefined#from_embed" style="text-decoration: underline;" title="View 's profile on Scribd"></a> on Scribd</div>
<iframe class="scribd_iframe_embed" data-aspect-ratio="null" data-auto-height="true" frameborder="0" height="600" scrolling="no" src="https://www.scribd.com/embeds/413008908/content?start_page=1&view_mode=scroll&show_recommendations=true&access_key=key-t09uKEqUenxjKWdwIOBA" title="Document 3: A draft summary of the subcommittee regarding the results of the Full-Scale Screening of the Thyroid Ultrasound Examination (the second round)" width="100%"></iframe>@YuriHiranumahttp://www.blogger.com/profile/16819451884150838540noreply@blogger.com0tag:blogger.com,1999:blog-9200156515048577812.post-31079831076228898662019-06-02T01:14:00.001-07:002019-09-28T16:49:01.706-07:00Pediatric and Adolescent Thyroid Cancer Data: Fukushima and Beyond<span style="font-family: "trebuchet ms" , sans-serif; font-size: small;"><i>*Table for Latest Data was replaced with a corrected version showing that Age 25 Milestone Examination was conducted in FY2017, not FY2016 as stated in the original version. Also a link was added for the post on the unreported cases. (September 28, 2019)</i></span><br />
<span style="font-family: "trebuchet ms" , sans-serif; font-size: medium;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>Thyroid Ultrasound Examination (TUE)</b></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Eight years have passed since the March 11, 2011 triple disaster of earthquake, tsunami, and nuclear accident in Japan. The Thyroid Ultrasound Examination (TUE) </span><span style="font-family: "trebuchet ms" , sans-serif;">was launched in October 2011 </span><span style="font-family: "trebuchet ms" , sans-serif;">as part of the </span><a href="http://fmu-global.jp/our-activities/health-management-survey/" style="font-family: "trebuchet ms", sans-serif;" target="_blank">Fukushima Health Management Survey</a><span style="font-family: "trebuchet ms" , sans-serif;"> (FHMS), targeting</span><span style="font-family: "trebuchet ms" , sans-serif;"> over 367,000 children who were aged </span><span style="font-family: "trebuchet ms" , sans-serif;">≤</span><span style="font-family: "trebuchet ms" , sans-serif;"> </span><span style="font-family: "trebuchet ms" , sans-serif;">18 and residing in Fukushima Prefecture at the time of the accident. The FHMS was </span><span style="font-family: "trebuchet ms" , sans-serif;">commissioned to Fukushima Medical University (FMU) by Fukushima Prefectural government, </span><span style="font-family: "trebuchet ms" , sans-serif;">with the fund originating in Ministry of Economy, Trade and Industry (METI) which manages nuclear power plants. The fund has been distributed by Ministry of the Environment (MOE) which oversees environmental contamination by toxins such as heavy metal, asbestos, and radiation. Incidentally, involvement of Ministry of Health, Labour and Welfare (MHLW) with radiation exposure issues is limited to nuclear workers (worker's compensation certification and epidemiological studies) and atomic bomb survivors (</span><span style="font-family: "trebuchet ms" , sans-serif;">medical certification)</span><span style="font-family: "trebuchet ms" , sans-serif;">.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> </span><span style="font-family: "trebuchet ms" , sans-serif;">Details of the TUE are described in the </span><a href="https://www.iwanami.co.jp/kagaku/eKagaku_201709_Hiranuma-rev2.pdf" style="font-family: "trebuchet ms", sans-serif;" target="_blank">September 2017 Fact Sheet</a><span style="font-family: "trebuchet ms" , sans-serif;">. T</span><span style="font-family: "trebuchet ms" , sans-serif;">he first-round screening, which was scheduled to run from October 2011 through March 2014, was considered to provide "baseline" prevalence of thyroid cancer </span><span style="font-family: "trebuchet ms" , sans-serif;">in Fukushima children aged 18 or younger</span><span style="font-family: "trebuchet ms" , sans-serif;"> during the </span><span style="font-family: "trebuchet ms" , sans-serif;">"latency period." This was based on the fact that thyroid cancer dramatically increased in young children beginning 4 years after the 1986 Chernobyl accident. The first round was to be conducted through Fiscal Year (FY) 2013, ending in March 2014 with a Japanese FY running from April through the following March, and each subsequent round every two years. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>Time lag and overlapping data</b></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> In reality the primary examination (cursory ultrasound screening) of the first- round screening </span><span style="font-family: "trebuchet ms" , sans-serif;">dragged on for an additional 13 months, overlapping with the first year of the second-round screening. This extended period was likely due to a simple lack of manpower and a large number (> 300,000) of participants. Furthermore, if someone decided to undergo the TUE <i>for the first time</i> during the time the second round screening was going on, they would be included in the first-round cohort as long as they had not received notifications for the second-round screening. (Part of the reason was probably to increase a participation rate, although FMU officials insist they were honoring the "right of residents to participate in the first-round screening.") </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> With the primary examination lagging behind, the confirmatory examination for those who had ultrasound abnormalities also lagged behind, </span><span style="font-family: "trebuchet ms" , sans-serif;">extending way beyond each screening period, with an average wait time of 6 months</span><span style="font-family: "trebuchet ms" , sans-serif;">. After undergoing a </span><span style="font-family: "trebuchet ms" , sans-serif;">more detailed ultrasound examination and blood/urine testing, most confirmatory examination participants were placed on regular, biennial screening cycle, while some who needed more frequent observation were moved to a clinical follow-up track which was no longer part of the TUE as described in the next section. And yet some underwent </span><span style="font-family: "trebuchet ms" , sans-serif;">fine-needle aspiration cytology (</span><span style="font-family: "trebuchet ms" , sans-serif;">FNAC</span><span style="font-family: "trebuchet ms" , sans-serif;">) which eventually </span><span style="font-family: "trebuchet ms" , sans-serif;">detected 116 nodular lesions suspected of thyroid cancer in the first round: </span><span style="font-family: "trebuchet ms" , sans-serif;">an unexpectedly high number. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><span style="font-family: "trebuchet ms" , sans-serif;"> In April 2018 the TUE began its 4th cycle of screening. The TUE data as of December 2018 show that cytologically suspected thyroid cancer was detected in 212 patients, and 169 of them have undergone surgery which confirmed thyroid cancer in 168 and benign nodule in 1. </span></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>Missing data</b></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> We now know that this is far from a complete picture, as the official data released by FMU to the quarterly FHMS Oversight Committee <i>only</i> includes thyroid cancer cases diagnosed <i>directly during</i> the confirmatory examination. As mentioned above, some confirmatory examination participants are placed on a clinical follow-up track for closer observation. Unlike the specially-funded TUE, the follow-up visits are considered regular medical visits, which are covered by the national health insurance. A more private nature of the follow-up visits gives FMU a cover not to release clinical data: the follow-up track has effectively become a "black box." On a rare occasion, a case "pops out" of the black box, as in thyroid cancer diagnosed in a male who was at 4 at the time of the accident (see <a href="https://fukushimavoice-eng2.blogspot.com/2017/03/fukushima-prefecture-and-fukushima.html" target="_blank">this post</a>). </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Moreover, an <a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/278763.pdf" target="_blank">official report</a> has revealed that, as of June 2017, there are 12 thyroid cancer surgeries conducted at the FMU hospital which have never been reported to the Oversight Committee, including 3 cases that never participated in the TUE. (See <a href="https://fukushimavoice-eng2.blogspot.com/2018/07/results-of-survey-on-fukushima-thyroid.html" target="_blank">this post</a> for English translation of the report.) The table shown below reflects these 12 "unreported" cases. </span><span style="font-family: "trebuchet ms" , sans-serif;">Also, FMU has </span><a href="https://fukushimavoice-eng2.blogspot.com/2018/10/fukushima-thyroid-examination-september.html" style="font-family: "trebuchet ms", sans-serif;" target="_blank">admitted</a><span style="font-family: "trebuchet ms" , sans-serif;"> not to have kept track of surgeries conducted at facilities other than the FMU hospital beyond the already known 7 cases from the first round, making the <i>actual</i> number of surgically confirmed cases uncertain. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<br />
<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>Latest Data</b></span><br />
<div class="separator" style="clear: both; text-align: center;">
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<div class="separator" style="clear: both; text-align: center;">
</div>
<span style="font-family: "trebuchet ms" , sans-serif;"><i style="font-family: "trebuchet ms", sans-serif;">(See <a href="https://fukushimavoice-eng2.blogspot.com/2018/07/results-of-survey-on-fukushima-thyroid.html" target="_blank">this post</a> for details of the "unreported" cases.)</i></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<b>
<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">The TUE support program as a source of supplementary information</span></b><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> The TUE support program, as described in <a href="https://fukushimavoice-eng2.blogspot.com/2019/05/implementation-status-of-support.html" target="_blank">this post</a>, is offered by </span><span style="font-family: "trebuchet ms" , sans-serif;">Fukushima Prefecture to </span><span style="font-family: "trebuchet ms" , sans-serif;">offset the out-of-pocket expenses </span><span style="font-family: "trebuchet ms" , sans-serif;">(30% co-payment)</span><span style="font-family: "trebuchet ms" , sans-serif;"> </span><span style="font-family: "trebuchet ms" , sans-serif;">associated with receiving medical care for thyroid nodular lesions suspected to be malignant, </span><i style="font-family: "Trebuchet MS", sans-serif;">in exchange for</i><span style="font-family: "trebuchet ms" , sans-serif;"> clinical information. Eligibility criteria limit benefits to those </span><span style="font-family: "trebuchet ms" , sans-serif;">not receiving any other medical or public assistance, which means</span><span style="font-family: "trebuchet ms" , sans-serif;"> those </span><span style="font-family: "trebuchet ms" , sans-serif;">aged </span><span style="font-family: "trebuchet ms" , sans-serif;">≥</span><span style="font-family: "trebuchet ms" , sans-serif;">18 because those under age 18 receive free medical care in Fukushima Prefecture. At age 18, many residents leave Fukushima Prefecture for schooling and jobs, and the TUE has a very low participation rate for this age group. In addition to clinical information, the TUE support program could supplement the official data with basic data of participants undergoing the TUE and subsequent medical care elsewhere</span><span style="font-family: "trebuchet ms" , sans-serif;">.</span><span style="font-family: "trebuchet ms" , sans-serif;"> However,</span><span style="font-family: "trebuchet ms" , sans-serif;"> very little effort has been made to analyze the collected information to compare</span><span style="font-family: "trebuchet ms" , sans-serif;"> with the FMU data.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> For instance, according to the most recent <a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/320843.pdf" target="_blank">report</a>, the support program disbursed 375 payments to 257 individuals through December 2018, including 95 surgeries for 93 recipients. Pathological diagnoses for these 93 individuals include</span><span style="font-family: "trebuchet ms" , sans-serif;"> </span><span style="font-family: "trebuchet ms" , sans-serif;">87 thyroid cancers (85 papillary, 1 poorly-differentiated, and 1 follicular) and 6 non-cancer cases such as follicular adenoma</span><span style="font-family: "trebuchet ms" , sans-serif;">. Knowing how many of these surgical cases are included in the FMU data would help gain a better grasp of the actual thyroid cancer status.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>Non-transparent data</b></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Besides the "missing data," Fukushima's thyroid cancer data suffers from lack of transparency, hindering third-party analysis and even discussions/interpretations at the Oversight Committee and </span><span style="font-family: "trebuchet ms" , sans-serif;">the Thyroid Examination Assessment Subcommittee (herein, the TUE subcommittee)</span><span style="font-family: "trebuchet ms" , sans-serif;">.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> First, very little clinical information was initially released, confusing and complicating discussions on the high number of cancer cases detected and whether unneeded surgeries were being conducted. When the clinicopathological data on surgical cases was first <a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/90997.pdf" target="_blank">released in November 2014</a> (see <a href="https://fukushimavoice-eng2.blogspot.com/2014/11/details-of-fukushima-thyroid-cancer.html" target="_blank">this post</a> for translation), it was neither specific nor adequate enough to create a more integrated clinical picture for each case. The format remained essentially the same even in the <a href="https://fukushimavoice-eng2.blogspot.com/2016/10/clinicopathological-findings-of.html" target="_blank">"latest" update in September 2016</a>.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Second, t</span><span style="font-family: "trebuchet ms" , sans-serif;">he format in which data is released has actually "devolved." From the third-round screening onward, neither the results nor the implementation status of the confirmatory examination are no longer available by municipality. Instead they are only offered by four "administrative" regions. FMU explains this shift was to avoid potential identification of individual cancer cases particularly in small municipalities, but the shift to provide less detailed data would effectively "shut down" a continued analysis by <a href="https://www.ncbi.nlm.nih.gov/pubmed/26441345" target="_blank">Tsuda et al</a> from Okayama University.</span><br />
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<span style="font-size: large;"><b><span style="font-family: "trebuchet ms" , sans-serif;">Sharing</span><span style="font-family: "trebuchet ms" , sans-serif;"> data</span></b></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> FMU's Radiation Medical Science Center website declares</span><span style="font-family: "trebuchet ms" , sans-serif;"> <a href="http://kenko-kanri.jp/en/" target="_blank">"</a></span><span style="background-color: transparent; font-family: "trebuchet ms" , sans-serif;"><a href="http://kenko-kanri.jp/en/" target="_blank">unshakable resolve to disseminate survey results domestically and internationally."</a> This resolve mostly appears to concern the world of academia, such as journal publications and annual meetings of thyroid and endocrine organizations in Japan and overseas. Time after time, academic presentations have taken precedence over presenting data and its analysis to </span><span style="font-family: "trebuchet ms" , sans-serif;">the Oversight Committee and/or the TUE subcommittee, let alone residents. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> For instance, the September 2016 clinicopathological data (with data compiled as of March 2016) mentioned above was first <a href="http://fmu-global.jp/download/shinichi-suzuki/?wpdmdl=2047" target="_blank">released</a> in English at an <a href="http://fmu-global.jp/workshop/symposium/26-27-sep-2016-5th-intl-expert-symposium-in-fukushima-2/" target="_blank">international symposium</a>. </span><span style="font-family: "trebuchet ms" , sans-serif;">(Note: This blog posted some of the data presented in </span><a href="http://fukushimavoice-eng2.blogspot.com/2016/10/clinicopathological-findings-of.html" style="font-family: "trebuchet ms", sans-serif;" target="_blank">English</a><span style="font-family: "trebuchet ms" , sans-serif;"> and </span><a href="https://fukushimavoice2.blogspot.com/2016/10/201610.html" style="font-family: "trebuchet ms", sans-serif;" target="_blank">Japanese</a><span style="font-family: "trebuchet ms" , sans-serif;"> in October 2016.) </span><span style="font-family: "trebuchet ms" , sans-serif;">This data was not officially released <a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/244314.pdf" target="_blank">in Japanese</a> until November 2017, when the TUE subcommittee resumed after a three-year hiatus with new members. However, by this time, a more updated version of data compiled as of March 2017 had been presented at the Japan Thyroid Association meeting in October 2017. This data was also presented at the American Thyroid Association meeting in October 2018, a</span><span style="font-family: "trebuchet ms" , sans-serif;">s described in </span><a href="https://fukushimavoice-eng2.blogspot.com/2018/10/fukushima-thyroid-examination-september.html" style="font-family: "trebuchet ms", sans-serif;" target="_blank">this post</a><span style="font-family: "trebuchet ms" , sans-serif;"> under "Reluctance on releasing detailed data," but it has <i>yet</i> to be presented to the TUE subcommittee.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Publications in English are beyond the reach of most residents whose very data are presented in them, due to a language barrier and frequent paywalls. Although most are eventually summarized in plain language on the Japanese <a href="http://fukushima-mimamori.jp/publications/" target="_blank">website</a> of the Radiation Medical Science Center for FMU, </span><span style="font-family: "trebuchet ms" , sans-serif;">there is a time lag and definite information gap.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Japanese summaries of selected papers</span><span style="font-family: "trebuchet ms" , sans-serif;"> have been presented to the Oversight Committee or TUE subcommittee meetings. These tend to be in more detail. and papers selected tend to have "favorable" conclusions supporting "absence" of radiation exposure.</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>Second round analysis</b></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> With the first-round screening designated as "baseline screening," data from the second-round screening onward were to be carefully analyzed to assess any effect of radiation exposure. Yet, even now, no "proper" analysis of the second-round data has been conducted </span><span style="font-family: "trebuchet ms" , sans-serif;">when the fourth-round screening is ongoing and the third-round results are about to be finalized. </span><span style="font-family: "trebuchet ms" , sans-serif;">This is mainly because the TUE subcommittee, which was supposed to be conducting such analyses, </span><span style="font-family: "trebuchet ms" , sans-serif;">took a three-year hiatus for unknown reasons</span><span style="font-family: "trebuchet ms" , sans-serif;">. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> When the TUE subcommittee resumed with new members in November 2017, FMU began to submit various "analyses" of the second-round data but they have had limited value because they were uninformative due to insufficient information (i.e., data shown in percentages rather than actual numbers) or unreliable due to unclear methodology (as analyzed by Junichiro Makino in April to June 2019 issues of <i>Kagaku</i>, only available in Japanese).</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>Cancer screening vs. health monitoring</b></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> The English website of FMU's Radiation Health Science Center <a href="http://fmu-global.jp/our-activities/health-management-survey/" target="_blank">states</a> that the primary purpose of the FHMS is to "monitor the long-term health of residents, promote their well-being, and confirm whether long-term, low-dose radiation exposure has health effects." </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Hence the TUE is not considered "cancer screening" in a traditional sense, which measures its effectiveness by reduced mortality. (T</span><span style="font-family: "trebuchet ms" , sans-serif;">hyroid cancer screening in adults is not recommended because screening does not lead to reduced mortality.) </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Rather the TUE is considered "health screening" to monitor health and well-being of residents against a unique backdrop of radiation exposure. However, the TUE is often considered in traditional context of cancer screening, leading to misguided and confusing discussions as described in the next section.</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;"><b><span style="font-size: large;">Overdiagnosis? </span></b></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> The official discourse of the TUE leans towards "overdiagnosis" of thyroid cancer, which implies that these cancers are "quiet" cancers which will never have been <i>clinically</i> found for lifetime without the TUE. However, this discourse is incongruous with clinical data which shows 39.2% extrathyroidal spread, 77.6% regional (lymph node) and 2.4% distant (lung) metastasis. As "health screening," the TUE is leading to early diagnosis and treatment of thyroid cancer, requiring less aggressive surgery and treatment and maintaining decent QOL.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Yet some Oversight Committee and TUE subcommittee members insist that detection of these cancer cases could have waited until becoming symptomatic instead of being detected by screening, because the existing literature show that the survival rate of thyroid cancer in children is very high even with lymph node metastasis. However this claim should be examined cautiously. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Pediatric thyroid cancer is rare, and most of the existing studies on survival rates are from outside Japan. Clinical management strategies of pediatric and adolescent thyroid cancer in Japan do not necessarily follow those recommended in the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4854274/" target="_blank">2015 ATA pediatric guidelines</a>. In Japan, a more conservative surgical method, hemithyroidectomy, has been used partially because of limited availability of radioiodine treatment. Also in Japan lymph node dissection is conducted more frequently and extensively. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> On the other hand, clinical management strategies in other countries gear towards total thyroidectomy with limited lymph node dissection, often followed by radioiodine treatment that kills any remaining cancer cells. This might lead to a high survival rate, but it is not without any side effect and/or complications which might lower QOL.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> It is impossible to know what would have happened to the Fukushima cases without surgery. For record, surgery <i>was</i> <i>indicated</i> for the vast majority of them. It is certainly inappropriate to extrapolate findings from different treatment approaches in order to negate the necessity of the TUE. </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>Difficult comparison of data</b></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Interpretation of the Fukushima data is difficult due to the absence of comparative data in Japan. The MOE sponsored three-prefecture study conducted in supposedly non-exposed Aomori, Yamanashi, and Nagasaki Prefectures does not offer a valid comparison due to non-matched cohort and lack of statistical power. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> A straight comparison between Fukushima data and other existing data is even more difficult. One of the reasons is lack of other large-scale screening data in this age group in populations with a similar iodine status. Another reason, previously described, is a </span><span style="font-family: "trebuchet ms" , sans-serif;">difference in surgical methods and treatment approaches which complicates comparison of metastatic rates.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Regarding extrathyroidal extension or invasion, Japan has its own classification, "Ex." So far all Fukushima cases have been classified as "Ex1" meaning minimal extension and corresponding to "T3" in the </span><span style="font-family: "trebuchet ms" , sans-serif;">TNM classification (in the </span><span style="font-family: "trebuchet ms" , sans-serif;">previous 7th edition of AJCC/TNM staging system). Other data such as a </span><a href="https://ec.bioscientifica.com/view/journals/ec/aop/ec-19-0069.xml" style="font-family: "trebuchet ms", sans-serif;" target="_blank">recent study from Czech Republic</a><span style="font-family: "trebuchet ms" , sans-serif;"> do not always specify degree of extension, not keeping T3 and more extensive T4 (= "Ex2") separate. </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">Addendum on June 7, 2019:</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> The 1998 study by Nagasaki University, <a href="https://www.ncbi.nlm.nih.gov/pubmed/9700473/" target="_blank">"Childhood thyroid cancer: comparison of Japan and Belarus,"</a> including Yamashita and late Nagataki as co-authors, offers some data in pediatric thyroid cancer which were diagnosed clinically </span><span style="font-family: "trebuchet ms" , sans-serif;">in Japan</span><span style="font-family: "trebuchet ms" , sans-serif;">. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> As seen below, in the Japanese clinical cases, mean age at operation was 11.9 ± 1.9 years (</span><span style="font-family: "trebuchet ms" , sans-serif;">17.8 ± 3.1 years in Fukushima</span><span style="font-family: "trebuchet ms" , sans-serif;">) and mean tumor size was 41 ± 17 mm (</span><span style="font-family: "trebuchet ms" , sans-serif;">14.0 ± 8.5 mm in Fukushima</span><span style="font-family: "trebuchet ms" , sans-serif;">). Regional lymph node metastasis was found in 73% (77.6% in Fukushima), pulmonary metastasis in 19% (2.4% in Fukushima), and extrathyroidal extension in 35% (39.2% in Fukushima). (Fukushima data can be seen <a href="http://fmu-global.jp/download/shinichi-suzuki/?wpdmdl=2047" target="_blank">here</a>.)</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTyfTvsEjNGlqlTKCiw1BvcpJ-dCJ_t3TyTAZYTpky5aS6ZTBDnLObu-BCyWpS-RlL7CwhnMOAelb-cgLlzwFSO4aBfphW6_LbMWkurXqtmAHWVC3YtdW348n4yBkMgHKjZe-7jMe57g9_/s1600/Screen+Shot+2019-06-07+at+6.35.34+PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="385" data-original-width="486" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTyfTvsEjNGlqlTKCiw1BvcpJ-dCJ_t3TyTAZYTpky5aS6ZTBDnLObu-BCyWpS-RlL7CwhnMOAelb-cgLlzwFSO4aBfphW6_LbMWkurXqtmAHWVC3YtdW348n4yBkMgHKjZe-7jMe57g9_/s1600/Screen+Shot+2019-06-07+at+6.35.34+PM.png" /></a></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"><b><span style="font-size: large;">Updated staging system</span></b></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Complicating the picture even more, the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5467103/" target="_blank">2017 update to the 8th edition of the AJCC/TNM staging system</a> no longer includes lymph node metastasis in T3 or considers minimal, microscopic extension in staging, potentially leading to </span><span style="font-family: "trebuchet ms" , sans-serif;"><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6153343/" target="_blank">downstaging</a>. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Thyroid cancer in age < 55 never exceeds stage 2 by the current staging system. However, for children and adolescents, there is no single staging system that is appropriate as stated in the aforementioned <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4854274/" target="_blank">ATA pediatric guidelines</a>. Furthermore, a disparity in classifying extrathyroidal extension between the Japanese Ex system and the 8th edition of AJCC/TNM could lead to difficulty in discerning the Fukushima data.</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;"><b><span style="font-size: large;">Valuable but deceitful data</span></b></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Because ultrasound screening for thyroid cancer is not commonly conducted in children and adolescents, the TUE data from Fukushima has been welcomed as a valuable source of epidemiological data for lesions such as <a href="https://academic.oup.com/jcem/article/103/3/861/4630428" target="_blank">thyroid nodules (benign and malignant) and cysts </a>as well as <a href="https://www.ncbi.nlm.nih.gov/pubmed/25778711" target="_blank">ectopic intrathyroidal thymus</a>.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> One cannot fault those embracing the Fukushima data for not being aware of the fact that the data is ladened with incompleteness and lack of transparency. After all, the data comes from FMU, supposedly an authoritative source, so what is there to doubt about? </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> It takes more than careful discernment, namely Japanese language skills, to identify inconsistencies or inadequacies in the information released by FMU, even in peer-reviewed journals. In fact, most of the studies published by FMU, including some published collaboratively with other institutions such as Nagasaki University, tend to be biased, as explained later.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Publishing studies with incomplete dataset </span><span style="font-family: "trebuchet ms" , sans-serif;">should be scientifically unacceptable.</span><span style="font-family: "trebuchet ms" , sans-serif;"> But that is what's happening with the TUE papers, and there has never been official disclosure of missing data </span><i style="font-family: "trebuchet ms", sans-serif;">in English</i><span style="font-family: "trebuchet ms" , sans-serif;">. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> </span><br />
<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>Inconsistent data</b></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> It's not just that data is missing but sometimes data presented is inconsistent. One such example is a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5770131/" target="_blank">2018 paper</a> published in <i>Thyroid</i> by Yamashita et al, which is the most recent "comprehensive" TUE paper at this time. It is stated in this paper, "Out of 146 surgical cases, 126 patients underwent surgery at Fukushima Medical University Hospital, and 125 were postoperatively diagnosed with thyroid cancer," which suggests there are 20 patients that underwent surgery at facilities other than FMU. That's not the case.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> The number of surgical cases, 146, is from data as of December 2016, while the number of patients undergoing surgery at FMU, 126, is from data as of March 2016 when there were 132 surgical cases. Of 126, one was postoperatively diagnosed as benign nodule, leaving 125 with thyroid cancer. The <i>known</i> number of patients undergoing surgery at facilities other than FMU is and remains 7, as mentioned in "Missing data" section, which means 139 of 146 surgical cases would have been diagnosed with thyroid cancer after undergoing surgery at FMU. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Also Table 2 shows the total number of cases suspected of thyroid cancer for the first through third rounds, 191, which is from data </span><span style="font-family: "trebuchet ms" , sans-serif;">as of March 2017 when the number of surgical cases was 153 (including one benign case). All these numbers are so confusing that most readers will not have any idea that<span style="background-color: transparent;"> the data pres</span>ented in the most recent TUE paper is inconsistent and partially outdated. And certainly the way the surgical data is presented does not suggest how outdated it might be.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> The Yamashita paper, like other FMU papers by <a href="https://www.clinicaloncologyonline.net/article/S0936-6555%2816%2900002-9/fulltext" target="_blank">Suzuki (2016)</a> and <a href="https://www.liebertpub.com/doi/abs/10.1089/thy.2015.0564?rfr_dat=cr_pub%3Dpubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&journalCode=thy" target="_blank">Suzuki et al (2016)</a>, gives an impression that the "baseline" actually covers the first 4 years after the accident, not the first 3 years when the first-round screening was conducted, obscuring the line between the first and second rounds. In reality, the line did become fuzzy<i> </i></span><span style="font-family: "trebuchet ms" , sans-serif;">during the fourth post-accident year </span><span style="font-family: "trebuchet ms" , sans-serif;">when the first and second rounds went on simultaneously with some new cases still being added to the first round, but that should not lead to an altered baseline. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> This arbitrary shift of baseline is accompanied by dismissal of radiation effects based on comparison with Chernobyl (no cancer case in age </span><span style="font-family: "trebuchet ms" , sans-serif;">≤</span><span style="font-family: "trebuchet ms" , sans-serif;"> 5, lower radiation doses) and claim of no regional difference (i.e., dose-response). The latter, absence of regional differences, has solely been based on analyses </span><span style="font-family: "trebuchet ms" , sans-serif;">of the first-round data only </span><span style="font-family: "trebuchet ms" , sans-serif;">by Ohira et al (<a href="https://www.ncbi.nlm.nih.gov/pubmed/27583855" target="_blank">2016</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/29634592" target="_blank">2018</a>)</span><span style="font-family: "trebuchet ms" , sans-serif;">,</span><span style="font-family: "trebuchet ms" , sans-serif;"> </span><span style="font-family: "trebuchet ms" , sans-serif;">with questionable classification of municipalities into dose groups not necessarily reflecting actual doses. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> <span style="background-color: transparent;">In addition,</span> </span><span style="font-family: "trebuchet ms" , sans-serif;">due to insufficient internal dose data, </span><span style="font-family: "trebuchet ms" , sans-serif;">the analyses were conducted with external doses which are not as relevant. These external dose estimates are derived from the <a href="http://fmu-global.jp/download/basic-survey-19/?wpdmdl=2585" target="_blank">Basic Survey</a> portion of the FHMS, with only a quarter of the residents returning the individual questionnaire used in estimating doses. Dose estimation by nature is accompanied by large uncertainties, which are further exacerbated by recall bias inherent in a questionnaire-based survey.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Thus the TUE papers by FMU have consistently clouded the picture by obscuring the baseline boundary and prematurely dismissing radiation effects <i>even before</i> the second-round data is properly analyzed. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><b><span style="font-size: large;">Misrepresented data</span></b> </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Then, FMU went one step further by shifting the baseline to 5 years. </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;"> On November 29, 2018, <a href="https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2716821?resultClick=1" target="_blank">another FMU paper</a> was published </span><span style="font-family: "trebuchet ms" , sans-serif;">by </span><span style="font-family: "trebuchet ms" , sans-serif;">Ohtsuru et al </span><span style="font-family: "trebuchet ms" , sans-serif;">in <i>JAMA Otolaryngology-Head & Neck Surgery</i>,</span><span style="font-family: "trebuchet ms" , sans-serif;"> evaluating the number of thyroid cancer cases by age groups within 5 years of the Fukushima accident. </span><span style="font-family: "trebuchet ms" , sans-serif;">C</span><span style="font-family: "trebuchet ms" , sans-serif;">omparing basic clinical characteristics and demographic patterns in the first and second rounds, the </span><span style="font-family: "trebuchet ms" , sans-serif;"><a href="https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2716821?resultClick=1" target="_blank">Ohtsuru study</a> claims</span><span style="font-family: "trebuchet ms" , sans-serif;"> similarities between the two rounds with no major changes in overall characteristics within 5 years, suggesting that </span><span style="font-family: "trebuchet ms" , sans-serif;">the first 2 rounds simply uncovered a "subclinical pool of thyroid cancer" in children and adolescents and implying that the first 5 years after the accident constitute a <i>de facto</i> baseline.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Unbelievably, even before the second-round data is <i>properly analyzed </i>to examine any potential effects of radiation exposure, thyroid cancer cases detected during the second round are clumped together with cases from the first round to constitute a "subclinical pool of thyroid cancer," previously unknown in children and adolescents.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Although it is likely for s</span><span style="font-family: "trebuchet ms" , sans-serif;">ome of them to be subclinical cancers </span><span style="font-family: "trebuchet ms" , sans-serif;">whose growth might have been promoted by radiation exposure, </span><span style="font-family: "trebuchet ms" , sans-serif;">there really is no way to know which ones. Of 125 surgical cases, 5 turned out to be microcarcinoma (< 10 mm) with no extrathyroidal extension or metastasis (lymph node or distant). Lack of more relevant clinical information does not allow any further scrutiny. This is also a delicate subject: calling only some of the detected cancers subclinical is divisive, giving rise to a sense of inequality especially involving any future potential compensation.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> It is unscientific to collectively designate <i>all</i> thyroid cancers detected during the first and second rounds as "subclinical cancer." But it</span><span style="font-family: "trebuchet ms" , sans-serif;"> happens to nicely explain away why 58 of 71 thyroid cancer cases detected in the second round had no ultrasound findings in the first round: subclinical cancers only became "detectable" with time.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Ohtsuru et al. back up this claim of a "subclinical pool of thyroid cancer" with essentially 3 things</span><span style="font-family: "trebuchet ms" , sans-serif;">: autopsy data and two FMU studies by </span><a href="https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2663380" style="font-family: "trebuchet ms", sans-serif;" target="_blank">Midorikawa et al (2017) </a><span style="font-family: "trebuchet ms" , sans-serif;">and </span><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5728738/" style="font-family: "trebuchet ms", sans-serif;" target="_blank">Takahashi et al (2017)</a><span style="font-family: "trebuchet ms" , sans-serif;">. As these 3 elements play an important role to support the claim of "overdiagnosis of subclinical cancer" in Fukushima, each is reviewed in detail below.</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>1) Autopsy data</b></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> <a href="https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2716821?resultClick=1" target="_blank">Ohtsuru et al</a> state, "many more thyroid papillary cancers are observed in autopsies among people who are relatively young than among those in cancer registries," citing two papers, a <a href="https://ascopubs.org/doi/full/10.1200/JCO.2016.67.7419?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed" target="_blank">2016 meta-analysis</a> and a <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/1097-0142(19840415)53%3A8%3C1790%3A%3AAID-CNCR2820530831%3E3.0.CO%3B2-9" target="_blank">1984 Swedish study</a>. What is meant by "relatively young" is vague here. Fukushima's thyroid cancer cases have been detected in ages up to 25 so far. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> In the meta-analysis, there is one study with median age of 16 with 13 thyroid cancer cases. However, </span><span style="font-family: "trebuchet ms" , sans-serif;">in this <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/1097-0142(19860801)58%3A3%3C715%3A%3AAID-CNCR2820580319%3E3.0.CO%3B2-P" target="_blank">1986 Finland study</a> </span><span style="font-family: "trebuchet ms" , sans-serif;">by Franssila and Harach based on autopsies conducted on 93 cases (age < 40), </span><span style="font-family: "trebuchet ms" , sans-serif;">only 3 of 13 thyroid cancers were detected in ages 11–20</span><span style="font-family: "trebuchet ms" , sans-serif;"> (n = 22) with the youngest being age 18. No cancer was found in age < 1 (n = 15) or ages 1–10 (n = 21), while 4 cases with unspecified age were detected in ages 21–30 (n = 18). </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> The 1984 Sweden study by Bondeson and Ljungberg, also included in the meta-analysis, conducted autopsy on 430 patients (ages 11–100) showing 2 cancer cases (both age 17) in ages 11–20 (n = 12) and 1 case (age 21) in ages 21–30 (n = 50). </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> The Finland study goes so far as to say, "Although OPC (occult papillary cancer) seems to be rare in children, its prevalence in young adults after age 18 years is the same order as in older age groups, although there may be a slight rise in prevalence at middle age." </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> In Fukushima, about half of those with nodules suspicious of cancer are age <18 (at diagnosis) overall, but the proportion of age < 18 increases with subsequent rounds: 43% in the first round, 55% in the second round, and 57% in the third round. Although autopsy data might suggest presence of subclinical thyroid cancer in the age ≥ 18 (or age </span><span style="font-family: "trebuchet ms" , sans-serif;">≥ 17 considering the Swedish study) </span><span style="font-family: "trebuchet ms" , sans-serif;">group, it certainly could not designate all the Fukushima cases in that age group or other age groups as "subclinical" without consideration of clinicopathological characteristics of individual cases.</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">Addendum on June 7, 2019:</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> The 1986 Finland study is cited in "<a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/%28SICI%291097-0215%2819960103%2965%3A1%3C29%3A%3AAID-IJC6%3E3.0.CO%3B2-3?sid=nlm%3Apubmed" target="_blank">Histopathological characteristics of pediatric thyroid cancer in Gomel, Belarus"</a> by Ito et al (1996) as evidence that "occult thyroid carcinoma is observed rarely at autopsy in adolescents." This is the <i>opposite</i> of how the Finland is study is cited by FMU, an interesting fact especially because co-authors of the 1996 study </span><span style="font-family: "trebuchet ms" , sans-serif;">include Yamashita and late Nagataki, key players after the Fukushima accident. </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>2) The Midorikawa study</b></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> In the TUE, all participate in the primary examination with cursory ultrasound screening, and only those with nodules </span><span style="font-family: "trebuchet ms" , sans-serif;">≥ 5.1 mm or cysts </span><span style="font-family: "trebuchet ms" , sans-serif;">≥ 20.1 mm undergo the confirmatory examination with a more detailed ultrasound examination as well as urine and blood tests.</span><span style="font-family: "trebuchet ms" , sans-serif;"> </span><a href="https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2663380" style="font-family: "trebuchet ms", sans-serif;" target="_blank">Midorikawa et al</a><span style="font-family: "trebuchet ms" , sans-serif;"> compared two ultrasound measurements from the primary and confirmatory examinations in 116 thyroid nodules suspected of cancer in the first round, classifying them into 3 groups according to changes in tumor diameter (less than - 10%, ± 10%, greater than + 10%). </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> As a result, 7 cases with an average diameter of 12.1 </span><span style="font-family: "trebuchet ms" , sans-serif;">± 5.2 m</span><span style="font-family: "trebuchet ms" , sans-serif;">m showed an average of 16.5 </span><span style="font-family: "trebuchet ms" , sans-serif;">± 4.8</span><span style="font-family: "trebuchet ms" , sans-serif;">% reduction in size, 81 with an average diameter of 13.9 </span><span style="font-family: "trebuchet ms" , sans-serif;">± 8.5 m</span><span style="font-family: "trebuchet ms" , sans-serif;">m showed an average of 1.7 </span><span style="font-family: "trebuchet ms" , sans-serif;">± 5.5</span><span style="font-family: "trebuchet ms" , sans-serif;">% increase in size, and remaining 28 with an average diameter of 12.8 </span><span style="font-family: "trebuchet ms" , sans-serif;">± 7.9 mm</span><span style="font-family: "trebuchet ms" , sans-serif;"> showed an average of 24.1 </span><span style="font-family: "trebuchet ms" , sans-serif;">± 24.9</span><span style="font-family: "trebuchet ms" , sans-serif;">% increase in size.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Midorikawa et al also used mathematical models to evaluate the tumor growth rate, concluding that a tumor with a diameter of 5 mm would reach a growth arrest point in 8.0 (range 5.1-17.6) years. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> In Discussion, the authors state that many of thyroid cancers in the first round "did not grow linearly and instead entered growth arrest, even in young patients. </span><span style="font-family: "trebuchet ms" , sans-serif;">Furthermore, the mean duration during which the tumor grew from a diameter of 5 mm to the growth arrest point was 8.0 years."</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> There are two issues with this statement. First, the average observation period of barely 6 months is rather short to declare the cancers "entered growth arrest." Second, the statement is written as if the growth arrest point was actually "observed." This is misleading because the growth arrest point is based on simulation.</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;"> There are other issues in this study, such as questionable methodology. </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;"> A criterion of "10%" was selected because </span><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4435986/" style="font-family: "trebuchet ms", sans-serif;" target="_blank">Choi et al</a><span style="font-family: "trebuchet ms" , sans-serif;"> suggest, </span><span style="font-family: "trebuchet ms" , sans-serif;">"Any differences smaller than 13.1% and 7.3% in volume and maximum diameter, respectively, measured by using US for well-defined thyroid nodules of > 1 cm should not be considered as a real change in size."</span><span style="font-family: "trebuchet ms" , sans-serif;"> <a href="https://www.sciencedirect.com/science/article/pii/S0936655516000029#bib22" target="_blank">U</a></span><span style="font-family: "trebuchet ms" , sans-serif;"><a href="https://www.sciencedirect.com/science/article/pii/S0936655516000029#bib22" target="_blank">ltrasound diagnostic criteria</a> for malignant nodules include irregular shape and ill-defined edge with jagged border, and </span><span style="font-family: "trebuchet ms" , sans-serif;"><a href="https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2716821?resultClick=1" target="_blank">Ohtsuru et al</a> have shown in Table 1 that 55 of 116 cancer cases </span><span style="font-family: "trebuchet ms" , sans-serif;">In the first round </span><span style="font-family: "trebuchet ms" , sans-serif;">had tumor diameter of 5.0–1.0 mm. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> </span><span style="font-family: "trebuchet ms" , sans-serif;">As </span><span style="font-family: "trebuchet ms" , sans-serif;">addressed by the authors, </span><span style="font-family: "trebuchet ms" , sans-serif;">changes in a tumor diameter do not accurately reflect changes in tumor volume or tumor cell proliferation. It is curious why the authors did not use the actual tumor volume and heed the caution from <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4435986/" target="_blank">Choi et al</a> not to rely on volume change of smaller than 13.1%, especially when half the authors were involved in a <a href="https://www.jstage.jst.go.jp/article/endocrj/62/3/62_EJ14-0478/_article" target="_blank">2015 study</a> that actually determined thyroid volume based on the elliptical shape volume formula. </span><span style="font-family: "trebuchet ms" , sans-serif;"> </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Further, unlike the authors' suggestion, </span><span style="font-family: "trebuchet ms" , sans-serif;">changes </span><span style="font-family: "trebuchet ms" , sans-serif;">in tumor diameter alone are clearly not adequate in determining a treatment course, considering most of these cases actually had <i>valid indications for surgery</i>. L</span><span style="font-family: "trebuchet ms" , sans-serif;">inking the observed changes with clinical behaviors of each tumor, when available, would have been much more informative. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Last but not the least, this study offers an excuse <i>not to look for tumor that is going to stop growing anyway</i>, a good news to </span><span style="font-family: "trebuchet ms" , sans-serif;">Midorikawa who is known to <a href="http://fmu-global.jp/2016/06/30/article-of-the-fukushima-minyu-shimbun%e3%80%80%E3%80%90wednesday-june-15-2016%E3%80%91/" target="_blank">actively discourage</a> participation in the TUE in order to reduce a psychological burden. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> </span><br />
<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>3) The Takahashi study</b></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> In the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5728738/" target="_blank">Takahashi study</a>, a cancer progression model was formulated under the assumption of no radiation exposure, and the number of pediatric and adolescent thyroid cancer cases that would have been detected in Fukushima was estimated based on </span><span style="font-family: "trebuchet ms" , sans-serif;">the national cancer registry (NCR) data with a </span><span style="font-family: "trebuchet ms" , sans-serif;">sensitivity simulation. </span><span style="font-family: "trebuchet ms" , sans-serif;"> </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> In other words, the study estimated how many thyroid cancer cases would have been diagnosed by the TUE in Fukushima if radiation exposure had never occurred. It concluded that suspected thyroid cancer cases detected in 77 females and 39 males during the first round fell within 95% confidence interval of the estimates derived from the model. (Translation: There was a 95% chance that the same number of cancer cases would have been detected from the TUE without the accident, a finding that essentially dismisses radiation effects on the first round results.)</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;"> The <a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/250459.pdf" target="_blank">Japanese summary</a> presented to the 8th TUE subcommittee (held on January 26, 2018) states, "(...) parameters for the model were estimated so that the estimated prevalence matches values from the national cancer registry. As a result, latency was estimated to be 34 years for male and 30 years for female (...)." </span><span style="font-family: "trebuchet ms" , sans-serif;">This statement suggests that Takahashi et al found just the right parameter values so that the estimated prevalence would match the first round results 95% of the time. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> The latency (called "sojourn time" in the study) of 34 years for males and 30 years for females means that the cancers would not have become clinically apparent for 30-34 years without the TUE. The authors appear to equate latency with age, assuming latent cancer already exists in infancy, which is a scientifically unfounded assumption claimed by some researchers, most notably <a href="http://www.med.osaka-u.ac.jp/pub/labo/www/CRT/CRT%20Home.html" target="_blank">Toru Takano</a> of Osaka University. (Note: Takano is a controversial figure who <i>happens to be</i> the only dual member of the Committee and TUE subcommittee upon recommendations by the Japan Thyroid Association.) </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;"> A sensitivity simulation was conducted in order to overcome 3 difficulties encountered when directly comparing the TUE data with the NCR data: 1) different index (prevalence proportion in the TUE vs. incidence rate in the NCR), 2) method of detection (mass screening in age 0-18 in the TUE vs. routine detection in clinical settings in all ages in the NCR), and 3) unknown sensitivity in the TUE. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> However, accuracy of the <a href="https://academic.oup.com/jjco/article/45/9/884/900441" target="_blank">NCR data</a> itself is in question with a poor reporting quality with the overall DCO (Death Certificate Only) rate of 13.4% (should be < 10% according to the international standard). Also, cancer registry in Japan only became mandated in 2016, and the <a href="https://academic.oup.com/jjco/article/45/9/884/900441" target="_blank">2009 NCR data</a> used by Takahashi et al. is much lower in quality than the TUE data. In addition, detection method was unknown in a little over 80% of thyroid cancer in the NCR.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Poor accuracy and unknown sensitivity of the NCR data question validity of </span><span style="font-family: "trebuchet ms" , sans-serif;">the authors' statement, “In this research, we only used published NCR data, and we built a radiation-free model, which is applicable in any region in Japan.”</span><span style="font-family: "trebuchet ms" , sans-serif;"> </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>Endorsing the Ohtsuru study</b></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> The Ohtsuru study has essentially <i>shifted</i> the baseline period from 3 to 5 years, based on a claim that the cases detected in the first and second rounds constitute </span><span style="font-family: "trebuchet ms" , sans-serif;">a "subclinical pool of thyroid cancer." A careful review of the "supporting evidence" proves that this is an unfounded claim. Yet the claim gains <i>seemingly legitimate</i> support in <a href="https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2716818" target="_blank">Invited Commentary</a> accompanying the Ohtsuru study, co-authored </span><span style="font-family: "trebuchet ms" , sans-serif;">by Bauer and Davies who were </span><a href="http://tmnuc.iarc.fr/en/TmnucMembers" style="font-family: "trebuchet ms", sans-serif;" target="_blank">members</a><span style="font-family: "trebuchet ms" , sans-serif;"> of </span><a href="http://tmnuc.iarc.fr/" style="font-family: "trebuchet ms", sans-serif;" target="_blank">TM-NUC</a><span style="font-family: "trebuchet ms" , sans-serif;">, an IARC international expert group on thyroid monitoring after nuclear accidents. (See <a href="https://fukushimavoice-eng2.blogspot.com/2017/11/circumstances-regarding-japan-sponsored.html" target="_blank">this post</a> for more details on TM-NUC.)</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Not only do Bauer and Davies erroneously acknowledge that the TUE data from the first 5 years after the accident represents "background rates of cancer," but they also <i>praise</i> Ohtsuru et al for "doing an excellent job" explaining why those Fukushima cases are </span><span style="font-family: "trebuchet ms" , sans-serif;">"prevalent (subclinical, asymptomatic) disease</span><span style="font-family: "trebuchet ms" , sans-serif;">." Proceeding to highlight two points addressed by Ohtsuru et al, latency and molecular signature, </span><span style="font-family: "trebuchet ms" , sans-serif;">Bauer and Davies</span><span style="font-family: "trebuchet ms" , sans-serif;"> do an excellent job of self-revealing their lack of knowledge in radiation-induced thyroid cancer in children, which is alarming considering they <i>are</i> the expert members on TM-NUC. </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;"> After acknowledging that latency for radiation-induced pediatric thyroid cancer was 3-5 years after Chernobyl, Bauer and Davies propose that latency is longer </span><span style="font-family: "trebuchet ms" , sans-serif;">among iodine-sufficient people </span><span style="font-family: "trebuchet ms" , sans-serif;">at 5 to 10 years, citing <a href="https://www.unscear.org/docs/publications/2006/UNSCEAR_2006_Annex-A-CORR.pdf" target="_blank">Annex A </a>of the UNSCEAR 2016 report. They conclude that Japan is an iodine-rich country and hence latency for Japanese people is longer at 5 to 10 years, "</span><span style="font-family: "trebuchet ms" , sans-serif;">which is longer than the </span><span style="font-family: "trebuchet ms" , sans-serif;">2-year and 4-year post-accident time frame in which these base</span><span style="font-family: "trebuchet ms" , sans-serif;">line </span><span style="font-family: "trebuchet ms" , sans-serif;">measures were obtained."</span><span style="font-family: "trebuchet ms" , sans-serif;"> </span><span style="font-family: "trebuchet ms" , sans-serif;">(Notice they get the time frame wrong here: It should be "the 3-year and 5-year post-accident time frame.") This effectively gives the scientific-sounding backing to the arbitrary shift of baseline in the Ohtsuru study.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> There are several issues with this claim. First, even though a traditional Japanese diet includes high-iodine foods, not all Japanese people at present time are iodine-sufficient owing to modern diet and life style, as shown in a <a href="https://www.liebertpub.com/doi/10.1089/thy.2016.0313" target="_blank">urinary iodine study</a> and acknowledged in <a href="http://www.journalrcr.org/article.asp?issn=2588-9273;year=2019;volume=10;issue=1;spage=79;epage=80;aulast=Reiners" target="_blank">comments by other TM-NUC members</a>. Second, there is <i>no</i> evidence for longer latency for iodine-sufficient people in UNSCEAR 2016 Annex A. An email inquiry to Davies, corresponding author, revealed that evidence would be found in the Life Span Study (LSS) of the atomic bomb survivors. However, nothing of the sort was found in the LSS papers. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> The truth is that the LSS does <i>not</i> offer a good basis for latency for thyroid cancer because the tumor registry was <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/ijc.27749" target="_blank">not established until 1958</a>. (To be exact, <a href="http://xn--19571958-vn3d/" target="_blank">1957 in Hiroshima and 1958 in Nagasaki</a>.) In other words, there isn't good data on any cancer in the first 12-13 years after the atomic bombs were dropped, and the LSS data does not offer evidence for latency of 5 to 10 years. Also, Atomic Bomb Casualty Commission (ABCC), now Radiation Effects Research Foundation (RERF) was initially alerted to leukemia, not thyroid cancer.</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;"> Next, Bauer and Davies note a higher incidence of <i>BRAF</i> point mutation and fewer cases with <i>RET/PTC</i> gene rearrangement in Fukushima than in Chernobyl. As stated in a title of <a href="https://www.nature.com/articles/srep16976" target="_blank">the cited study</a>, this is a "different oncogenic profile from Chernobyl," seemingly validating FMU's claim that Fukushima cases are not radiation-induced.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> However, as Gerry Thomas writes in Chapter 12 of <i><a href="https://www.researchgate.net/publication/316144143_Chapter_6_Clinical_Aspects_of_Pediatric_Thyroid_Cancer_and_Follow-Up_of_Patients_in_Belarus_Following_the_Chernobyl_Accident/download" target="_blank">Thyroid Cancer and Nuclear Accidents</a>,</i> it is now known that "<i>RET</i> rearrangement and <i>BRAF</i> mutation are not related to exposure to radiation, but show a strong association with age of the patient at operation." Thus a "different oncogenic profile from Chernobyl" is nothing more than a reflection of a "different age profile in Fukushima."</span><br />
<br />
<span style="font-family: "trebuchet ms" , sans-serif;"> To be fair, Bauer is a pediatric endocrinologist and Davies is an ENT surgeon who may not necessarily be well-versed in the subject of radiation and thyroid cancer after nuclear accidents, at least not beyond what was learned as TM-NUC members. It does not help that FMU seems to do everything possible to obfuscate the situation by publishing studies after studies with arbitrary data and study design while withholding critical data from the public as well as third-party researchers.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Even then, lack of discernment exhibited by Bauer and Davies is concerning. Most of all, their endorsement of the first 5 years as baseline, backing it up with an unfounded claim of "longer latency in iodine-sufficient people," is frankly misleading and alarming. </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;"> Then the plot thickens.</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;"><b><span style="font-size: large;">Beyond Fukushima</span></b></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;">On April 23, 2019, a <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/cncr.32125" target="_blank">study</a> by Bernier et al was published in <i>Cancer</i>, showing that pediatric thyroid cancer in the US increased 4.43% annually from 1998 to 2013, and that this was not just because of increased surveillance but a "true increase." The Bernier study had actually been submitted on February 20, 2018 and accepted on May 8, 2018. When finally published a year later, it was accompanied by two editorial comments, one of which was <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/cncr.32124" target="_blank">co-authored by Chen and Davies</a>. Aside from being an ENT surgeon, Davies is an overdiagnosis expert, who has done <a href="http://10.0.3.233/jamaoto.2017.0502" target="_blank">contract work related to overdiagnosis for the US Preventative Health Task Force</a> (as per Davies's COI disclosure in the editorial comment) and co-authored multiple papers with Welch who is well known for his overdiagnosis theory. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> The editorial comment was submitted on July 22, 2018 and accepted on December 19, 2018 while Davies was actively involved with TM-NUC. Apparently taking a full advantage of Davies's newly acquired knowledge about the Fukushima data, Chen and Davies refute Bernier et al for reporting that there is no reservoir of clinically silent cancers in the pediatric population. They state,</span><br />
<blockquote class="tr_bq">
<span style="font-family: "trebuchet ms" , sans-serif;">Because the radiation exposure was so low, the cancers were found so soon after the accident, and the growth patterns suggested the identified cancers actually were falling into an arrest pattern, it now is believed that the “high prevalence of childhood thyroid cancer detected in this four year study in Fukushima can be attributed to mass screening. </span><span style="font-family: "trebuchet ms" , sans-serif;">The work from Fukushima strongly refutes the premise that there is not a reservoir of clinically silent cancers in the pediatric population. </span></blockquote>
<span style="font-family: "trebuchet ms" , sans-serif;">The reference to "the identified cancers actually were falling into an arrest pattern" obviously comes from the Midorikawa study which was available when the comment was written. This editorial comment was written before the Ohtsuru study was published, hence the reference to "this four year study in Fukushima," which is inaccurate but consistent with the cited studies as explained in section "Inconsistent data."</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Overall, Chen and Davies strongly point to overdiagnosis as a cause of the increase in pediatric thyroid cancer in the United States.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;"> What is curious is the publishing timeline of the Bernier paper. Why was it held up for nearly a year before actually getting published? Timeline of the accompanying editorial comments might give us a clue. The Bernier paper was received on February 20, 2018, revised on April 9, 2018, and accepted on May 8, 2018. The Chen and Davies comment was received on July 22, 2018 and accepted on December 19, 2018. The <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/cncr.32123" target="_blank">other comment by Goldenberg</a>, an ENT surgeon, was received on November 1, 2018 and revised and accepted on March 19, 2019. Then all three were published on April 23, 2019.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Countering the comment by Chen and Davies, t</span><span style="font-family: "trebuchet ms" , sans-serif;">he Goldenberg comment</span><span style="font-family: "trebuchet ms" , sans-serif;"> encourages investigation into "whether</span><span style="font-family: "trebuchet ms" , sans-serif;"> changes i</span><span style="font-family: "trebuchet ms" , sans-serif;">n environmental factors or lifestyle changes are driving part of this increase." Goldenberg further states, </span><br />
<blockquote class="tr_bq">
<span style="font-family: "trebuchet ms" , sans-serif;">(...) it is our role </span><span style="font-family: "trebuchet ms" , sans-serif;">as physicians to protect our patients from complacency </span><span style="font-family: "trebuchet ms" , sans-serif;">and undertreatment. </span><span style="font-family: "trebuchet ms" , sans-serif;">Explaining away thyroid cancers as </span><span style="font-family: "trebuchet ms" , sans-serif;">being subclinical or clinically insignificant is reminiscent </span><span style="font-family: "trebuchet ms" , sans-serif;">of days past when we told our patients: “don’t worry, it’s </span><span style="font-family: "trebuchet ms" , sans-serif;">good cancer.”</span></blockquote>
<span style="font-family: "trebuchet ms" , sans-serif;"> It appears that the Bernier paper was "held up" until two opposing comments were obtained. That wasn't the case with <a href="https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2734347" target="_blank">another study</a> on </span><span style="font-family: "trebuchet ms" , sans-serif;">pediatric thyroid cancer in the United States </span><span style="font-family: "trebuchet ms" , sans-serif;">by Qian et al</span><span style="font-family: "trebuchet ms" , sans-serif;">, which was accepted on March 24, 2019 and published </span><span style="font-family: "trebuchet ms" , sans-serif;">in <i>JAMA Otolaryngology-Head & Neck Surgery</i> </span><span style="font-family: "trebuchet ms" , sans-serif;">on May 23, 2019. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;"> Like Bernier et al, Qian et al found a true increase in pediatric thyroid cancer. Both Qian et al and </span><a href="https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2734343" style="font-family: "Trebuchet MS", sans-serif;" target="_blank">Invited Commentary</a><span style="font-family: "trebuchet ms" , sans-serif;"> by Rastatter et al acknowledge the Ohtsuru study. Qian et al </span><span style="font-family: "trebuchet ms" , sans-serif;">state, </span><br />
<blockquote class="tr_bq">
<span style="font-family: "trebuchet ms" , sans-serif;">Ohtsuru et al showed that large </span><span style="font-family: "trebuchet ms" , sans-serif;">scale </span><span style="font-family: "trebuchet ms" , sans-serif;">mass ultrasonography screening of children and young </span><span style="font-family: "trebuchet ms" , sans-serif;">adults within 5 years of the 2011 Fukushima Daiichi nuclear </span><span style="font-family: "trebuchet ms" , sans-serif;">power station accident identified many subclinical thyroid can</span><span style="font-family: "trebuchet ms" , sans-serif;">cers i</span><span style="font-family: "trebuchet ms" , sans-serif;">n an age-dependent manner. (...) </span><span style="font-family: "trebuchet ms" , sans-serif;">These high incidence rates represent </span><span style="font-family: "trebuchet ms" , sans-serif;">prevalent disease rather than effects of radiation because </span><span style="font-family: "trebuchet ms" , sans-serif;">all diagnoses were made before the effects of radiation </span><span style="font-family: "trebuchet ms" , sans-serif;">could manifest according to epidemiologic evidence for </span><span style="font-family: "trebuchet ms" , sans-serif;">postradiation-exposure thyroid cancer in Japan.</span></blockquote>
<span style="font-family: "trebuchet ms" , sans-serif;"> Rastatter et al state, "(...) clinicians should be mindful that large-scale screening by </span><span style="font-family: "trebuchet ms" , sans-serif;">ultrasound can identify nonclinical or subclinical thyroid can</span><span style="font-family: "trebuchet ms" , sans-serif;">cers </span><span style="font-family: "trebuchet ms" , sans-serif;">in children, putting them at risk for overdiagnosis." Unlike Chen and Davies, however, Rastatter et al do not attribute the increase to overdiagnosis. Rather, they encourage continued efforts to determine whether there is a true increase exists and what factors might be contributing to the increase.</span><br />
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<b style="font-family: "trebuchet ms", sans-serif;"><span style="font-size: large;">TM-NUC</span></b><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> There is no doubt that the TUE data (and actually other FHMS data) propagated by FMU are biased. Focusing on arbitrarily selected data and tactfully withholding relevant clinical data, FMU has successfully promoted an unfounded notion that all thyroid cancers detected in the TUE have existed subclinically prior to the Fukushima nuclear accident. This in turn offered new evidence of "a subclinical reservoir of pediatric thyroid cancer" to the world.</span><br />
<br />
<span style="font-family: "trebuchet ms" , sans-serif;"> The plot thickens even more.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;"> T</span><span style="font-family: "trebuchet ms" , sans-serif;">he IARC expert group <a href="http://tmnuc.iarc.fr/en/" target="_blank">TM-NUC</a> recommends against systematic thyroid cancer screening after nuclear accidents for fear of overdiagnosis. (See their <a href="http://tmnuc.iarc.fr/public/docs/TM-NUC_lay_summary_final2.pdf" target="_blank">summary</a> for details.) But evidence used in </span><span style="font-family: "trebuchet ms" , sans-serif;">section "Overdiagnosis in Pediatric Thyroid Cancer" of the</span><span style="font-family: "trebuchet ms" , sans-serif;"> </span><a href="http://publications.iarc.fr/571" style="font-family: "Trebuchet MS", sans-serif;" target="_blank">TM-NUC report 1</a><span style="font-family: "trebuchet ms" , sans-serif;"> </span><span style="font-family: "trebuchet ms" , sans-serif;">is the very evidence that was used in the Ohtsuru study as the backing for </span><span style="font-family: "trebuchet ms" , sans-serif;">"a subclinical reservoir of pediatric thyroid cancer": </span><span style="font-family: "trebuchet ms" , sans-serif;">the autopsy data as well as the </span><span style="font-family: "trebuchet ms" , sans-serif;">Midorikawa and Takahashi studies. (Also mentioned is the </span><a href="https://www.clinicaloncologyonline.net/article/S0936-6555(16)00002-9/fulltext" style="font-family: "Trebuchet MS", sans-serif;" target="_blank">Suzuki</a> <span style="font-family: "trebuchet ms" , sans-serif;">study which appears as Suzuki (2016) in section "Inconsistent data." Suzuki prematurely concludes that the Fukushima cases are unlikely to be due to radiation exposure, only one year into the second round when 25 of eventual 71 cancer cases were detected.) </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Granted, evidence on the subject of overdiagnosis in pediatric thyroid cancer is scarce. But drawing "evidence" from the biased FMU studies only worsens the situation in two ways: 1) propagate the biased evidence and 2) legitimize the biased evidence. Incorporation of biased evidence into an official report of an authoritative international agency practically endorses such biased evidence. Whether the TM-NUC members were aware of the biased nature of the FMU studies is beyond anyone's guess. Looking at the <a href="http://tmnuc.iarc.fr/en/TmnucMembers" target="_blank">member roster</a>, some are usual suspects who might tend to overlook potential flaws and biases for their own gain. Others, like Davies, might be keen on grabbing some "evidence" from an authoritative source that would advance their own agenda.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;"> In late November, two months after the TM-NUC report 1 was released, <i>JAMA Otolaryngology-Head & Neck Surgery </i>published <a href="http://tmnuc.iarc.fr/en/TmnucMembers" target="_blank">Clinical Guideline Synopsis on Thyroid Cancer Screening after Nuclear Accidents</a>. Published in the same issue were the <a href="https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2716821?resultClick=1" target="_blank">Ohtsuru study</a> titled "Incidence of Thyroid Cancer Among Children and Young Adults in Fukushima, Japan, Screened With 2 Rounds of Ultrasonography Within 5 Years of the 2011 Fukushima Daiichi Nuclear Power Station Accident" and <a href="https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2716818" target="_blank">Invited Commentary</a> by Bauer and Davies, titled "</span><span style="font-family: "trebuchet ms" , sans-serif;">Why the Data From the Fukushima Health Management Survey After the Daiichi Nuclear Power Station Accident Are Important."</span><span style="font-family: "trebuchet ms" , sans-serif;"> (Incidentally, Davies is an associate editor of this journal.) These titles seem "loaded" once the dots are connected. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> New "scientific evidence" based on the skewed Fukushima data was introduced to the world with an endorsement of "experts" who served on the IARC expert group TM-NUC. This new "evidence" of </span><span style="font-family: "trebuchet ms" , sans-serif;">"a subclinical reservoir of pediatric and adolescent thyroid cancer" can</span><span style="font-family: "trebuchet ms" , sans-serif;"> attribute the recently reported increase in pediatric thyroid cancer in the United States to overdiagnosis. It is sobering to think this <i>is</i> the lesson from Fukushima.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> TM-NUC was fully sponsored by the Japanese government which shelled out </span><span style="font-family: "trebuchet ms" , sans-serif;">362,400 Euro (> $400,000), a bargain price to gain an endorsement of an authoritative international agency on "new baseline" which, for all practical purposes, dismisses potential radiation effects on Fukushima's thyroid cancer.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> </span><br />
<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>Internal review or censorship?</b></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Why do studies on the FHMS data published by FMU, either alone or collaboratively with other institutions such as Nagasaki University, tend to be biased? An answer warrants careful consideration.</span><span style="font-family: "trebuchet ms" , sans-serif;"> </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> FMU has its <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/175795.pdf" target="_blank">own guidelines</a> about the u</span><span style="font-family: "trebuchet ms" , sans-serif;">se and reporting of the FHMS data and its analytical results,</span><span style="font-family: "trebuchet ms" , sans-serif;"> requiring any papers to undergo an "internal review" before submission to journals. </span><span style="font-family: "trebuchet ms" , sans-serif;">The internal review is for FMU to ascertain that papers meet conditions such as "contribution to t</span><span style="font-family: "trebuchet ms" , sans-serif;">he primary purpose of the FHMS which is to monitor the long-term health of residents" and "accuracy of the results and interpretations." </span><span style="font-family: "trebuchet ms" , sans-serif;">FMU could scrutinize the results and interpretations according to what is considered "accurate." This might be one of the reasons for an arbitrary study design and writing style commonly seen in the FMU studies. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> In 2016 the Oversight Committee created the <a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-data.html" target="_blank">Subcommittee for Data Provision for the Purpose of Academic Research</a> (herein, the data subcommittee) in order to establish </span><span style="font-family: "trebuchet ms" , sans-serif;">guidelines on provision the FHMS data to third-party researchers. </span><span style="font-family: "trebuchet ms" , sans-serif;">W</span><span style="font-family: "trebuchet ms" , sans-serif;">aiving informed consent acquisition for the third-party researchers has been considered due to a sheer difficulty of obtaining informed consent from more than half a million Fukushima residents who have participated in the FHMS. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> In justifying the waiver, the data subcommittee gives consideration to public interest and consent. The subcommittee presumes that facilitation of broad-based research with the FHMS data is critical for maintaining and improving health of residents. Offering residents an opportunity to opt-out is also on the table, "in consideration of their benefit," a euphemism for "so they are not harmed." </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> R</span><span style="font-family: "trebuchet ms" , sans-serif;">egarding the FHMS data,</span><span style="font-family: "trebuchet ms" , sans-serif;"> u</span><span style="font-family: "trebuchet ms" , sans-serif;">nderlying the issue of harm and benefit is FMU's internal rule</span><span style="font-family: "trebuchet ms" , sans-serif;"> </span><i style="font-family: "trebuchet ms", sans-serif;">not</i><span style="font-family: "trebuchet ms" , sans-serif;"> </span><span style="font-family: "trebuchet ms" , sans-serif;">to allow research that might ultimately be harmful to residents. This "unscientific" (and unspoken) rule seems to give a priority to curbing psychosocial and economic effects. What exactly is meant by "harm" is usually not spelled out clearly, but what FMU is concerned seems not so much "harm to residents themselves" as "harm to someone other than residents when effects of radiation exposure are shown."</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> As a result, any scientific research that might prove effects of radiation exposure could be rejected during an initial application process or an internal review of the finished product. This explains why s</span><span style="font-family: "trebuchet ms" , sans-serif;">ome of the FHMS papers published so far on medical issues (other than thyroid cancer) barely mention "radiation exposure," attributing any abnormal findings to to evacuation-related stress. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Clearly, FMU's internal rule defies t</span><span style="font-family: "trebuchet ms" , sans-serif;">he primary purpose of the FHMS to "monitor the long-term health of residents, promote their well-being, and confirm whether long-term, low-dose radiation exposure has health effects." </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"></span>
<span style="font-family: "trebuchet ms" , sans-serif;"> It should be kept in mind that FMU's internal rule is likely to be applied to domestic and international third-party requests to conduct research using the FHMS data, once data provision commences. (Trial period for data request is <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/305468.pdf" target="_blank">scheduled</a> to begin in April 2020.)</span><br />
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@YuriHiranumahttp://www.blogger.com/profile/16819451884150838540noreply@blogger.com0tag:blogger.com,1999:blog-9200156515048577812.post-37119351139523828812019-05-16T14:02:00.000-07:002019-09-28T11:58:08.748-07:00Fukushima Thyroid Examination April 2019: 168 Surgically Confirmed as Thyroid Cancer Among 212 Cytology Suspected Cases<span style="font-size: medium;"><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><i style="font-size: medium;">*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.</i></span></span><br />
<span style="font-size: medium;"><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><i style="font-size: medium;"><br /></i></span></span>
<span style="font-size: medium;"><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>Highlights</b></span></span><b style="font-family: "trebuchet ms", sans-serif;"> </b><br />
<ul>
<li><b style="font-family: "Trebuchet MS", sans-serif;">The third round: 3 cases newly diagnosed as suspicious or malignant, and 2 new cases surgically confirmed.</b></li>
<li><b style="font-family: "Trebuchet MS", sans-serif;">The fourth round: 2 cases diagnosed as suspicious or malignant</b></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><b>Total number of suspected/confirmed thyroid cancer is now</b> <span style="color: red; font-weight: bold;">211 </span><b style="font-family: "trebuchet ms", sans-serif; font-weight: bold;"><i>excluding</i> a single case of benign tumor: </b><b>115 in the first round, 71 in the second round, 21 in the third round, 2 in the fourth round, and 2 in Age 25 Milestone Screening.</b></span></li>
<li><b style="font-family: "Trebuchet MS", sans-serif;">Total number of surgically confirmed thyroid cancer cases has increased by 2 to <span style="color: red;">168 </span>(101 in the first round, 52 in the second round, and 15 in the third round).</b></li>
<li><b style="font-family: "Trebuchet MS", sans-serif;">Report of the 12th Thyroid Examination Assessment Subcommittee held on February 22, 2019 shows a "new" regional (dose-response) analysis and a disagreement on incorporation of TM-NUC recommendations into a new informed consent form. </b></li>
</ul>
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<b><span style="font-size: large;"><span style="font-family: "trebuchet ms" , sans-serif;">The latest overall results including "unreported" cases</span></span></b></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgpK2h6qrWZSNAu_YFxGmXxaHqq5uA_S2h8PpqZiVyd_8KyslCTiEgt0Y5YvWlDAMuo8958AA0rwDeIyq1_0cDJcsyL2CY9u6zLE3uAgiXOBTi5bDXpiBImvq5Fa6HUlmfLC96ozLSOztHm/s1600/%252334+English+total+results.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="417" data-original-width="667" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgpK2h6qrWZSNAu_YFxGmXxaHqq5uA_S2h8PpqZiVyd_8KyslCTiEgt0Y5YvWlDAMuo8958AA0rwDeIyq1_0cDJcsyL2CY9u6zLE3uAgiXOBTi5bDXpiBImvq5Fa6HUlmfLC96ozLSOztHm/s640/%252334+English+total+results.png" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><i style="font-family: "trebuchet ms", sans-serif; font-size: 12.8px;"><span style="font-size: small;">(</span><span style="font-size: x-small;">See <a href="https://fukushimavoice-eng2.blogspot.com/2018/07/results-of-survey-on-fukushima-thyroid.html" target="_blank">this post</a> for the details of the "unreported" cases.</span><span style="font-size: small;">)</span></i></td></tr>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>Delayed timing</b></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> On April 8, 2019, the 34th Oversight Committee for Fukushima Health Management Survey (FHMS) convened in Fukushima City, Fukushima Prefecture. This was the "later-than-usual" first meeting of the quarterly Oversight Committee meetings <a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/65129.pdf" target="_blank">to be held</a> in 2019: first meetings of each <i>calendar</i> year which correspond to last meetings of each <i>fiscal</i> year ending March 31 have mostly been held in February (one in early March) reporting results as of December 31 of the previous year. Fiscal reports as of March 31 are usually released at the second meeting of each calendar year corresponding to the first meeting of each fiscal year usually held in mid-May to mid-June. There is a concern that delayed timing of the 34th Oversight Committee meeting could interfere with "timely" reporting of the final results of the 3rd round.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Among other information, </span><span style="font-family: "trebuchet ms" , sans-serif;">the Oversight Committee released the latest results (as of December 31, 2018) of the <a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/320487.pdf" target="_blank">third</a> and <a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/320488.pdf" target="_blank">fourth</a> rounds of the </span><span style="font-family: "trebuchet ms" , sans-serif;">Thyroid Ultrasound Examination (TUE).</span><span style="font-family: "trebuchet ms" , sans-serif;"> Official English translation will be available <a href="http://fmu-global.jp/our-activities/prefectural-oversight-committee-meeting/" target="_blank">here</a> in the hopefully "near" future. <i>(Note: English translation for the December 27, 2018 meeting was posted online on April 5, 2019.)</i></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><i><br /></i></span>
<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>Summary on the current status of the TUE</b></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> A five-page <a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/320491.pdf" target="_blank">summary</a> of the first through fourth rounds as well as the Age 25 Milestone Screening, "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. </span><a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/320491.pdf" style="font-family: "trebuchet ms", sans-serif;" target="_blank">This summary</a> <span style="font-family: "trebuchet ms" , sans-serif;">is <i>not</i> translated into English officially,</span><span style="font-family: "trebuchet ms" , sans-serif;"> but here's an unofficial translation. </span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"><b><span style="font-size: large;">Report from the 12th Thyroid Examination Assessment Subcommittee</span></b></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Chair of the Thyroid Examination Assessment Subcommittee (herein, subcommittee), Gen Suzuki, reported the content of the <a href="http://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-b12.html" target="_blank">12th subcommittee</a> held on February 22, 2019. Suzuki's report is summarized <a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/320489.pdf" target="_blank">here</a>.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Notably, Fukushima Medical University (FMU) </span><a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/311587.pdf" style="font-family: "Trebuchet MS", sans-serif;" target="_blank">reported</a> <span style="font-family: "trebuchet ms" , sans-serif;">a new analysis </span><span style="font-family: "trebuchet ms" , sans-serif;">on associations between thyroid cancer occurrence in</span><span style="font-family: "trebuchet ms" , sans-serif;"> 2 age groups (6-14, ≥15) </span><span style="font-family: "trebuchet ms" , sans-serif;">and minimum and maximum values of <a href="http://www.unscear.org/docs/publications/2013/UNSCEAR_2013_Annex-A_Attach_C-16.pdf" target="_blank">estimated thyroid absorption doses by UNSCEAR</a>, concluding no observation of dose response. (However, an astrophysicist Junichiro Makino has questioned scientific validity of the analysis itself </span><span style="font-family: "trebuchet ms" , sans-serif;">i</span><span style="font-family: "trebuchet ms" , sans-serif;">n April-June 2019 issues of </span><i style="font-family: "Trebuchet MS", sans-serif;">Kagaku</i><span style="font-family: "trebuchet ms" , sans-serif;">, </span><span style="font-family: "trebuchet ms" , sans-serif;">pointing out inconsistencies between the original data and the 95% CI shown in graphs <i>and</i> between the results of this analysis and a <a href="https://www.ncbi.nlm.nih.gov/pubmed/29634592" target="_blank">previously published paper</a>.</span><span style="font-family: "trebuchet ms" , sans-serif;">)</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Discussions regarding </span><span style="font-family: "trebuchet ms" , sans-serif;">risks and benefits of the TUE have long been incong</span><span style="font-family: "trebuchet ms" , sans-serif;">ruous. </span><span style="font-family: "trebuchet ms" , sans-serif;">On September 28, an IARC expert group, Thyroid Monitoring after Nuclear Accidents (TM-NUC) released the <a href="http://publications.iarc.fr/571" target="_blank">first report</a> as an IARC publication, followed by an <a href="https://doi.org/10.1016/S1470-2045(18)30680-6" target="_blank">article</a> in the October 1, 2018 issue of the Lancet Oncology and the <a href="http://tmnuc.iarc.fr/public/docs/TM-NUC_Report2.pdf" target="_blank">second report</a> in March. (See <a href="https://fukushimavoice-eng2.blogspot.com/2017/11/circumstances-regarding-japan-sponsored.html" target="_blank">this post</a> on the "birth" of TM-NUC.) </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> </span><span style="font-family: "trebuchet ms" , sans-serif;">T</span><span style="font-family: "trebuchet ms" , sans-serif;">he TUE informed consent form is currently undergoing revision to better inform participants of the risks and benefits. </span><span style="font-family: "trebuchet ms" , sans-serif;">During the 12th subcommittee meeting, the discussion reached a </span><i style="font-family: "Trebuchet MS", sans-serif;">new</i><span style="font-family: "trebuchet ms" , sans-serif;"> level of dichotomy between pubic health specialists wanting to use as the TM-NUC recommendations (summarized </span><a href="http://tmnuc.iarc.fr/public/docs/TM-NUC_lay_summary_final2.pdf" style="font-family: "Trebuchet MS", sans-serif;" target="_blank">here</a><span style="font-family: "trebuchet ms" , sans-serif;">) as evidence for overdiagnosis risks and clinicians doubting the evidence level of the TM-NUC report which is built on known-to-be-scarce evidence of pediatric thyroid cancer.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> As a matter of fact, TM-NUC's first report is <i>not</i> intended to guide how Fukushima's TUE should be implemented as described by TM-NUC chair Joachim Schüz </span><span style="font-family: "trebuchet ms" , sans-serif;">during the </span><a href="https://www.youtube.com/watch?v=x5HPKswAjbQ" style="font-family: "Trebuchet MS", sans-serif;" target="_blank">press conference</a><span style="font-family: "trebuchet ms" , sans-serif;"> after the March 7, 2019 symposium in Tokyo sponsored by Ministry of the Environment and moderated by none other than Shunichi Yamashita to introduce the report. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> The first report does incorporate findings from Fukushima's TUE by necessity, as data from one of the three nuclear accidents. Its section on "Overdiagnosis in Pediatric Thyroid Cancer" relies heavily on published papers on Fukushima's TUE, yet most of the published papers on the TUE are inherently biased. This is partly because the publicized data itself is incomplete and lacks transparency and partly due to the premature and scientifically unfounded premise by FMU to dismiss effects of radiation exposure before conducting a proper analysis on data beyond the first round. This topic is to be covered in a separate post, time permitted.</span><br />
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@YuriHiranumahttp://www.blogger.com/profile/16819451884150838540noreply@blogger.com0tag:blogger.com,1999:blog-9200156515048577812.post-33544635704561694692019-05-13T01:07:00.001-07:002019-05-16T13:20:02.615-07:00Implementation Status of the Support Program for the Thyroid Ultrasound Examination in Fukushima<br />
<span style="font-family: "trebuchet ms" , sans-serif;">Fukushima Prefecture offers a financial support program for the Thyroid Ultrasound Examination (TUE) of the Fukushima Health Management Survey (FHMS) as described on their <a href="http://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kojyosen-support.html" target="_blank">website</a> (Japanese only). The TUE support program (herein, "the support program") was begun on July 10, 2015, after financial assistance was recommended by the Thyroid Examination Assessment Subcommittee in their <a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/174220.pdf" target="_blank">March 2015 interim report</a>, in order to lessen residents' financial burden from medical costs related to thyroid ultrasound findings. </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">Since the 2011 nuclear accident Fukushima Prefecture has offered free medical care to those younger than 18, but as soon as they turn 18, they must pay 30% of costs of medical care related to thyroid nodular diseases diagnosed from the TUE. The support program is offered for </span><span style="font-family: "trebuchet ms" , sans-serif;">for thyroid nodules suspected or confirmed of malignancy</span><span style="font-family: "trebuchet ms" , sans-serif;"> but </span><span style="font-family: "trebuchet ms" , sans-serif;">excludes non-cancer thyroid diseases even when diagnosed through the TUE because the fundamental purpose of the TUE is to detect thyroid cancer which is known to occur in children after radiation exposure as in Chernobyl.</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">The support program was created to offset the out-of-pocket expenses as long as patients were not receiving any other public assistance including medical. However, the assistance was conditional: applicants to the program were to 1) be the TUE participants, 2) be receiving care from either FMU or medical facilities approved by FMU to offer the confirmatory examination (FMU-approved facilities), and 3) provide <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/302504.pdf" target="_blank">clinical information </a>related to medical care rendered at the FMU-approved facilities which otherwise are not reported to FMU or Fukushima Prefecture.</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">In December 2018, condition 2) was dropped in order to expand the assistance to those who have sought medical care related to thyroid ultrasound findings completely outside of the FMU framework. However, the eligible applicants still had to have participated in the TUE at some point, reinforcing the original premise that the support program was to act as a feedback mechanism for improving the FHMS.</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">However, it was <a href="http://www.ourplanet-tv.org/?q=node/2256" target="_blank">revealed</a> in May 2018 that Fukushima Prefecture has done very little with the clinical information collected from the applicants, other than releasing a brief fiscal report on the implementation status (<a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/219717.pdf" target="_blank">FY 2016</a>, <a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/273530.pdf" target="_blank">FY 2017</a>) which included general information on the cumulative number of disbursements as well as the actual number and the age range of recipients. For the surgical cases, the same information was provided with an addition of the number of cases for each post-surgical pathological diagnosis.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">For instance, the FY 2017 report shows 313 (121 in FY 2015, 104 in FY 2016, and 88 in FY 2017) disbursements were made cumulatively for 233 individuals during FY 2015-2017 for ages 18-25. Of 313, 82 </span><span style="font-family: "trebuchet ms" , sans-serif;">(42 in FY 2015, 25 in FY 2016, and 15 in FY 2017)</span><span style="font-family: "trebuchet ms" , sans-serif;"> </span><span style="font-family: "trebuchet ms" , sans-serif;">disbursements were made cumulatively for surgeries to 82 individuals, including 77 thyroid cancer cases (76 papillary and 1 poorly-differentiated) and 5 non-cancer cases such as follicular adenoma. It was not known how many of 82 surgical cases were actually included in the official count, and i</span><span style="font-family: "trebuchet ms" , sans-serif;">t became clear that the collected information never was or was to be cross-checked with the official data in order to assess which "supplementary" information might have been obtained. </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">On December 12, 2018, it was <a href="http://www.ourplanet-tv.org/?q=node/2342" target="_blank">reported</a> that chief of the FHMS department in the prefectural government, Yoichi Suzuki, stated during a prefectural assembly session that almost all 233 individuals receiving assistance, including 151 that haven't undergone surgeries, had thyroid cancer. At the 33rd FHMS Oversight Committee meeting on December 27, 2018, Suzuki was grilled on the actual number of thyroid cancer cases among recipients of the assistance, but he would only repeat that the number of thyroid cancer cases was 77, and declined to elaborate any further. At the March 7, 2019 prefectural assembly session, Suzuki officially</span><span style="font-family: "trebuchet ms" , sans-serif;"> </span><a href="http://www.ourplanet-tv.org/?q=node/2382" style="font-family: "Trebuchet MS", sans-serif;" target="_blank">recanted</a><span style="font-family: "trebuchet ms" , sans-serif;"> his previous statement</span><span style="font-family: "trebuchet ms" , sans-serif;">. </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">Because the </span><span style="font-family: "trebuchet ms" , sans-serif;">support program is for</span><span style="font-family: "trebuchet ms" , sans-serif;"> thyroid nodules suspected or confirmed of malignancy diagnosed <i>after</i> FNAC (fine-needle aspiration cytology), which as part of the TUE should not incur any out-of-pocket expenses, almost all recipients of the support program would have suspected or confirmed thyroid cancer by default, with some exceptions such as follicular adenoma that is difficult to distinguish from follicular cancer. Yet diagnosis is provided only for surgical cases, which is somewhat understandable because a definitive diagnosis of thyroid cancer requires pathological examination of thyroid tissues excised during surgery. On the other hand, applicants must submit <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/302504.pdf" target="_blank">clinical information</a> including a given diagnosis, which Suzuki confirms with the medical facility where the applicant is receiving care.</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">Suzuki was no where in sight at the 34th Oversight Committee meeting held on April 8, 2019, having been </span><span style="font-family: "trebuchet ms" , sans-serif;">replaced by another official through a routine, fiscal personnel reshuffling. New chief, Tatsuya Sugano, provided an <a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/320843.pdf" target="_blank">updated report</a> as of December 2018 (hence <i>not</i> a fiscal report) with an additional information such as breakdown of recipients by region and sex. </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">Between July 10, 2015 and December 2018, 375 </span><span style="font-family: "trebuchet ms" , sans-serif;">cumulative disbursements were made for 257 (90 males and 167 females; 47 from Hamadori, 165 from Nakadori, 25 from Aizu, and 20 from the evacuation zone; ages 18 to 26) individuals. This represents an addition of 62 disbursements in FY 2018 (through December 2018) and 24 individuals since the FY 2017 report. For surgical cases, 95 cumulative disbursements were </span><span style="font-family: "trebuchet ms" , sans-serif;">made to 93 (38 males and 55 females) individuals, </span><span style="font-family: "trebuchet ms" , sans-serif;">reflecting a FY 2018 </span><span style="font-family: "trebuchet ms" , sans-serif;">increase of 13 disbursements. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">A discrepancy between the cumulative disbursements, 95, and the number of individuals, 93, means two extra surgeries conducted in FY 2018, suggestive of completion thyroidectomy following a lobectomy and/or surgery for a recurrence. Pathological diagnoses for 93 surgical cases include 87 thyroid cancers (85 papillary, 1 poorly-differentiated, and 1 follicular) and 6 non-cancer cases such as follicular adenoma, reflecting an additional 9 papillary thyroid cancers, a newly diagnosed follicular cancer, and an additional non-cancer case in FY 2018.</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">The updated report with a few additional details did nothing to resolve the fundamental issue of the support program data not being compared with the official count, failing to offer a more comprehensive picture of the current status of thyroid cancer in Fukushima. Granted, there are other factors contributing to incompleteness and lack of transparency in the official data: failure to report thyroid cancer cases diagnosed during clinical follow-up visits or even collect cases diagnosed at non-FMU facilities inside or totally outside the TUE framework. </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">With dramatically declining participating rates in successive rounds of the TUE for ages 18 and older who might seek medical care outside Fukushima as they move on with their lives, the support program could be a valuable source of <i>otherwise unavailable</i> information for this age group, as in the actual number of suspected or confirmed thyroid cancer cases. Yet no matching or comparison with the official data has been conducted, and diagnoses <i><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/302504.pdf" target="_blank">provided by the participants themselves</a></i> remain under the veil unless they had surgeries. Whatever this lack of transparency is suppressing must be very inconvenient.</span>@YuriHiranumahttp://www.blogger.com/profile/16819451884150838540noreply@blogger.com0tag:blogger.com,1999:blog-9200156515048577812.post-10313406458601242302019-02-17T11:58:00.000-08:002019-02-17T11:58:32.209-08:00Where to Find Fukushima Radiation Health Survey Information: : Fukushima Medical University's Radiation Medical Science Center Website <br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: x-large;">Where to Find Fukushima Radiation Health Survey Information:</span><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"> </span><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;">Fukushima Medical University's Radiation Medical Science Center Website </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">Fukushima Medical University's Radiation Medical Science Center opened a <a href="http://kenko-kanri.jp/en/" target="_blank">new website</a> 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.)</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">The top page looks like this:</span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg17TwJutU5jxBKV7obcz0xvu4fXw0QD-tB0MHWvIZkt6lw968LW4ntZvq3rlWt0jhESdVpG2viUxQ4C52DHLSW6hc28ot_lg28hI8GLnkhQJxqgIE7xQyi0kFxg9gYw7nG_00ZZdDiWXwN/s1600/Screen+Shot+2019-02-17+at+10.39.30+AM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="749" data-original-width="1218" height="392" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg17TwJutU5jxBKV7obcz0xvu4fXw0QD-tB0MHWvIZkt6lw968LW4ntZvq3rlWt0jhESdVpG2viUxQ4C52DHLSW6hc28ot_lg28hI8GLnkhQJxqgIE7xQyi0kFxg9gYw7nG_00ZZdDiWXwN/s640/Screen+Shot+2019-02-17+at+10.39.30+AM.png" width="640" /></a></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">When you scroll down, 4 blue rectangles appear: </span><br />
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<ol>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><a href="http://kenko-kanri.jp/en/#greeting" target="_blank">Radiation Medical Science Center</a>: scrolls down the screen to show a greeting and organizational information. </span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><a href="http://kenko-kanri.jp/en/pdf/report_e.pdf" target="_blank">Fukushima Health Management Survey</a>: 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 <a href="https://documentcloud.adobe.com/link/track?uri=urn%3Aaaid%3Ascds%3AUS%3A768fd319-5c99-4f90-b7a5-a31a926e9c46" target="_blank">here</a>.)</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><a href="http://fmu-global.jp/publications-2018/" target="_blank">Research/Publication</a>: jumps to the Publications page of the Office of the International Cooperation</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><a href="http://fmu-global.jp/" target="_blank">Office of International Cooperation</a>: jumps to the original website where official English translation of selected reports presented at the Oversight Committee meetings (<a href="http://fmu-global.jp/our-activities/prefectural-oversight-committee-meeting/" target="_blank">here</a>) and links to past conference and workshops (<a href="http://fmu-global.jp/conferences-and-workhops/" target="_blank">here</a>) can be accessed.</span></li>
</ol>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdxIGHvSBYONJdy1qFvPAClAEy7xZPvJxXqoxsLsEyl0-4VEDqCcSBkskAQL9bKkCmn8lWECQ7XeJ0HJ-VAQpxXI_7lulE01tZV3H19gLucd-zobgPnF6MlDY_vKekHj5zoBv_O0Ff-j6o/s1600/Screen+Shot+2019-02-17+at+10.39.47+AM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="447" data-original-width="1022" height="278" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdxIGHvSBYONJdy1qFvPAClAEy7xZPvJxXqoxsLsEyl0-4VEDqCcSBkskAQL9bKkCmn8lWECQ7XeJ0HJ-VAQpxXI_7lulE01tZV3H19gLucd-zobgPnF6MlDY_vKekHj5zoBv_O0Ff-j6o/s640/Screen+Shot+2019-02-17+at+10.39.47+AM.png" width="640" /></a></div>
<span style="font-family: "trebuchet ms" , sans-serif;">If you are interested in information available in Japanese, click "<a href="http://kenko-kanri.jp/" target="_blank">Japanese Website</a>" in the right upper corner of the top page. There are 3 blue rectangles with Japanese/English labels. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;"><a href="http://kenko-kanri.jp/#greeting" target="_blank">Radiation Medical Science Center</a>: scrolls down to the greeting and organizational information. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><a href="http://fukushima-mimamori.jp/" target="_blank">Fukushima Health Management Survey</a>: 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.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><a href="http://fukushima-mimamori.jp/publications/" target="_blank">Research/Publications</a>: jumps to the publications page of the above Japanese website.</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">*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 <a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai.html" target="_blank">here</a> (in Japanese). </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">Here's the screenshot of the partial list of the Oversight Committee meetings: </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9QTVi339ouRkzoEOKBPZC-eoUh95yL6casNGuK5t1H1cfk0FhqJDWiosKFuvLn-KgdFHltOjzB4yV8vD44y_L_fI2bXXAJdrGife6f6BhMATrncK6EJqmD20ml8zBdT3LmFG8fYaO0yI3/s1600/Screen+Shot+2019-02-17+at+11.47.24+AM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="317" data-original-width="1127" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9QTVi339ouRkzoEOKBPZC-eoUh95yL6casNGuK5t1H1cfk0FhqJDWiosKFuvLn-KgdFHltOjzB4yV8vD44y_L_fI2bXXAJdrGife6f6BhMATrncK6EJqmD20ml8zBdT3LmFG8fYaO0yI3/s640/Screen+Shot+2019-02-17+at+11.47.24+AM.png" width="640" /></a></div>
<span style="font-family: "trebuchet ms" , sans-serif;">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. </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">For instance, the 32nd Oversight Committee meeting details look like this:</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">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.</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">Information on the Thyroid Examination Assessment Subcommittee can be similarly accessed <a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-b.html" target="_blank">here</a> (in Japanese).</span><br />
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<br />@YuriHiranumahttp://www.blogger.com/profile/16819451884150838540noreply@blogger.com0tag:blogger.com,1999:blog-9200156515048577812.post-27136694316194555022019-02-11T20:06:00.000-08:002019-02-22T16:41:54.075-08:00Shin-ichi Kurokawa Sets Straight Dishonesty and Misrepresentation in the Hayano Statement Regarding the Radiation Dose Study with Alleged Misconduct<br />
<i><span style="font-family: "trebuchet ms" , sans-serif;">This is an unofficial English translation of the <a href="https://hbol.jp/185193" target="_blank">article that originally appeared on the HARBOR BUSINESS Online (HBOL) website</a> 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.</span></i><br />
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<span style="font-family: "georgia" , "times new roman" , serif;">*February 20, 2019 update: <a href="https://www.iwanami.co.jp/kagaku/eKagaku_201902_Kurokawa_Shima.pdf" target="_blank">PDF link</a> for translation of the article co-authored by Kurokawa and published in the February 2019 issue of <i>Kagaku</i> is inserted in appropriate places. This translation is available in <a href="https://www.iwanami.co.jp/kagaku/e-Kagaku.html" target="_blank"><i>Kagaku's</i> e-publication page</a> 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. <i>Kagaku</i>. 2019;89(2):e0017-e0024.</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: x-large;"><b>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</b></span></h2>
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<span style="font-family: "trebuchet ms" , sans-serif; text-align: justify;">Written by Shin-ichi Kurokawa</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"><span style="font-family: "trebuchet ms" , sans-serif;"> On January 8, 2019, Ryugo Hayano posted "</span><span style="font-family: "trebuchet ms" , sans-serif;"><span id="docs-internal-guid-2dc1fbaf-7fff-897b-5caa-0340b33ffe77"><span style="font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">A position statement regarding the external dose study in Date City residents"</span></span> (herein, "statement") </span><span style="font-family: "trebuchet ms" , sans-serif;">at the </span></span><span style="font-family: "trebuchet ms" , sans-serif; white-space: pre-wrap;">Ministry of Education, Culture, Sports, Science and Technology press club. He also <a href="https://twitter.com/hayano/status/1082488374043103232/photo/1" target="_blank">tweeted</a> it as below. </span></div>
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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→ <a href="https://t.co/OuHJKXZmY2">pic.twitter.com/OuHJKXZmY2</a></div>
— ryugo hayano (@hayano) <a href="https://twitter.com/hayano/status/1082488374043103232?ref_src=twsrc%5Etfw">January 8, 2019</a></blockquote>
<span style="font-size: 11pt; white-space: pre-wrap;"><span style="font-family: "trebuchet ms" , sans-serif;">(Translation of Hayano’s <a href="https://twitter.com/hayano/status/1082488374043103232/photo/1" target="_blank">tweet</a> 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.)</span></span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;"> This "statement" describes <span style="text-indent: 36pt; white-space: pre-wrap;">the "facts" surrounding the allegation made to the University of Tokyo for research misconduct as well as falsification regarding </span><span style="white-space: pre-wrap;">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):“</span></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">Paper I:</span><span style="font-family: "trebuchet ms" , sans-serif;"> </span><span style="font-family: "trebuchet ms" , sans-serif;"><a href="https://iopscience.iop.org/article/10.1088/1361-6498/37/1/1/meta" target="_blank">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</a> </span> </blockquote>
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<span style="font-family: "trebuchet ms" , sans-serif;">Paper II: </span><span style="font-family: "trebuchet ms" , sans-serif;"><span style="font-family: , serif;"><a href="https://iopscience.iop.org/article/10.1088/1361-6498/aa6094/meta" target="_blank">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</a> </span></span></blockquote>
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<span style="font-family: "trebuchet ms" , sans-serif;"><span style="text-indent: 48px; white-space: pre-wrap;"> 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).</span></span><br />
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<tr><td class="tr-caption" style="text-align: center;"><span id="docs-internal-guid-e277d9e8-7fff-757a-f0ea-619083483b3e"><span style="font-family: "trebuchet ms"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">English translation of the first page of the "statement" by Hayano from Hayano's </span><span style="color: #1155cc; font-family: "trebuchet ms"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;"><a href="https://twitter.com/hayano/status/1082488374043103232/photo/1" style="text-decoration-line: none;">tweet</a></span></span><br />
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: "trebuchet ms" , sans-serif;"><span style="font-size: small;">The second page of the "statement" by Hayano from Hayano's <a href="https://twitter.com/hayano/status/1082488374043103232/photo/1" target="_blank">tweet</a></span><br /><span style="font-size: x-small;">(Numbers added in reference to Japanese translation of text shown below.)</span></span><br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: normal;"><b><span style="color: red;">A</span></b> <span style="text-align: justify; white-space: pre-wrap;">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.</span></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"><b><span style="color: red;">B</span></b> <span style="font-variant-east-asian: normal; font-variant-numeric: normal; text-align: justify; vertical-align: baseline; white-space: pre-wrap;">Figure 6, </span><span style="font-variant-east-asian: normal; font-variant-numeric: normal; text-align: justify; vertical-align: baseline; white-space: pre-wrap;">Paper II</span><span style="font-variant-east-asian: normal; font-variant-numeric: normal; text-align: justify; vertical-align: baseline; white-space: pre-wrap;"> (excerpted for explanation), </span></span><span style="font-family: "trebuchet ms" , sans-serif; text-align: justify; white-space: pre-wrap;">Distribution of individual doses by the glass badge measurement period (µSv/h)</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"><span style="color: red;"><b>C</b></span> <span style="font-variant-east-asian: normal; font-variant-numeric: normal; text-align: justify; vertical-align: baseline; white-space: pre-wrap;">Figure 7, </span><span style="font-variant-east-asian: normal; font-variant-numeric: normal; text-align: justify; vertical-align: baseline; white-space: pre-wrap;">Paper II</span><span style="font-variant-east-asian: normal; font-variant-numeric: normal; text-align: justify; vertical-align: baseline; white-space: pre-wrap;"> (excerpted for explanation), </span></span><span style="font-family: "trebuchet ms" , sans-serif; text-align: justify; white-space: pre-wrap;">Cumulative doses (mSv)</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"><b><span style="color: red;">D</span></b> <span style="text-align: justify; white-space: pre-wrap;">Glass badges were worn for 3 months. </span></span><span style="font-family: "trebuchet ms" , sans-serif; text-align: justify; vertical-align: baseline; white-space: pre-wrap;">Figure 6 shows the </span><span style="font-family: "trebuchet ms" , sans-serif; text-align: justify; vertical-align: baseline; white-space: pre-wrap;">3-month average (dose rate) represented by the central month.</span></div>
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<span style="color: red; font-family: "trebuchet ms" , sans-serif;"><b>E</b></span><span style="font-family: "trebuchet ms" , sans-serif;"> </span><span style="font-family: "trebuchet ms" , sans-serif; text-align: justify; white-space: pre-wrap;">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.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"><span style="color: red;"><b>F</b></span></span><span style="font-family: "trebuchet ms" , sans-serif; font-weight: bold;"> </span><span style="font-family: "trebuchet ms" , sans-serif; text-align: justify; white-space: pre-wrap;">Added up to calculate the cumulative doses</span></div>
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<b style="font-family: "trebuchet ms", sans-serif;"><span style="color: red;">G</span></b><span style="font-family: "trebuchet ms" , sans-serif;"> </span><span style="font-family: "trebuchet ms" , sans-serif; text-align: justify; white-space: pre-wrap;">Error: </span><span style="font-family: "trebuchet ms" , sans-serif; text-align: justify; white-space: pre-wrap;">Data in Figure 6 were simply added.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"><b><span style="color: red;">H</span></b> <span style="font-variant-east-asian: normal; font-variant-numeric: normal; text-align: justify; vertical-align: baseline; white-space: pre-wrap;">To be correct</span><span style="font-variant-east-asian: normal; font-variant-numeric: normal; text-align: justify; vertical-align: baseline; white-space: pre-wrap;">, the data should have been tripled as above. </span></span><span style="font-family: "trebuchet ms" , sans-serif; text-align: justify; white-space: pre-wrap;">There is a similar error in the integrated theoretical curve, which should also have been tripled. </span><span style="font-family: "trebuchet ms" , sans-serif; text-align: justify; vertical-align: baseline; white-space: pre-wrap;">Figure 5 </span><span style="font-family: "trebuchet ms" , sans-serif; text-align: justify; vertical-align: baseline; white-space: pre-wrap;">also</span><span style="font-family: "trebuchet ms" , sans-serif; text-align: justify; vertical-align: baseline; white-space: pre-wrap;"> includes a similar error.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"> 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.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>Timeline of how the Letter criticizing the Hayano-Miyazaki Paper was accepted</b></span></h3>
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<span style="font-family: "trebuchet ms" , sans-serif;"> 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.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"> The status of My Letter to the Editor,</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">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 <a href="https://arxiv.org/pdf/1812.11453.pdf">the arXiv site</a>)</span></blockquote>
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<span style="font-family: "trebuchet ms" , sans-serif;">follows the timeline shown below:</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /> August 17, 2018: The Letter is received by JRP. <br /> September 13, 2018: First revision submitted.<br /> November 5, 2018: Second revision submitted.<br /> November 16, 2018: The Letter "is ready to accept," and it was sent to the authors.</span></div>
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<b style="text-align: justify;"><span style="font-family: "trebuchet ms" , sans-serif;"> 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.</span></b></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"> 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.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>"Deceptions" seen in the Hayano "statement"</b></span></h3>
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<span style="font-family: "trebuchet ms" , sans-serif;"> Now, I am going to examine the content of the "statement."</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;"> First, Item 1 states, "</span><span style="font-family: "arial"; white-space: pre-wrap;">I was contacted by JRP to 'comment on <b>Letter</b> by S. Kurokawa <b>with academic inquiries</b> regarding the contents of Paper II.'</span><span style="font-family: "trebuchet ms" , sans-serif;">" 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 </span><i style="font-family: "trebuchet ms", sans-serif;">not</i><span style="font-family: "trebuchet ms" , sans-serif;"> conducting academic inquiries nor sending a letter. Rather, what I did was </span><b style="font-family: "trebuchet ms", sans-serif;">submitting a form of academic paper called a Letter to the Editor</b><span style="font-family: "trebuchet ms" , sans-serif;">. When the Letter became "ready to accept" on November 16, </span><b style="font-family: "trebuchet ms", sans-serif;">the authors were asked by the Editorial Office to reply</b><span style="font-family: "trebuchet ms" , sans-serif;">. </span><b style="font-family: "trebuchet ms", sans-serif;">In explaining such a simple fact, Hayano's uses inappropriate and vague expressions</b><span style="font-family: "trebuchet ms" , sans-serif;">.</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;"> Next, I am going to examine the part, "</span><span style="white-space: pre-wrap;"><span style="font-family: "trebuchet ms" , sans-serif;"><b>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</b>.</span></span><span style="font-family: "trebuchet ms" , sans-serif;">"</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"> My Letter points out that even though Figure 7 should correspond to Figure 6 in Paper II, the <b>actual values [cumulative doses] in Figure 7 are only half of the values expected</b> from <span style="background-color: white;">calculation of </span>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 <b>Figure 7 is shrunk by half </b>while Figure 6 is correct. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><b> The miscalculation discovered by Hayano does <i>not</i> explain the discrepancy raised in my Letter</b>. </span><span style="font-family: "trebuchet ms" , sans-serif;">Thus, the phrase, </span><span style="font-family: "trebuchet ms" , sans-serif;">"<span style="white-space: pre-wrap;">I</span></span><span style="white-space: pre-wrap;"><span style="font-family: "trebuchet ms" , sans-serif;"> would like to express a deep gratitude to S. Kurokawa who gave me an opportunity to find the error,</span></span><span style="font-family: "trebuchet ms" , sans-serif;">" only leaves me perplexed.</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;"> Next, Item 2 says, "</span><span style="white-space: pre-wrap;"><span style="font-family: "trebuchet ms" , sans-serif;"><b>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</b>.'</span></span><span style="font-family: "trebuchet ms" , sans-serif;">" This phrase has two major problems. First, the part, "</span><span style="font-family: "trebuchet ms" , sans-serif; white-space: pre-wrap;">It is necessary to comment on the Letter and make corrections in the paper</span><span style="font-family: "trebuchet ms" , sans-serif;">" is a <b>false statement</b>.</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;"> In mid-December 2018, I received an email from the JRP Editorial Office including the authors' response.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> The authors' response stated, "<span style="text-align: start;">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.</span></span>
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<span style="font-family: "trebuchet ms" , sans-serif;"> It should be noted that Corrigendum is equivalent of "seigo-hyo" (which means "erratum") in Japanese. In fact, the authors have issued the <a href="https://iopscience.iop.org/article/10.1088/1361-6498/aa5c57" target="_blank">corrigendum</a> regarding Paper I. (See </span><a href="https://iopscience.iop.org/article/10.1088/1361-6498/aa5c57/pdf" target="_blank"><span style="font-family: "trebuchet ms" , sans-serif;">Corrigendum: Individual external dose monitoring </span><span style="font-family: "trebuchet ms" , sans-serif;">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</span></a>.)</div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggEDl4NvQ14wHwrIUARXZWkLXknTgY5J4nh1kCCBZKEnu4y0UiPqEMpsI9-lKopHYQOboFUuMqFaKlE6-h7I4VTESE6saBI6AqTxXj4JF7cWnE2k77dY5lF2VOHebodC61x_wwaepTra0Q/s1600/Corrigendum+for+Paper+I.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="690" data-original-width="619" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEggEDl4NvQ14wHwrIUARXZWkLXknTgY5J4nh1kCCBZKEnu4y0UiPqEMpsI9-lKopHYQOboFUuMqFaKlE6-h7I4VTESE6saBI6AqTxXj4JF7cWnE2k77dY5lF2VOHebodC61x_wwaepTra0Q/s640/Corrigendum+for+Paper+I.png" width="574" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: "trebuchet ms" , sans-serif;">Corrigendum: Individual external dose monitoring of <br />all citizens of Date City by passive dosimeter 5–51 months after <br />the Fukushima NPP Accident (series): I. Comparison of <br />individual dose with ambient dose rate monitored by aircraft <br />surveys (2016 J. Radiat. Prot. 37 1) <br />(Excerpted from the IOP Science <a href="https://iopscience.iop.org/article/10.1088/1361-6498/aa5c57/pdf" target="_blank">website</a>.)</span></td></tr>
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<span style="font-family: "trebuchet ms" , sans-serif;"> 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.</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;"> Also, please pay particular attention to the fact that the "statement" </span><b style="font-family: "trebuchet ms", sans-serif;">uses the term "revision" rather than "erratum"</b><span style="font-family: "trebuchet ms" , sans-serif;"> <b>or "correction"</b> 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 <b>a way to manipulate people's perception with an arbitrary use of the broad meaning of the word</b>.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large; text-align: justify;"><b>Slickly replacing JRP's request for a corrigendum with a rewrite</b></span></h3>
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<span style="font-family: "trebuchet ms" , sans-serif; text-align: justify;"> Also, as will be described later, it is clear <b>what JRP requested from the authors is not a rewrite but a corrigendum</b>. However, the "statement" says, "</span><span style="text-align: justify; white-space: pre-wrap;"><span style="font-family: "trebuchet ms" , sans-serif;"><b>JRP responded (...) and told us to 'submit a revised version</b>.'</span></span><span style="font-family: "trebuchet ms" , sans-serif; text-align: justify;">" This "revised version" is supposed to be a corrigendum, but Item 4 suggests <b>otherwise</b>.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; text-align: justify;"> Item 4 states, "</span><span style="white-space: pre-wrap;"><span style="font-family: "trebuchet ms" , sans-serif;"><b>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</b>."</span></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; text-align: justify;"> It was originally supposed to be a corrigendum, but somehow "a revised version" <b>has morphed into re-writing the paper after the data is re-supplied by Date City</b>. All that JRP requested is submission of a corrigendum. <b>Replacing that request with rewriting the paper</b> would have to be considered a fraud. </span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; text-align: justify;"> Item 4 also states, "</span><span style="white-space: pre-wrap;"><b><span style="font-family: "trebuchet ms" , sans-serif;">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</span></b><span style="font-family: "arial"; font-size: 10pt;">.</span></span><span style="font-family: "trebuchet ms" , sans-serif; text-align: justify;">"</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; text-align: justify;"> Deletion (more appropriately called "destruction") of data is a violation of the <a href="https://www.mhlw.go.jp/file/06-Seisakujouhou-10600000-Daijinkanboukouseikagakuka/0000080278.pdf" target="_blank">Ethical Guidelines</a> which would be considered research misconduct, as pointed out in the article that I co-authored with another person in the February issue of <i>Kagaku </i>[Note: English translation of an abridged version of the article <strike>will be</strike> is now available on the <a href="https://www.iwanami.co.jp/kagaku/e-Kagaku.html" target="_blank"><i>Kagaku</i> website</a> <strike>soon</strike>. <a href="https://www.iwanami.co.jp/kagaku/eKagaku_201902_Kurokawa_Shima.pdf" target="_blank">PDF download link</a>.] 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 </span><span style="font-family: "trebuchet ms" , sans-serif; white-space: pre-wrap;">Status Report on the Maintenance of Materials and Data which is attached to the </span><span style="font-family: "trebuchet ms" , sans-serif; white-space: pre-wrap;">Research Completion Report that was submitted to Fukushima Medical University (FMU).</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; text-align: justify;"> The "statement" only refers to destruction of the data, but actually the research itself was completed as of October 31, 2018. <b>There is no way to rewrite a paper when the research has already completed and all the data have been destroyed</b>. 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 <b>would no longer be a revised version, but an entirely different paper based on new research</b>. <b>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.</b></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-weight: bold; text-align: justify;"> </span><span style="font-family: "trebuchet ms" , sans-serif; text-align: justify;">Item 3</span><span style="font-family: "trebuchet ms" , sans-serif; font-weight: bold; text-align: justify;"> </span><span style="font-family: "trebuchet ms" , sans-serif; text-align: justify;">states that the authors "</span><span style="white-space: pre-wrap;"><span style="font-family: "trebuchet ms" , sans-serif;">discovered for the first time through a media report" that the data used included data without appropriate consent of Date City residents,</span><span style="font-family: "arial";"><span style="font-size: 13.3333px;"> </span>but the previously mentioned <a href="https://www.iwanami.co.jp/kagaku/eKagaku_201902_Kurokawa_Shima.pdf" target="_blank">article</a> in the February issue of <i>Kagaku </i>clarifies that is not true. The <i>Kagaku</i> article also shows <b>the authors committed six more violations of the Ethical Guidelines</b> in addition to the data destruction. If you are interested in more details, please refer to the <a href="https://www.iwanami.co.jp/kagaku/eKagaku_201902_Kurokawa_Shima.pdf" target="_blank"><i>Kagaku</i> article</a>. </span></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>Hayano avoiding discussions in an academic setting</b></span></h3>
<span style="font-family: "trebuchet ms" , sans-serif;"><b> </b>Lastly, I would like to express my opinion regarding the part, "</span><span style="white-space: pre-wrap;"><span style="font-family: "trebuchet ms" , sans-serif;">As described above, </span></span><span id="docs-internal-guid-2d1f3e4a-7fff-0901-f5b3-915d51d7982f"><span style="font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: "trebuchet ms" , sans-serif;">the serious error in the study is advancing to be addressed in discussions in an academic setting of JRP</span></span></span><span style="font-family: "arial"; font-size: 10pt; white-space: pre-wrap;">.</span><span style="font-family: "trebuchet ms" , sans-serif;">" that appears on the first page of the "statement."</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"> 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 "</span><span style="font-family: "trebuchet ms" , sans-serif; white-space: pre-wrap;">advancing to be addressed in discussions in an academic setting</span><span style="font-family: "trebuchet ms" , sans-serif;">"? Regarding this, Hayano owes a clear explanation.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">*****</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">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, </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">"(...) 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."</span></blockquote>
<span style="font-family: "trebuchet ms" , sans-serif;">As described in the main body of this article, a corrigendum is a simple erratum, not a rewrite of the paper. </span><span style="font-family: "trebuchet ms" , sans-serif;">(An EOC is issued when an editorial office of a journal alerts readers regarding a potential issue in credibility of a paper.)</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">*****</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;"><span style="font-size: large;">Supplementary information regarding the reference to Paper I in the "statement"</span>:</span></h4>
<span style="font-family: "trebuchet ms" , sans-serif;"> Item 1 in the "statement" says, "</span><span style="white-space: pre-wrap;"><span style="font-family: "trebuchet ms" , sans-serif;">I<b>t 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</b>.</span></span><span style="font-family: "trebuchet ms" , sans-serif;">" This phrase strikes as bizarre.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> It was in <b>Paper II</b> that the cumulative doses were calculated, and <b>Paper I says nothing about the cumulative doses</b>. <b>Of course there is no analytical error in Paper I as in Paper II</b>. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> Researchers submitting papers to journals do so because they believe their papers contain no errors. After a paper is published, it is <b>not the author(s) but a community of scientists</b> 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.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> 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 <a href="https://hbol.jp/184914" target="_blank">here</a> only in Japanese).</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">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 <span style="text-align: left;">People's Republic of China International Science and Technology Cooperation Award in 2013. Specializes in accelerator physics.</span></span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">(Translation by <a href="http://yurihiranuma/" target="_blank">Yuri Hiranuma</a>)</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;"><span style="font-family: "times" , "times new roman" , serif;">Citation in AMA style for the article co-authored by Kurokawa and published in the February 2019 issue of Kagaku: </span></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"><span style="font-family: "times" , "times new roman" , serif;">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. </span><i style="font-family: times, "times new roman", serif;">Kagaku</i><span style="font-family: "times" , "times new roman" , serif;">. 2019;89(2):e0017-e0024.</span></span></div>
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@YuriHiranumahttp://www.blogger.com/profile/16819451884150838540noreply@blogger.com0tag:blogger.com,1999:blog-9200156515048577812.post-83230666394212787052019-01-10T00:20:00.000-08:002019-09-28T11:59:24.383-07:00Fukushima Thyroid Examination December 2018: 166 Surgically Confirmed as Thyroid Cancer Among 207 Cytology Suspected Cases<div class="separator" style="clear: both; text-align: center;">
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<span style="font-size: small;"><span style="font-family: "trebuchet ms" , sans-serif;"><i style="font-size: medium;">*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.</i></span></span><br />
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♦Note: This post is likely to be updated with key points from the meeting in the near future.<br />
♦The <span style="font-family: "times" , "times new roman" , serif;">February 21, 2019 update begins below the embedded file, "The Status of the Thyroid Ultrasound Examination."</span><br />
<span style="font-family: "times" , "times new roman" , serif;"><span style="font-family: "times";">♦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.</span></span><br />
<span style="font-family: "times" , "times new roman" , serif;"><span style="font-family: "times";"><br /></span></span>
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For more detailed information on the Fukushima Thyroid Examination itself, see the September 2017 fact sheet (<a href="http://fukushimavoice-eng2.blogspot.com/2017/09/fukushima-thyroid-examination-fact.html" target="_blank">long version</a>, or <a href="https://www.iwanami.co.jp/kagaku/eKagaku_201709_Hiranuma-rev2.pdf" target="_blank">e-published PDF</a>)<br />
<div>
<br /></div>
<span style="font-size: medium;"><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>Highlights:</b></span></span><b style="font-family: "trebuchet ms", sans-serif;"> </b><br />
<ul>
<li><b style="font-family: "Trebuchet MS", sans-serif;">The third round: 3 cases newly diagnosed as suspicious or malignant, and 2 new cases surgically confirmed.</b></li>
<li><b style="font-family: "Trebuchet MS", sans-serif;">The fourth round: No cytology conducted yet as of September 30, 2018.</b></li>
<li><b style="font-family: "Trebuchet MS", sans-serif;">Age 25 Milestone Screening for those born in FY1992: 2 cases diagnosed as suspicious or malignant. No surgery yet.</b></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><b>Total number of suspected/confirmed thyroid cancer is now</b> <span style="color: red; font-weight: bold;">206</span><span style="color: red; font-weight: bold;"> </span><b>(</b><b style="font-family: "trebuchet ms", sans-serif; font-weight: bold;"><i>excluding</i> a single case of benign tumor; </b><b>115 in the first round, 71 in the second round, 18 in the third round, and 2 in Age 25 Milestone Screening).</b></span></li>
<li><b style="font-family: "Trebuchet MS", sans-serif;">Total number of surgically confirmed thyroid cancer cases has increased by 2 to <span style="color: red;">166 </span>(101 in the first round, 52 in the second round, and 13 in the third round).</b></li>
</ul>
<div>
<b><span style="font-size: large;"><span style="font-family: "trebuchet ms" , sans-serif;">The latest overall results including "unreported" cases:</span></span></b><br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgX35gLfk33XS6sd8IQV0z5avibCYHVw4wXaGH8laSbues34ACNmh9SiHuSxWziN_njqVdU5k4BTbcV3EOlLfJpJL7uNv81gGA_0g57xDESSC3K3PWt7Prc70Dx-CVQkJqsKA9l3AFNlqXP/s1600/%252333+data+as+of+9-30-18.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="419" data-original-width="667" height="402" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgX35gLfk33XS6sd8IQV0z5avibCYHVw4wXaGH8laSbues34ACNmh9SiHuSxWziN_njqVdU5k4BTbcV3EOlLfJpJL7uNv81gGA_0g57xDESSC3K3PWt7Prc70Dx-CVQkJqsKA9l3AFNlqXP/s640/%252333+data+as+of+9-30-18.png" width="640" /></a></div>
<span style="font-family: "trebuchet ms" , sans-serif;"><i>(See <a href="https://fukushimavoice-eng2.blogspot.com/2018/07/results-of-survey-on-fukushima-thyroid.html" target="_blank">this post</a> for the details of the "unreported" cases.)</i></span><br />
<br />
<span style="font-family: "trebuchet ms" , sans-serif;">On December 27, 2018, the 33rd Oversight Committee for Fukushima Health Management Survey (FHMS) convened in Fukushima City, Fukushima Prefecture. Among other information, </span><span style="font-family: "trebuchet ms" , sans-serif;">the Oversight Committee released the latest results (as of September 30, 2018) of </span><span style="font-family: "trebuchet ms" , sans-serif;">Thyroid Ultrasound Examination (TUE) including</span><span style="font-family: "trebuchet ms" , sans-serif;"> the</span><span style="font-family: "trebuchet ms" , sans-serif;"> <a href="http://fmu-global.jp/download/33rd_fukushima-health-management-survey_report-of-third-round-thyroid-ultrasound-examinations/?wpdmdl=4838" target="_blank">third</a> and <a href="http://fmu-global.jp/download/33rd_fukushima-health-management-survey_report-of-fourth-round-thyroid-ultrasound-examinations/?wpdmdl=4839" target="_blank">fourth</a> rounds as well as the <a href="http://fmu-global.jp/download/33rd_thyroid-ultrasound-examinations_for-25/?wpdmdl=4840" target="_blank">Age 25 Milestone Screening</a> for those born in FY1992. Official English translation will be available <a href="http://fmu-global.jp/our-activities/prefectural-oversight-committee-meeting/" target="_blank">here</a> in the near future. <i>(Note on April 9, 2019: Official English translation was finally posted <a href="http://fmu-global.jp/survey/the-33rd-prefectural-oversight-committee-meeting-for-fukushima-health-management-survey/" target="_blank">here</a> on April 5, 2019.) </i></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span><span style="font-family: "trebuchet ms" , sans-serif;">A five-page <a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/303578.pdf" target="_blank">summary</a> 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. </span><a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/303578.pdf" style="font-family: "trebuchet ms", sans-serif;" target="_blank">This summary</a> <span style="font-family: "trebuchet ms" , sans-serif;">is <i>not</i> translated into English officially,</span><span style="font-family: "trebuchet ms" , sans-serif;"> but here's an unofficial translation. </span><br />
<br /></div>
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<u><span style="font-family: "trebuchet ms" , sans-serif;">Updated on February 20, 2019</span></u><br />
<span style="font-family: "trebuchet ms" , sans-serif;">Other topics covered at this Oversight Committee meeting include:</span><br />
<ol>
<li><span style="font-family: "trebuchet ms" , sans-serif;">Publication report of a paper in Scientific Reports.</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;">A report from the Eleventh session of the Thyroid Examination Assessment Subcommittee held on October 29, 2018.</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;">Recommendations by the IARC Expert Group on Thyroid Monitoring after Nuclear Accidents (TM-NUC). (See <a href="https://fukushimavoice-eng2.blogspot.com/2017/11/circumstances-regarding-japan-sponsored.html" target="_blank">this post</a> on what TM-NUC is all about.) </span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;">A compilation of surgical and pathological features of 125 thyroid cancer cases.</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;">A revision of the TUE support project provisions.</span></li>
</ol>
<div>
<b><span style="font-family: "trebuchet ms" , sans-serif;">1. </span><span style="font-family: "trebuchet ms" , sans-serif;">Publication report of a paper in Scientific Reports</span></b><br />
<b><span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></b></div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"> An FMU official reported publication of a paper, "</span><span style="font-family: "trebuchet ms" , sans-serif;">Spatial analysis of the geographical distribution of thyroid cancer cases from the first-round thyroid ultrasound examination in Fukushima Prefecture." (<a href="https://www.nature.com/articles/s41598-018-35971-7" target="_blank">link</a>) The paper concluded </span><span style="font-family: "trebuchet ms" , sans-serif;">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.</span></div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"><b>2. A report from the Eleventh session of the Thyroid Examination Assessment Subcommittee </b></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><b><br /></b></span></div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"> 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 <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/303570.pdf" target="_blank">here</a>. (The list of the materials handed out at the subcommittee meeting is available <a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kentoiinkai-b11.html" target="_blank">here</a>, and the detailed summary of this subcommittee meeting is included in pages 6-16 of the <a href="https://www.iwanami.co.jp/kagaku/eKagaku_201902_Hiranuma.pdf" target="_blank">Japanese article</a> e-published on the <i>Kagaku</i> website.)</span></div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"> <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/295101.pdf" target="_blank">Analyses conducted by FMU on the second round results</a> only include data from those who participated in <i>both the first and the second rounds</i>, 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 </span><span style="font-family: "trebuchet ms" , sans-serif;">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 <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/303570.pdf" target="_blank">report</a>), 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. </span></div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"> 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. </span></div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"> 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 </span><span style="font-family: "trebuchet ms" , sans-serif;">FMU's partial analysis of some of the first and second round data (available only in Japanese </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/278761.pdf" style="font-family: "trebuchet ms", sans-serif;" target="_blank">here</a> <span style="font-family: "trebuchet ms" , sans-serif;">and also included in the <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/303570.pdf" target="_blank">report</a> from the 11th subcommittee meeting</span><span style="font-family: "trebuchet ms" , sans-serif;">) released at the 10th subcommittee meeting on July 8, 2018 (described in <a href="https://fukushimavoice-eng2.blogspot.com/2018/10/fukushima-thyroid-examination-september.html" target="_blank">this post</a>). </span><span style="font-family: "trebuchet ms" , sans-serif;">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. </span></div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"> Subcommittee Chair Suzuki announced that <a href="http://www.unscear.org/docs/publications/2013/UNSCEAR_2013_Annex-A_Attach_C-16.pdf" target="_blank">thyroid doses by municipality and age group estimated by UNSCEAR</a> 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).</span></div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"> Regarding the TUE conducted in a school setting (herein, </span><span style="font-family: "trebuchet ms" , sans-serif;">school screening),</span><span style="font-family: "trebuchet ms" , sans-serif;"> 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. </span></div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"> 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.</span></div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"> Toru Takano of Osaka University, who is also a subcommittee member (he is <i>the</i> </span><i style="font-family: "Trebuchet MS", sans-serif;">only </i><span style="font-family: "trebuchet ms" , sans-serif;">dual member) and a vocal opponent of the school screening, explained that, in accordance with the Declarations of Helsinki, the adverse effects of </span><span style="font-family: "trebuchet ms" , sans-serif;">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</span><span style="font-family: "trebuchet ms" , sans-serif;">, commonly experienced by cancer patients, </span><span style="font-family: "trebuchet ms" , sans-serif;">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, <i>not</i> something that should be used as a reason to stop the TUE or the school screening. </span></div>
<br />
<div>
</div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;">Table 1: Detection rates of suspected/confirmed thyroid cancer in the second round by age group</span></div>
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Name="List Number 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 5"/>
<w:LsdException Locked="false" Priority="10" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Closing"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Signature"/>
<w:LsdException Locked="false" Priority="1" SemiHidden="true"
UnhideWhenUsed="true" Name="Default Paragraph Font"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Message Header"/>
<w:LsdException Locked="false" Priority="11" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Salutation"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Date"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Heading"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Block Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Hyperlink"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="FollowedHyperlink"/>
<w:LsdException Locked="false" Priority="22" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Document Map"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Plain Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="E-mail Signature"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Top of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Bottom of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal (Web)"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Acronym"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Address"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Cite"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Code"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Definition"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Keyboard"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Preformatted"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Sample"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Typewriter"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Variable"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal Table"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="annotation subject"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="No List"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Contemporary"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Elegant"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Professional"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Balloon Text"/>
<w:LsdException Locked="false" Priority="39" Name="Table Grid"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Theme"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" QFormat="true"
Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" QFormat="true"
Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" QFormat="true"
Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" QFormat="true"
Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" QFormat="true"
Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" QFormat="true"
Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" SemiHidden="true"
UnhideWhenUsed="true" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/>
<w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/>
<w:LsdException Locked="false" Priority="42" Name="Plain Table 2"/>
<w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/>
<w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/>
<w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/>
<w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/>
<w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 2"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 2"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 2"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 3"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 3"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 3"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 3"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 4"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 4"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 4"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 4"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 5"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 5"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 5"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 5"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 5"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 6"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 6"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 6"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 6"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 6"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 6"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 6"/>
<w:LsdException Locked="false" Priority="46" Name="List Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 2"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 2"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 2"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="46"
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<span style="font-family: "trebuchet ms" , sans-serif;">Table 3: Detection rates of suspected/confirmed thyroid cancer in the second round by region</span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjsO37ic5DBOnSgQtfPfakQcWELqBzDiWPfs6KfR28qeTt79leEFbgTVZn6A3kmiXcMO0vOO0uyqE8wxIvbrczmMLxznsWKdC3-Lk8TMWF_O-8vGVWrqJlMWiWOKKex115VbPt4QVeQ7eZF/s1600/Screen+Shot+2019-02-18+at+11.36.21+PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em; text-align: center;"><img border="0" data-original-height="419" data-original-width="465" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjsO37ic5DBOnSgQtfPfakQcWELqBzDiWPfs6KfR28qeTt79leEFbgTVZn6A3kmiXcMO0vOO0uyqE8wxIvbrczmMLxznsWKdC3-Lk8TMWF_O-8vGVWrqJlMWiWOKKex115VbPt4QVeQ7eZF/s1600/Screen+Shot+2019-02-18+at+11.36.21+PM.png" /></a></div>
<!--EndFragment--><br />
<div>
<span style="font-family: "trebuchet ms" , sans-serif; text-align: center;">Table 4: Detection rates of suspected/confirmed thyroid cancer in the second round by screening year for the primary examination in the first round</span></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDuqwJctqz7VJ0y9X0qVrBLK2rxZgBsbFEuaTFg1ek24j3ktv52eP9nW1wNTM76i_bebQmMjuhgIRQXgavzPb-MV56SurMAMyOjWp7239MvNI9VVHC1-MwV8QnoyIYgOywlB3jZEMZYd3Z/s1600/Screen+Shot+2019-02-18+at+10.18.20+PM.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="418" data-original-width="460" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDuqwJctqz7VJ0y9X0qVrBLK2rxZgBsbFEuaTFg1ek24j3ktv52eP9nW1wNTM76i_bebQmMjuhgIRQXgavzPb-MV56SurMAMyOjWp7239MvNI9VVHC1-MwV8QnoyIYgOywlB3jZEMZYd3Z/s1600/Screen+Shot+2019-02-18+at+10.18.20+PM.png" /></a></td></tr>
</tbody></table>
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<br /></div>
<b><span style="font-family: "trebuchet ms" , sans-serif;">3. </span><span style="font-family: "trebuchet ms" , sans-serif;">Recommendations by the IARC Expert Group on Thyroid Monitoring after Nuclear Accidents (TM-NUC)</span></b><br />
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"> </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> An official from Ministry of the Environment (MOE) presented a Japanese translation of the TM-NUC recommendations, which is actually a translation of an <a href="https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(18)30680-6/fulltext" target="_blank">article</a> published in the Lancet Oncology, "Long-term strategies for thyroid health monitoring after nuclear accidents: recommendations from an Expert Group convened by IARC." T</span><span style="font-family: "trebuchet ms" , sans-serif;">ranslation 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 <a href="https://fukushimavoice-eng2.blogspot.com/2017/11/circumstances-regarding-japan-sponsored.html" target="_blank">this post</a>.) The entire report, "Thyroid health monitoring after nuclear accidents," issued as "</span><span style="font-family: "trebuchet ms" , sans-serif;"><a href="http://publications.iarc.fr/_publications/media/download/4947/3800bc75449e052deef18957446717c07d7d7399.pdf" target="_blank">IARC Technical Publication 46</a>" can be accessed from the <a href="http://tmnuc.iarc.fr/en/DescriptionOfWork" target="_blank">TM-NUC website</a> or the <a href="http://publications.iarc.fr/571" target="_blank">IARC website</a> (or from <a href="http://publications.iarc.fr/_publications/media/download/4947/3800bc75449e052deef18957446717c07d7d7399.pdf" target="_blank">this PDF link</a>.) </span><span style="font-family: "trebuchet ms" , sans-serif;">For clarification, the TM-NUC recommendations are <i>not</i> meant to be applied to the TUE already undergoing in Fukushima. </span></div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"> As described in <a href="http://tmnuc.iarc.fr/public/docs/TM-NUC_lay_summary_final2.pdf" target="_blank">this summary</a>, the IARC Expert Group recommends against <i>population thyroid screening</i>, 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 </span><span style="font-family: "trebuchet ms" , sans-serif;">recommends a </span><i style="font-family: "Trebuchet MS", sans-serif;">long-term thyroid monitoring program in higher-risk individuals</i><span style="font-family: "trebuchet ms" , sans-serif;">. 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 <i>screening</i> is distinguished from <i>monitoring</i>. The recommendations do <i>not</i> preclude lower-risk individuals with lower doses from participating in the monitoring program after fully informed of pros and cons of thyroid examinations.</span></div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"> 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.</span></div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"> 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.</span></div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"> 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. </span></div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"> 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, g</span><span style="font-family: "trebuchet ms" , sans-serif;">iven 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.")</span></div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"> Another issue with Tsugane's remark about how the </span><span style="font-family: "trebuchet ms" , sans-serif;">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 <i>not</i> include any cancer cases diagnosed during clinical follow-up </span><span style="font-family: "trebuchet ms" , sans-serif;">("unreported cases") </span><span style="font-family: "trebuchet ms" , sans-serif;">or undergoing surgery at non-FMU medical facilities. Thus, TM-NUC <i>could not</i> have </span><span style="font-family: "trebuchet ms" , sans-serif;">"learned and understood all that has happened in Fukushima's TUE," as recognized by Tsugane. </span><span style="font-family: "trebuchet ms" , sans-serif;">(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 <i>all</i> cases diagnosed during a given period.)</span></div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"> 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.</span></div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"><b>4. A compilation of surgical and pathological features of 125 thyroid cancer cases</b></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><b><br /></b></span></div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"> This <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/303579.pdf" target="_blank">handout</a> titled "Regarding surgical cases at Fukushima Medical University hospital" is a compilation of clinical information already released and included in the following four references:</span></div>
<ul>
<li><span style="font-family: "trebuchet ms" , sans-serif;">"<a href="https://www.sciencedirect.com/science/article/pii/B9780128127681000150" target="_blank">The features of childhood and adolescent thyroid cancer after Fukushima nuclear power plant accident</a>" by Shinichi Suzuki in a book titled "<a href="https://www.sciencedirect.com/book/9780128127681/thyroid-cancer-and-nuclear-accidents" target="_blank">Thyroid Cancer and Nuclear Accidents</a>" which was a compilation of presentations at the <a href="http://fmu-global.jp/workshop/symposium/26-27-sep-2016-5th-intl-expert-symposium-in-fukushima-2/" target="_blank">5th International Expert Symposium</a> held on September 26-27, 2016 in Fukushima. (Most of the information is included in Suzuki's presentation slides accessed <a href="http://fmu-global.jp/download/shinichi-suzuki/?wpdmdl=2047" target="_blank">here</a> and explained in <a href="https://fukushimavoice-eng2.blogspot.com/2016/10/clinicopathological-findings-of.html" target="_blank">the previous post</a>.)</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"> "<a href="https://www.liebertpub.com/doi/10.1089/thy.2017.0283" target="_blank">Lessons from Fukushima: Latest findings of Thyroid Cancer After the Fukushima Nuclear PowerPlant Accident</a>" by Yamashita et al., published in the January 2018 issue of <i>Thyroid</i>. (<a href="https://www.liebertpub.com/doi/10.1089/thy.2017.0283" target="_blank">link</a>)</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"> "<a href="https://www.nature.com/articles/srep16976" target="_blank">BRAF(V600E) mutation is highly prevalent in thyroid carcinomas in the young population in Fukushima: a different oncogenic profile from Chernobyl</a>" by Mitsutake et al., published in the November 5, 2015 issue of <i>Scientific Report</i>. (<a href="https://www.nature.com/articles/srep16976" target="_blank">link</a>)</span></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;">An additional handout at the 32nd Oversight Committee meeting held on September 5, 2018, titled "Regarding surgically indicated cases (report of corrections)" accessed <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/287608.pdf" target="_blank">here</a>. What was actually corrected is explained in <a href="https://fukushimavoice-eng2.blogspot.com/2018/10/fukushima-thyroid-examination-september.html" target="_blank">this post</a> under the section, "Correction of the number of surgeries conducted outside FMU."</span></li>
</ul>
<div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"> 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 <i><a href="https://www.kanehara-shuppan.co.jp/books/detail.html?isbn=9784307203500" target="_blank">Thyroid Cancer Management Guidelines</a></i>. 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.</span></div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"> More information about inconsistencies of the second and third references will be added at the end of the current post.</span></div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"><b>5. A revision of the TUE support program provisions</b></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><b><br /></b></span></div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"> As explained in the<a href="https://fukushimavoice-eng2.blogspot.com/2018/07/fukushima-thyroid-examination-in-june.html" target="_blank"> July 2018 post</a>, 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 <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/303575.pdf" target="_blank">this handout</a> 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 <a href="https://www.pref.fukushima.lg.jp/site/portal/kenkocyosa-kojyosen-support.html" target="_blank">Fukushima Prefecture website</a>, 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. </span></div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"> The TUE support program offers financial support in exchange for some clinical information. The revision also calls for an additional collection of clinical information</span><span style="font-family: "trebuchet ms" , sans-serif;">, such as the presence of distant metastasis, which is</span><span style="font-family: "trebuchet ms" , sans-serif;"> necessary for continuous support.</span></div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"> In Fukushima Prefecture, children aged 18 or younger receive free medical care until the end of fiscal year when they turn 18. </span><span style="font-family: "trebuchet ms" , sans-serif;">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.</span></div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"> </span></div>
<div>
<span style="font-family: "trebuchet ms" , sans-serif;"> 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 </span><span style="font-family: "trebuchet ms" , sans-serif;">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</span><span style="font-family: "trebuchet ms" , sans-serif;"> did clarify that there were indeed</span><span style="font-family: "trebuchet ms" , sans-serif;"> 77 </span><span style="font-family: "trebuchet ms" , sans-serif;">cancer</span><span style="font-family: "trebuchet ms" , sans-serif;"> cases.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"> </span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span></div>
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</style>@YuriHiranumahttp://www.blogger.com/profile/16819451884150838540noreply@blogger.com0tag:blogger.com,1999:blog-9200156515048577812.post-87585298907446407252018-10-01T00:45:00.000-07:002019-05-19T13:49:38.041-07:00Fukushima Thyroid Examination September 2018: 164 Surgically Confirmed as Thyroid Cancer Among 201 Cytology Suspected Cases<br class="Apple-interchange-newline" />
For more detailed information on the Fukushima Thyroid Examination itself, see the September 2017 fact sheet (<a href="http://fukushimavoice-eng2.blogspot.com/2017/09/fukushima-thyroid-examination-fact.html" target="_blank">long version</a>, or <a href="https://www.iwanami.co.jp/kagaku/eKagaku_201709_Hiranuma-rev2.pdf" target="_blank">e-published PDF</a>)<br />
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<span style="font-size: medium;"><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><b>Highlights:</b></span></span><b style="font-family: "trebuchet ms", sans-serif;"> </b><br />
<ul>
<li><b style="font-family: "Trebuchet MS", sans-serif;">The third round: 3 cases newly diagnosed as suspicious or malignant, and 2 new cases surgically confirmed.</b></li>
<li><b style="font-family: "Trebuchet MS", sans-serif;">The fourth round began on April 1, 2018.</b></li>
<li><span style="font-family: "trebuchet ms" , sans-serif;"><b>Total number of suspected/confirmed thyroid cancer is now</b> <span style="color: red; font-weight: bold;">201</span><span style="color: red; font-weight: bold;"> </span><b>(</b><b style="font-family: "trebuchet ms", sans-serif; font-weight: bold;"><i>excluding</i> a single case of benign tumor; </b><b>115 in the first round, 71 in the second round, and 15 in the third round).</b></span></li>
<li><b style="font-family: "Trebuchet MS", sans-serif;">Total number of surgically confirmed thyroid cancer cases has increased by 2 to <span style="color: red;">164</span> (101 in the first round, 52 in the second round, and 11 in the third round)</b></li>
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<b><span style="font-size: large;"><span style="font-family: "trebuchet ms" , sans-serif;">The latest overall results:</span></span></b></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkr7rOlCovDNVKBqrOgeBA6wUFkLD62TB1MwISiK3G-mKsHC2NSYkrJI19LFdtei0JyRj_oA4brUQ9Z5gu1NrtC-bURbsjQIHpNk2jgKNvfGJMeyCaWLfnQ7sso95griGEEmaQx1DPFwWr/s1600/%252332+results+table.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="164" data-original-width="608" height="172" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkr7rOlCovDNVKBqrOgeBA6wUFkLD62TB1MwISiK3G-mKsHC2NSYkrJI19LFdtei0JyRj_oA4brUQ9Z5gu1NrtC-bURbsjQIHpNk2jgKNvfGJMeyCaWLfnQ7sso95griGEEmaQx1DPFwWr/s640/%252332+results+table.png" width="640" /></a></div>
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<i><span style="font-family: "trebuchet ms" , sans-serif;">(Scroll down for the latest results including the "unreported" cases explained in <a href="https://fukushimavoice-eng2.blogspot.com/2018/07/results-of-survey-on-fukushima-thyroid.html" target="_blank">this post</a>.)</span></i><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span><span style="font-family: "trebuchet ms" , sans-serif;">On September 5, 2018, the 32nd Oversight Committee for Fukushima Health Management Survey (FHMS) convened in Fukushima City, Fukushima Prefecture. Among other information, </span><span style="font-family: "trebuchet ms" , sans-serif;">the Oversight Committee released the latest results (as of June 30, 2018) of the</span><span style="font-family: "trebuchet ms" , sans-serif;"> <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/287518.pdf" target="_blank">third</a> and <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/287519.pdf" target="_blank">fourth</a> rounds of the Thyroid Ultrasound Examination (TUE). </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">A four-page <a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/287524.pdf" target="_blank">summary</a> 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. </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/287524.pdf" style="font-family: "trebuchet ms", sans-serif;" target="_blank">This summary</a> <span style="font-family: "trebuchet ms" , sans-serif;">is <i>not</i> translated into English officially,</span><span style="font-family: "trebuchet ms" , sans-serif;"> but here's an unofficial translation. </span><br />
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<a href="https://www.scribd.com/document/389832536/Status-of-the-Thyroid-Ultrasound-Examination-September-5-2018#from_embed" style="text-decoration: underline;" target="_blank" title="View Status of the Thyroid Ultrasound Examination (September 5, 2018) on Scribd">Status of the Thyroid Ultrasound Examination (September 5, 2018)</a> by <a href="https://www.scribd.com/user/233065310/Yuri-Hiranuma#from_embed" style="text-decoration: underline;" title="View Yuri Hiranuma's profile on Scribd">Yuri Hiranuma</a> on Scribd</div>
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<b><span style="font-size: large;">Key points from the Oversight Committee:</span></b></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: 14px;"><br /></span><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><u>Target population shrinks</u></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;">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).</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">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 <i>not</i> be reflected in the age distribution graphs of the main dataset. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">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.</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><u>Participation rates</u></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">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 </span><span style="font-family: "trebuchet ms" , sans-serif;">(age at examination)</span><span style="font-family: "trebuchet ms" , sans-serif;"> has gone from already low 25.7% in the second round to even lower 15.9% in the third round. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">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.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><u>Correction of the number of surgeries conducted outside FMU</u></span></div>
<span style="font-family: "trebuchet ms" , sans-serif;">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.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">So far clinicopathological information on surgical cases have been released three times: as a document called </span><span style="font-family: "trebuchet ms" , sans-serif;">"Regarding Surgical Indicated Cases" in</span><span style="font-family: "trebuchet ms" , sans-serif;"> </span><a href="http://fukushimavoice-eng2.blogspot.com/2014/11/details-of-fukushima-thyroid-cancer.html" style="font-family: "trebuchet ms", sans-serif;" target="_blank">November 2014</a><span style="font-family: "trebuchet ms" , sans-serif;"> (at the 4th Thyroid Examination Assessment Subcommittee) and</span><span style="font-family: "trebuchet ms" , sans-serif;"> </span><a href="http://fukushimavoice-eng2.blogspot.com/2015/09/surgical-and-pathological-details-of.html" style="font-family: "trebuchet ms", sans-serif;" target="_blank">August 2015</a><span style="font-family: "trebuchet ms" , sans-serif;"> (at the 20th Oversight Committee);</span><span style="font-family: "trebuchet ms" , sans-serif;"> and presented at an international symposium in </span><a href="http://fukushimavoice-eng2.blogspot.com/2016/10/clinicopathological-findings-of.html" style="font-family: "trebuchet ms", sans-serif;" target="_blank">September 2016</a>.<span style="font-family: "trebuchet ms" , sans-serif;"> (Note</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;">the 2016 information was later reported as "Regarding Surgical Indicated Cases" </span><span style="font-family: "trebuchet ms" , sans-serif;">at the 8th Thyroid Examination Assessment Subcommittee in November 2017. This means and no <i>new </i>clinical information has been reported to the Oversight Committee since 2016.) </span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">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. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">A closer look at the 2016 number shows that there were 132 surgical cases between August 2012 and March 2016 (see Slide 1 in <a href="http://fukushimavoice-eng2.blogspot.com/2016/10/clinicopathological-findings-of.html" target="_blank">this post</a>). 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. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">However, this creates another discrepancy because Slide 2 of <a href="http://fukushimavoice-eng2.blogspot.com/2016/10/clinicopathological-findings-of.html" target="_blank">this post</a> discusses "Characteristics of 125 thyroid cancers at Fukushima Medical University", not 124. This was resolved in </span><span style="font-family: "trebuchet ms" , sans-serif;">the </span><a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/287608.pdf" style="font-family: "trebuchet ms", sans-serif;" target="_blank">correction report</a><span style="font-family: "trebuchet ms" , sans-serif;"> (only in Japanese) which explained that the clinicopathological details given on 125 FMU surgical cases includes the April 2016 case.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"> </span><br />
<u style="font-family: "trebuchet ms", sans-serif;"><span style="font-size: large;">Non-FMU surgical cases have not been kept track of</span></u><br />
<span style="font-family: "trebuchet ms" , sans-serif;">In relation to the above corrections, </span><span style="font-family: "helvetica" , "arial" , sans-serif;">Hiroki Shimura, head of the TUE program,</span><span style="font-family: "trebuchet ms" , sans-serif;"> 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 </span><span style="font-family: "trebuchet ms" , sans-serif;">on the last page of the report, </span><i style="font-family: "trebuchet ms", sans-serif;">separately</i><span style="font-family: "trebuchet ms" , sans-serif;"> 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. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">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. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">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.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">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.</span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">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.</span><br />
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<span style="font-size: large;"><u>Reluctance on releasing detailed data</u></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">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, <span style="background-color: transparent; color: #333333;">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.</span> </span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">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 <a href="https://www.liebertpub.com/doi/full/10.1089/thy.2018.29065.abstracts" target="_blank">here</a>.)</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvF7ydY3RYZERZD8Hkk6g2ZvQDgdJMYB_gW9Ymkz1bsZOWPjHKLM1WsCkD4Xv9p4nAZPgC9qOvz1oEFsaorrkcldyvt6mIPYbxrN-DzDxAuQ0blhcq5MjJS3CAnQJIs4sh8l4hOAbXXhH8/s1600/Screen+Shot+2018-09-30+at+11.26.30+PM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="594" data-original-width="792" height="480" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhvF7ydY3RYZERZD8Hkk6g2ZvQDgdJMYB_gW9Ymkz1bsZOWPjHKLM1WsCkD4Xv9p4nAZPgC9qOvz1oEFsaorrkcldyvt6mIPYbxrN-DzDxAuQ0blhcq5MjJS3CAnQJIs4sh8l4hOAbXXhH8/s640/Screen+Shot+2018-09-30+at+11.26.30+PM.png" width="640" /></a></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">Furthermore, FMU's partial analysis of some of the first and second round data (available only in Japanese </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/278761.pdf" style="font-family: "trebuchet ms", sans-serif;" target="_blank">here</a><span style="font-family: "trebuchet ms" , sans-serif;">) 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 </span><a href="https://www.pref.fukushima.lg.jp/uploaded/attachment/286866.pdf" style="font-family: "trebuchet ms", sans-serif;" target="_blank">here</a><span style="font-family: "trebuchet ms" , sans-serif;"> in Japanese). At the time, FMU officials asserted as before that detailed information were not to be released for the protection of patient privacy. </span><br />
<span style="font-family: "trebuchet ms" , sans-serif;"><br /></span>
<span style="font-family: "trebuchet ms" , sans-serif;">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.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">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 <a href="http://fukushimavoice-eng2.blogspot.com/2018/07/results-of-survey-on-fukushima-thyroid.html" target="_blank">unreported cases</a> clinically and surgically managed at FMU (see the post on the previous Oversight Committee meeting <a href="http://fukushimavoice-eng2.blogspot.com/2018/07/fukushima-thyroid-examination-in-june.html" target="_blank">here</a>). Kasuga also made a similar request.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><u>The latest overall results including "unreported" cases</u></span><br />
<span style="font-family: "trebuchet ms" , sans-serif;">Here's the latest results including unreported cases. </span><i style="font-family: "trebuchet ms", sans-serif;">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)</i></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"><span style="font-size: large;"><u>The first round results</u> </span><span style="font-size: x-small;">(no change from the previous report)</span></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">From the <a href="http://fmu-global.jp/download/thyroid-ultrasound-examination-supplemental-report-of-the-fy-2016-surveypreliminary-baseline-screening/?wpdmdl=2690" target="_blank">FY 2016 supplemental report</a> with data as of March 31, 2017. (<a href="http://www.pref.fukushima.lg.jp/uploaded/attachment/273522.pdf" target="_blank">Summary report</a> 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.)</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif; font-size: 14px;"><span style="font-size: large;"><u>The second round results</u> </span></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">No change since the March 5, 2018 Oversight Committee meeting.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"><span style="font-size: large;"><u>The third round results</u></span></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">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.</span></div>
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