The Atomic Age

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An issue of the female to male ratio
The female to male ratio of cancer cases warrants a special attention. For thyroid cancer, the female to male ratio is nearly 1:1 in the very young, but it is known to increase with age and decrease with radiation exposure. In the second round, the female to male ratio has been decreasing with successive results. It was 1.36:1 when the results were released in September 2016, and now it is 1.19:1.

Towards the end of the press conference, Mako Oshidori sharply asked why there has been no evaluation regarding the female to male ratio in the Fukushima thyroid cancer cases. (For the transcript of her question in Japanese, see here). She pointed out that Kazuo Shimizu, a committee member and thyroid surgeon, has asked questions regarding the female to male ratio issue multiple times in the past three and a half years. In fact, Ohtsuru responded to an earlier question by Shimizu during this meeting that the female to male ratio issue is yet to be evaluated by Fukushima Medical University and that the committee meeting was simply a place where results were presented.

Oshidori chastised Fukushima Medical University for not even trying to compare results with existing outside data and conduct any analysis in all these years. In response, Ohtsuru acknowledged that the female to male ratio is smaller than what is clinically expected but explained they were not sure what is causing it. Oshidori stated there was no scientific paper that showed a decrease in the female to male ratio due to the screening activity. Rather, scientific evidence shows screening activities generally increase the female to male ratio due to more females being diagnosed with thyroid cancer. Ohtsuru replied that it is true that screening activities increased the female to male ratio in adults but it was unclear if the similar trend is expected in children. Furthermore, differences in a screening frequency and screening equipments should be taken into consideration. Oshidori acknowledged there was much to be considered and pressed for the Thyroid Examination Evaluation Subcommittee to be reconvened.

A new third-party committee proposed
At the end of the Oversight Committee meeting, an issue was raised by Chairman Hokuto Hoshi relating to the recommendations received by the Fukushima governor from the 5th International Expert Symposium in Fukushima on Radiation and Health: “Chernobyl+30, Fukushima+5 – Lessons and Solutions for Fukushima’s Thyroid Question.” (See this post for more information on the symposium). Hiroyuki Kobayashi, a Fukushima prefectural government official in charge of the Fukushima Health Management Survey, reported that the governor received the recommendations on December 9, 2016. Kobayashi stated that the prefectural government has received opinions and suggestions from various entities and the recommendations by the 5th International Expert Symposium were placed in the same category (as if to explain the recommendations did not have any special status). Kobayashi then asked the committee to discuss the recommendations.

In his monologue, Chairman Hoshi went on to propose an establishment of an “international, third-party, neutral, scientific, up-to-date and evidence-based” expert committee that would discuss issues surrounding the TUE and present information in a manner that would aid the “understanding by Fukushima residents.” This proposal appeared to be taken from the item number 4 of the recommendations “to convene the expert working groups on ‘Nuclear Disasters and Health Monitoring,’ especially focusing on thyroid problems, could provide professional recommendations to the current TUE in Fukushima in the future.”

Chairman Hoshi proceeded to have some of the committee members explain how third-party evaluation committees function at the Radiation Effect Research Foundation (RERF) and the National Institute of Radiological Sciences (NIRS). This clearly came as a surprise to those who were asked to make presentations on the spot, creating a slightly uncomfortable atmosphere.

Multiple questions and opinions ensued during the press conference doubting the necessity and validity of such a new third-party committee when the Oversight Committee’s own Thyroid Examination Evaluation Subcommittee, which last met in March 2015 and issued a mid-term report on the first round screening, has not even been reconvened to consider the second round screening results. (At the last Oversight Committee meeting held on September 14, 2016, the FMU officials said the second round screening data would be analyzed when all the second round data is in, and the Oversight Committee itself seemed to be waiting for the completion of the second round rather than holding the subcommittee meetings concurrently).

Regarding the future status of the TUE
The recommendations by The 5th International Symposium include clauses such as:

“(…) thyroid screening of people who do not have symptoms of possible thyroid disease has the potential to do more harm than good to the population, and should only be carried out, when clear benefits to the population can be defined.”

“Participation in the health surveys and the thyroid screening program should be voluntary.”

It should be noted that the recommendations did not consider opinions by Chernobyl researchers such as Yuri Demidchik from Belarus, Tetiana Bogdanova from Ukraine and Pavel Rumiantsev from Russia, whose presentations at the symposium made clear that thyroid ultrasound screening is beneficial, since their names are not included in the list of invited experts who were consulted.

[…]Moreover, the clinical information of cancer cases is not taken into consideration. In fact, clinical data is not willingly released citing the privacy protection of the patients. Shinichi Suzuki’s presentation at the 5th International Symposium came as a surprise (see this post for details). Concerning clinical features include:

• a high rate of lymph node metastases
• microcarcinoma (diameter ≤ 10 mm) requiring surgical intervention for various reasons–cancer cells moving outside the thyroid capsule or invading surrounding structures such as the trachea or the recurrent laryngeal nerve
• a low female to male ratio

It is precisely these clinical features that should be discussed at the Thyroid Examination Evaluation Subcommittee, given the fact there are many unknowns about thyroid cancer in children and young adults diagnosed by screening before clinical symptoms appear.

Thyroid cancer cases outside Fukushima Prefecture
Furthermore, an independent group, “311 Fund for Children with Thyroid Cancer ,” established on the principles of the Nuclear Accident Child Victims’ Support Law which was enacted but never actually carried out by the Japanese government, released some information at a December 27, 2016 press conference, shortly before the 25th Oversight Committee meeting. The 311 Fund for Children with Thyroid Cancer collects donations nationwide and offers 100,000 yen (about $864 at today’s exchange rate) to an individual aged 25 or younger diagnosed with thyroid cancer and residing in 11 prefectures that received a significant amount of radioactive iodine after the Fukushima nuclear accident. The financial support is intended to help alleviate the financial strain experienced by the patients and their families in undergoing cancer treatment. This should have been covered by the Nuclear Accident Child Victims’ Support Law which was intended to provide health care and financial support for relocation in areas exposed to radiation. Although the Nuclear Accident Child Victims’ Support Law covers conditions which are potentially related to radiation exposure, distribution of the financial support by the 311 Fund for Children with Thyroid Cancer does not prove or certify the particular thyroid cancer case is radiation-induced.

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