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Age Distribution of Childhood Thyroid Cancer Patients in Ukraine After Chernobyl and in Fukushima After the TEPCO-Fukushima Daiichi NPP Accident

DOI:10.1089/thy.2014.0198.
Authors:
Mykola Tronko at National Academy of Medical Sciences of Ukraine
Mykola Tronko
Vladimir Saenko at Nagasaki University
Vladimir Saenko
Viktor M Shpak at National Academy of Medical Sciences of Ukraine
Viktor M Shpak
Tetiana Bogdanova at V.P. Komissarenko Institute of Endocrynology and Metabolism, National Academy of Medical Sciences of Ukraine
Tetiana Bogdanova
  • V.P. Komissarenko Institute of Endocrynology and Metabolism, National Academy of Medical Sciences of Ukraine
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LETTER TO THE EDITOR
Age Distribution of Childhood Thyroid Cancer
Patients in Ukraine After Chernobyl and in Fukushima
After the TEPCO-Fukushima Daiichi NPP Accident
Mykola D. Tronko,
1
Vladimir A. Saenko,
2
Victor M. Shpak,
1
Tetiana I. Bogdanova,
1
Shinichi Suzuki,
3
and Shunichi Yamashita
2,4,5
Dear Editor:
The epidemic of thyroid cancer among children exposed to
radiation is a worldwide known health consequence of the
Chernobyl accident, which took place on April 26, 1986. In
Ukraine, a sharp increase in the incidence of thyroid cancer
was observed since 1990, and had been preceded by a so-
called period of latency during which no significant raise in
baseline incidence was registered (1). Current interpretation
of the cases in young patients detected during the period
of latency in Chernobyl areas is that they were not due to
radiation.
A large-scale nuclear accident occurred at the TEPCO-
Fukushima Daiichi Nuclear Power plant in Mach 2011. In
response to the disaster, Fukushima Prefecture launched the
Fukushima Health Management Survey to investigate long-
term low-dose radiation health effects. The Thyroid Ultra-
sound Examination Program, a component of the Survey,
was started in October 2011 aiming at performing ultra-
sound examination of the neck in some 360,000 Fukushima
Prefecture residents aged up to 18 years in March 2011. As
of February 2014, the Program covered nearly 80% of the
target population and reported 75 cases suspicious for ma-
lignancy or malignant (2). Note that these findings were
obtained using highly sensitive ultrasound equipment in the
course of an unprecedented mass screening, which un-
avoidably increases incidence rate (3); the screening is be-
ing performed for the first time in this geographic area, and
in a screening-naı
¨ve population. Thirty-four patients have
received surgery; pathological diagnoses include one be-
nign tumor, one suspicious for poorly differentiated thyroid
carcinoma, and 32 papillary thyroid carcinomas. Such a
high prevalence has not been anticipated, and is widely
discussed by the specialists and the public, sometimes ex-
pressing concerns about possible relationship to radiation
exposure.
In bF1
Figure 1, we plotted the distribution of thyroid cancer
patients aged up to 18 years at accident by their age at
exposure diagnosed in Ukraine during the period of latency
and first years after it (1), and of those diagnosed in Fu-
kushima (2). There is a striking similarity between the
profiles of patients diagnosed during the period of latency
after Chernobyl in Ukraine and currently in Fukushima. In
contrast, patients diagnosed in Ukraine after the period of
latency, when radiation-induced tumors started to manifest,
display principally a different age pattern. A large number
of individuals exposed below five years of age, who are
at the highest risk for radiation-induced thyroid cancer,
have been seen. No such patients have been diagnosed in
Fukushima so far.
In our opinion, if thyroid cancers in Fukushima were due
to radiation, more cases in exposed preschool-age children
would have been expected. In addition, thyroid doses in
Fukushima are markedly lower than those in Chernobyl
areas (4). Further analysis will be necessary with respect to
the thyroid cancer cases that may appear in the coming
years, once the period of latency has passed. Particular at-
tention should be paid to thyroid dose reconstruction, age at
exposure and diagnosis, tumor morphology (the solid
growth pattern was frequently observed in childhood pap-
illary thyroid carcinomas that developed after the short
period of latency in Chernobyl), and whether there will be a
‘‘harvesting effect,’’ which is a spike in cases after intro-
duction of screening.
1
State Institution ‘‘VP Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of
Ukraine,’’ Kiev, Ukraine.
Departments of
2
Health Risk Control and
4
Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki,
Japan.
3
Department of Thyroid and Endocrinology;
5
Radiation Medical Science Center for the Fukushima Health Management Survey;
Fukushima Medical University School of Medicine, Fukushima, Japan.
THYROID
Volume 24, Number 10, 2014
ªMary Ann Liebert, Inc.
DOI: 10.1089/thy.2014.0198
1
THY-2014-0198-ver9-Tronko_1P
Type: letter
THY-2014-0198-ver9-Tronko_1P.3d 08/07/14 4:14pm Page 1
Acknowledgments
This publication was supported by research grant 25257508
from the Japan Society for the Promotion of Science (JSPS).
Author Disclosure Statement
No competing financial interests exist.
References
1. Tronko M, Shpak V, Bogdanova T, Saenko V, Yamashita S
2014 Epidemiology of thyroid cancer in Ukraine after
Chernobyl. In: Tronko M, Bogdanova T, Saenko V, Thomas
GA, Likhtarov I, Yamashita S (eds) Thyroid Cancer in
Ukraine after Chernobyl. Dosimetry, Epidemiology, Pa-
thology, Molecular Biology. IN–TEX, Nagasaki, Japan, pp
39–64.
2. Thyroid Ultrasound Examination, Fukushima Health Man-
agement Survey. Available at: www.fmu.ac.jp/radiationhealth/
results/media/14-2_ThyroidUE.pdf (accessed April 21, 2014).
3. Jacob P, Kaiser JC, Ulanovsky A 2014 Ultrasonography
survey and thyroid cancer in the Fukushima Prefecture.
Radiat Environ Biophys 53:391–401.
4. UNSCEAR 2014 Sources, effects and risks of ionizing ra-
diation. Volume I: Scientific Annex A. Levels and effects of
radiation exposure due to the nuclear accident after the 2011
great east-Japan earthquake and tsunami. UNSCEAR 2013
Report. United Nations, New York.
Address correspondence to:
Vladimir Saenko, PhD
Department of Health Risk Control
Nagasaki University Graduate School
of Biomedical Sciences
1-12-4 Sakamoto
Nagasaki 852-8523
Japan
E-mail: saenko@nagasaki-u.ac.jp
FIG. 1. Distribution of thyroid cancer patients by age at
exposure diagnosed during the period of latency (1986–
1989) and after it (1990–1993) in Ukraine, and patients with
verified or suspicious thyroid cancer in Fukushima diag-
nosed during 2011–2013. Numbers above the bars corre-
spond to the number of patients of a given age at exposure.
Note that comparison of the absolute number of cases be-
tween the two regions of radiological accidents would be
inappropriate because of differences in population size and
screening protocols, in particular a more systematic ap-
proach, higher population coverage, and advanced ultra-
sound equipment in Fukushima.
2 TRONKO ET AL.
THY-2014-0198-ver9-Tronko_1P.3d 08/07/14 4:14pm Page 2
... Age dependence of childhood and adolescent thyroid cancer in Ukraine, Belarus and Russia after Chernobyl accident was analysed from published data of National Report of Ukraine, report of thyroid cancer in Belarus, Ukraine, and Russia by Demidchik et al., a comparison of age distributions in Chernobyl and Fukushima by Tronko et al., and National report of Russia [6][7][8][9]. Change of age distributions after the accident for groups of the age at exposure (AE) and the age at diagnosis (AD) will be studied in three countries of various radioactive contaminations. ...
... Distribution of thyroid cancer patients in Ukraine by age at exposure diagnosed during 0-8 years after Chernobyl were compared with the one in Fukushima by Tronko et al. [8]. The authors pointed out a striking similarity between the profiles of patients diagnosed in Ukraine during the first four years after Chernobyl and in E-I in Fukushima during the first three years after the accident. ...
... The first reason for the conclusion was a striking discrepancy in the age distribution of cancer patients in Fukushima within 0-3 years following the accident versus similar data in Ukraine 4-7 years after exposure. However, if the difference in age distributions can be used as a criterion of radiation-associated thyroid cancer, it may be possible to conclude that thyroid cancers detected in Ukraine are unlikely to be radiation-induced because of the difference in age patterns in Ukraine and Belarus after Chernobyl [8,12]. ...
Change of Age Distribution of Childhood and Adolescent Thyroid Cancer after the Fukushima Nuclear Accident Compared with the Chernobyl Cases
Article
Full-text available
  • Aug 2020
Background and Methods: Comparison of age patterns of childhood and adolescent childhood thyroid cancer after the nuclear accidents in Fukushima and Chernobyl is often used as a criterion of radiationinduced thyroid cancer in Fukushima. The Fukushima Health Management Survey reports that thyroid cancers in Fukushima are unlikely to be radiation-induced, and one reason for the conclusion was no case was found in the age of 0-5 years at exposure. Published data on the health effects of the Chernobyl accident were analysed to assess whether there was one age pattern common in Chernobyl to be used as a criterion of radiation-induced thyroid cancer. Various age distributions of thyroid cancer as to the age at exposure and age at diagnosis, which depend on the country and the extent of radiation contamination, were studied as a function of years after exposure. Results and Conclusion: The highest incidence of thyroid cancer for infants aged 0-4 at exposure was observed only in Belarus. The high incidence of age group 0-4 AE became apparent only after 12 years from the accident in Ukraine and Russia. Age distribution of diagnosed or suspected thyroid cancer cases in Fukushima by age at exposure shifts to younger age side, average age from 14.9 to 8.3 years in 9 years after the accident. This trend agrees with the one in Ukraine and Russia. Because there is no common age pattern in Chernobyl, we should better not use age pattern as a simple criterion of radiation-induced thyroid cancer.
View
... Besides the contrast in thyroid doses between Fukushima and Chornobyl, many differences in age distribution, pathological findings, and driver oncogenes between Fukushima and Chornobyl thyroid cancers have been reported. Tronko et al observed that many thyroid cancer cases had occurred in people who were 0-5 years old at the time of the Chornobyl accident, but no cases had occurred in people who were 0-5 years old at the time of the Fukushima accident (257). In terms of the pathological findings, radiation-associated PTCs in Ukraine demonstrated the higher frequency of tumors with a dominant solid-trabecular pattern, higher invasiveness, more frequent extrathyroidal extension, and lymphatic/vascular invasion compared with sporadic PTCs in the same area (258). ...
Radiation-Related Thyroid Cancer
Article
Full-text available
Radiation is an environmental factor that elevates the risk of developing thyroid cancer. Actual and possible scenarios of exposures to external and internal radiation are multiple and diverse. This article reviews radiation doses to the thyroid and corresponding cancer risks due to planned, existing, and emergency exposure situations, and medical, public, and occupational categories of exposures. Any exposure scenario may deliver a range of doses to the thyroid, and the risk for cancer is addressed along with modifying factors. The consequences of the Chornobyl and Fukushima nuclear power plants accidents are described, summarizing the information on thyroid cancer epidemiology, treatment and prognosis, clinicopathological characteristics, and genetic alterations. The Chornobyl thyroid cancers evolve in time: becoming less aggressive and driver shifting from fusions to point mutations. A comparison of thyroid cancers from the two areas reveals numerous differences that cumulatively suggest the low probability of radiogenic nature of thyroid cancers in Fukushima. In view of continuing usage of different sources of radiation in various settings, the possible ways of reducing thyroid cancer risk from exposures are considered. For the external exposures, reasonable measures are generally in line with the "As Low As Reasonably Achievable" (ALARA) principle, while for the internal irradiation from radioiodine, thyroid blocking with stable iodine may be recommended in addition to other measures in case of anticipated exposures from a nuclear reactor accident. Finally, the perspectives of studies of radiation effects on the thyroid are discussed from the epidemiological, basic science, and clinical points of view.
View
... The sex disparity in the detection rate of thyroid cancer was also evident in adolescents and young adults [19]. An age-dependent increase in thyroid cancer detection rate has been reported in the national cancer registry in Japan, even in Fukushima after the nuclear accident [20]. In our TUE program, the detection rate of malignant nodules was higher in females, and an increase in the detection rate with increasing age was also reported. ...
Confounding factors and biases involved in regional differences in the detection rate of thyroid cancer in the second-round Thyroid Ultrasound Examination: the Fukushima Health Management Survey
Article
Full-text available
In response to concerns about health due to radiation exposure, the Fukushima Prefecture launched the Thyroid Ultrasound Examination program for residents aged 0-18 years at the time of the earthquake. Herein, we considered the confounding factors involved in the regional differences in the development of thyroid cancer. In this study, the 242 065 individuals who participated in both first- and second-round surveys were classified into four groups by address according to their air radiation dose. The number of participants diagnosed as malignant or suspicious for malignancy by cytological examination were 17, 38, 10 and 4 with detection rates of 53.8, 27.8, 21.7 and 14.5 per 100 000 participants in Regions 1, 2, 3 and 4, respectively. Sex (P = 0.0400), age at the time of the primary examination (P < 0.0001) and interval between the first- and second-round surveys (P < 0.0001) were significantly different among the four regions, and these were suspected to be confounding factors affecting regional differences in malignant nodule detection rates. In addition, significant regional differences were observed in the participation rate in the confirmatory examination (P = 0.0037) and the fine needle aspiration cytology implementation rate (P = 0.0037), which could be potential biases. No significant regional differences in the detection of malignant nodules were found in the multivariate logistic regression analysis after adjusting for the survey interval alone or for sex, age and survey interval. The confounding factors and biases identified in this study that may have important impacts on thyroid cancer detection rate should be fully considered in future studies.
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... Patients Radiogenic MPTCs were from 465 patients aged 8.8 to 50.0 years at the time of diagnosis who were operated on at the State Institution "VP Komisarenko Institute of Endocrinology and Metabolism of the National Academy of Medical Sciences of Ukraine" (IEM), Kyiv during the period from 1992 to 2018 when a significant increase in thyroid cancer incidence after the Chornobyl accident was documented (15)(16)(17). Given that the high risk of thyroid cancer was observed in persons who were children and adolescents at the time of Chornobyl accident and lived in the six northern, most radiocontaminated regions of Ukraine (18,19), we defined inclusion criteria as age up to 18 years in April 1986, living in Kyiv, Chernihiv, Zhytomyr, Rivne, Cherkasy regions or Kyiv city at the time of the Chornobyl accident, non-incidental tumor finding, and the absence of screening history in tumor detection. ...
The relationship of the clinicopathological characteristics and treatment results of post-Chornobyl papillary thyroid microcarcinomas with the latency period and radiation exposure
Article
Full-text available
  • Dec 2022
Introduction A worldwide increase in the incidence of thyroid cancer during the last decades is largely due to papillary thyroid microcarcinomas (MPTCs), which are mostly low-risk tumors. In view of recent clinical recommendations to reduce the extent of surgery for low-risk thyroid cancer, and persisting uncertainty about the impact of radiation history, we set out to address whether clinicopathological characteristics and prognosis of post-Chornobyl MPTCs were changing with regard to: i) the latency period, ii) probability of causation (POC) of a tumor due to radiation, and iii) tumor size. Methods Patients (n = 465) aged up to 50 years at diagnosis who lived in April, 1986 in six northern, most radiocontaminated regions of Ukraine were studied. Results Latency period was statistically significantly associated with the reduction of POC level, tumor size and the frequency of fully encapsulated MPTCs. In contrast, the frequency of oncocytic changes and the BRAF V600E mutation increased. Invasive properties and clinical follow-up results did not depend on latency except for a lower frequency of complete remission after postsurgical radioiodine therapy. The POC level was associated with more frequent extrathyroidal extension, and lymphatic/vascular invasion, less frequent oncocytic changes and BRAF V600E , and did not associate with any clinical indicator. Tumor size was negatively associated with the latency period and BRAF V600E , and had a statistically significant effect on invasive properties of MPTCs: both the integrative invasiveness score and its components such as lymphatic/vascular invasion, extrathyroidal extension and lymph node metastases increased. The frequency of total thyroidectomy, neck lymph node dissection and radioiodine therapy also increased with the larger tumor size. The duration of the latency period, POC level or tumor size did not associate with the chance of disease recurrence. Discussion In summary, we did not observe overall worsening of the clinicopathological features or treatment results of radiogenic MPTCs that could be associated with the latency period or POC level, suggesting that radiation history did not strongly affect those in the analyzed MPTC patients. However, the increase in the invasive properties with tumor size indicates the need for individual risk stratification for each MPTC patient, regardless of radiation history, for treatment decision-making.
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... Plusieurs éléments disponibles à ce jour indiquent que la fréquence élevée de nodules tumoraux de la thyroïde observée à Fukushima est liée à un effet du dépistage plutôt qu'à un effet des rayonnements : entre novembre 2012 et janvier 2013, un dépistage par échographie thyroïdienne a été réalisé chez des enfants âgés de 18 ans ou moins dans trois préfectures japonaises non contaminées par les retombées radioactives de l'accident de Fukushima (Aomori, Yamanashi et Nagasaki), en utilisant le même protocole d'examen que celui de la préfecture de Fukushima afin de rendre la comparaison pertinente. La prévalence de nodules thyroïdiens détectés par échographie chez les enfants résidant dans ces trois préfectures était similaire à celle observée dans la première campagne de dépistage de la préfecture de Fukushima, quelle que soit la taille des nodules [47] ; les études publiées à ce jour ne montrent pas d'association entre la distribution des doses de rayonnement et la fréquence des cancers de la thyroïde observée dans la préfecture de Fukushima [48] ; la distribution d'âge des cas observés à Fukushima est proche de celle classiquement observée dans une population non exposée, alors que les cas observés après l'accident de Tchernobyl étaient beaucoup plus jeunes [49] ; la fréquence d'altérations génétiques observées à Fukushima est similaire à celle observée dans une population non exposée, mais est différente de celle observée après l'accident de Tchernobyl (prédominance de la mutation BRAF à Fukushima versus RET/PTC à Tchernobyl) [50]. ...
View
... In accordance with research on morbidity due to the Chernobyl accident [11,30,36,38,[44][45][46][47][48][49][50], hospitalizations from specific groups of diagnoses were examined based on International Classification of Diseases (ICD)-10 codes. This included: neoplasms (ICD 140-239), endocrine, nutritional or metabolic diseases (ICD 240-279), mental disorders (ICD 290-319), disorders of the eye (ICD 360-379), circulatory causes (ICD 390-459), and respiratory causes (ICD 460-519). ...
0123456789) 1 3 Journal of Immigrant and Minority Health
Article
Full-text available
  • Aug 2021
On April 26th, 1986 the nuclear reactor at Chernobyl, Ukraine exploded, causing the worst radiation disaster in history. The aim was to estimate hospitalization rates among exposed civilians who later immigrated to Israel. We conducted a historical follow-up study, among persons exposed to Chernobyl (n = 1128) using linked hospitalization records from Soroka University Medical Center (SUMC), compared with immigrants from other areas of the Former Soviet Union (FSU) (n = 11,574), immigrants not from FSU (n = 11,742) and native-born Israelis (n = 8351), matched on age and gender (N = 32,795). Hospitalizations for specific ICD-10 coded diagnostic groups were analyzed by exposure and comparison groups by gender and age at accident. In addition, the rate of hospitalization, and the duration of hospital days and the number of hospitalizations for these selected diagnostic groups was also calculated. Hospitalizations for specific ICD-10 coded diagnostic groups and for any hospitalization in these diagnostic groups in general were analyzed by exposure and comparison groups and by covariates (gender and age at accident). The rate of any hospitalization for the selected diagnostic groups was elevated in the low exposure Chernobyl group (51.1%), which was significantly higher than the immigrant (41.6%) and the Israel-born comparison group (35.1%) (p < .01) but did not differ from either the high exposure group (46.9%) or the FSU comparison group (46.4%), according to the post-hoc tests. The total number of hospitalizations in the low exposure Chernobyl group (2.35) differed from the immigrant (1.73) and Israel comparison group (1.26) (p < .01) but did not differ from the FSU comparison group (1.73) or the high exposure group (2.10). Low exposure women showed higher rates of circulatory hospitalizations (33.8%) compared to immigrants (22.8%) and Israeli born (16.5%), while high exposure women (27.5%) only differed from Israelis (p < .01). Neither exposure group differed from FSU immigrant women on the rate of circulatory hospitalizations. Post-hoc tests showed that among women in the low exposure group, there was a significant difference in rate of hospitalizations for neoplasms (28.6%) compared to the three comparison groups; FSU (18.6%), immigrants (15.7%) and Israel (13.1) (p < .01). Those among the low exposure group who were over the age of 20 at the time of the accident showed the higher rates of circulatory (51.2%) and neoplasm hospitalizations (33.3%), compared to the other immigrant groups (p < .01). When controlling for both age at accident and gender, hospitalizations for neoplasms were higher among Chernobyl-exposed populations (RR = 1.65, RR = 1.77 for high and low-exposure groups, respectively) compared to other FSU immigrants (RR = 1.31) other immigrants (RR = 1.11) and Israeli born (RR = 1.0) after controlling for gender and age at accident. High RRs attributable to Chernobyl exposure were also found for circulatory diseases compared to other immigrants and Israeli born (RRs = 1.50, 1.47 for high and low exposure compared to 1.11. and 1.0, other immigrants and Israeli born, respectively). Endocrine problems and disorders of the eye also showed elevated RR compared to the immigrant comparison groups. Respiratory and mental disorders did not show any consistent association with Chernobyl exposure. The findings support unique Chernobyl morbidity associations only in some diagnostic groups, particularly for low exposure women. General immigration effects on hospitalizations compared to the Israeli born population were found on all diagnostic groups. There is a need to improve the services and medical follow-up for these Chernobyl exposed groups in specific diagnostic groups.
View
... In accordance with research on morbidity due to the Chernobyl accident [11,30,36,38,[44][45][46][47][48][49][50], hospitalizations from specific groups of diagnoses were examined based on International Classification of Diseases (ICD)-10 codes. This included: neoplasms (ICD 140-239), endocrine, nutritional or metabolic diseases (ICD 240-279), mental disorders (ICD 290-319), disorders of the eye (ICD 360-379), circulatory causes (ICD 390-459), and respiratory causes (ICD 460-519). ...
Hospitalizations Among Chernobyl-Exposed Immigrants to the Negev of Israel, 1992–2017: A Historical Follow-Up Study
Article
Full-text available
  • Apr 2022
On April 26th, 1986 the nuclear reactor at Chernobyl, Ukraine exploded, causing the worst radiation disaster in history. The aim was to estimate hospitalization rates among exposed civilians who later immigrated to Israel. We conducted a historical follow-up study, among persons exposed to Chernobyl (n = 1128) using linked hospitalization records from Soroka University Medical Center (SUMC), compared with immigrants from other areas of the Former Soviet Union (FSU) (n = 11,574), immigrants not from FSU (n = 11,742) and native-born Israelis (n = 8351), matched on age and gender (N = 32,795). Hospitalizations for specific ICD-10 coded diagnostic groups were analyzed by exposure and comparison groups by gender and age at accident. In addition, the rate of hospitalization, and the duration of hospital days and the number of hospitalizations for these selected diagnostic groups was also calculated. Hospitalizations for specific ICD-10 coded diagnostic groups and for any hospitalization in these diagnostic groups in general were analyzed by exposure and comparison groups and by covariates (gender and age at accident). The rate of any hospitalization for the selected diagnostic groups was elevated in the low exposure Chernobyl group (51.1%), which was significantly higher than the immigrant (41.6%) and the Israel-born comparison group (35.1%) (p < .01) but did not differ from either the high exposure group (46.9%) or the FSU comparison group (46.4%), according to the post-hoc tests. The total number of hospitalizations in the low exposure Chernobyl group (2.35) differed from the immigrant (1.73) and Israel comparison group (1.26) (p < .01) but did not differ from the FSU comparison group (1.73) or the high exposure group (2.10). Low exposure women showed higher rates of circulatory hospitalizations (33.8%) compared to immigrants (22.8%) and Israeli born (16.5%), while high exposure women (27.5%) only differed from Israelis (p < .01). Neither exposure group differed from FSU immigrant women on the rate of circulatory hospitalizations. Post-hoc tests showed that among women in the low exposure group, there was a significant difference in rate of hospitalizations for neoplasms (28.6%) compared to the three comparison groups; FSU (18.6%), immigrants (15.7%) and Israel (13.1) (p < .01). Those among the low exposure group who were over the age of 20 at the time of the accident showed the higher rates of circulatory (51.2%) and neoplasm hospitalizations (33.3%), compared to the other immigrant groups (p < .01). When controlling for both age at accident and gender, hospitalizations for neoplasms were higher among Chernobyl-exposed populations (RR = 1.65, RR = 1.77 for high and low-exposure groups, respectively) compared to other FSU immigrants (RR = 1.31) other immigrants (RR = 1.11) and Israeli born (RR = 1.0) after controlling for gender and age at accident. High RRs attributable to Chernobyl exposure were also found for circulatory diseases compared to other immigrants and Israeli born (RRs = 1.50, 1.47 for high and low exposure compared to 1.11. and 1.0, other immigrants and Israeli born, respectively). Endocrine problems and disorders of the eye also showed elevated RR compared to the immigrant comparison groups. Respiratory and mental disorders did not show any consistent association with Chernobyl exposure. The findings support unique Chernobyl morbidity associations only in some diagnostic groups, particularly for low exposure women. General immigration effects on hospitalizations compared to the Israeli born population were found on all diagnostic groups. There is a need to improve the services and medical follow-up for these Chernobyl exposed groups in specific diagnostic groups.
View
... These data indicate that there was no increase in the number of thyroid cancer cases with chromosomal rearrangements ≥4 years after the incident. Morphological characteristics of thyroid cancer in the present study was were different from those in post-Chernobyl radiation-induced thyroid cancer (23,37). ...
The Clinicopathological Results of Thyroid Cancer With BRAFV600E Mutation in the Young Population of Fukushima
Article
  • Aug 2020
Background Thyroid ultrasound screening for children aged 0–18 years was performed in Fukushima following the accident at the Fukushima Daiichi Nuclear Power Plant. As a result, many thyroid cancer cases were detected. To explore the carcinogenic mechanisms of these cancers, we analyzed their clinicopathological and genetic features. Methods We analyzed 138 cases (52 males and 86 females) who had undergone surgery between 2013 and 2016 at Fukushima Medical University Hospital. Postoperative pathological diagnosis revealed 136 (98.6%) cases of papillary thyroid cancer (PTC). Results The BRAFV600E mutation was detected using direct DNA sequencing in 96 (69.6%) of the thyroid cancer cases. In addition, oncogenic rearrangements were detected in 23 cases (16.7%). Regarding chromosomal rearrangements, eight (5.8%) RET/PTC1, six (4.3%) ETV6(ex4)/NTRK3, two (1.4%) STRN/ALK, and one each of RET/PTC3, AFAP1L2/RET, PPFIBP/RET, KIAA1217/RET, ΔRFP/RET, SQSTM1/NTRK3 and TPR/NTRK1 were detected. Tumor size was smaller in the BRAFV600E mutation cases (12.8 ± 6.8 mm) than in wild-type BRAF cases (20.9 ± 10.5mm). In the BRAFV600E mutation cases, 83 (86.5%) showed lymph node metastasis; whereas 26 (61.9%) of the wild-type BRAF cases showed lymph node metastasis. Conclusions The BRAFV600E mutation was mainly detected in residents of Fukushima, which was different from post-Chernobyl PTC cases with RET/PTC3 rearrangement. PTC with the BRAFV600E mutation was smaller but was shown in the high rate of central cervical lymph node metastasis than the wild-type BRAF PTC in the young population of Fukushima.
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... There is no apparent regional difference in the rate of thyroid cancer cases among the residential areas at the time of the earthquake and, hence, exposure status of the patients (50,66). The mean age of the subjects diagnosed with thyroid cancer was 10-15 years at the time of accident, while there were no cases in younger children (aged 0-5 years for the first four years), who are more vulnerable to radiation exposure (67)(68)(69). Although it is expected that thyroid cancer will also be detected at certain frequencies in those who were infants at the time of accident after some years, its causes need to be specially investigated. ...
Breast-Milk Iodine Concentrations and Iodine Levels of Infants According to the Iodine Status of the Country of Residence: A Systematic Review and Meta-Analysis
Article
  • Jan 2018
Background: Iodine, an essential micronutrient, plays a critical role in normal growth and development, especially during the first two years of life. This systematic review and meta-analysis is among the first to evaluate breast-milk iodine concentrations and infant iodine status in countries characterized by iodine sufficiency or deficiency. Methods: PubMed, Web of Science, Cochrane Library, Google Scholar, and other relevant databases, as well as reference lists of previous reviews, were searched for relevant studies published between 1986 and 2016. Mean or median breast-milk and infant urinary iodine concentrations, along with other relevant data, were extracted from eligible studies. Each study was assessed for quality and risk of bias. Results: Of the 496 identified studies, 57 met the criteria for inclusion in the meta-analysis. The mean (confidence interval [CI]) iodine concentrations in maternal colostrum were 152.0 μg/L [CI 106.2-198.7 μg/L] and 57.8 μg/L [CI 41.4-74.1 μg/L] in iodine-sufficient and -deficient countries, respectively, indicating a significant difference between the two iodine statuses. By contrast, the corresponding values in mature milk did not differ significantly between mothers in iodine-sufficient and -deficient countries (71.5 μg/L [CI 51.0-92.0 μg/L] and 28.0 μg/L [CI -13.8 to 69.9 μg/L], respectively]. The weighted urinary iodine levels [CIs] of breast-fed infants in iodine-sufficient countries were significantly higher than those in iodine-deficient countries (164.5 μg/L [CI 116.4-212.7 μg/L] vs. 70.4 μg/L [CI 46.2-94.6 μg/L]). Similarly, a significant difference was observed in the pooled estimates of urinary iodine levels [CIs] among formula-fed infants in iodine-sufficient versus iodine-deficient countries (310.3 μg/L [CI 287.4-342.1 μg/L] vs. 38.3 μg/L [CI 23.4-53.2 μg/L]). Conclusion: The meta-analysis reveals that in iodine-sufficient countries, the mean iodine concentrations in colostrum and mature breast milk corresponded to iodine sufficiency among infants. The results are thus compatible with the international recommendation that lactating women and infants younger than two years of age who reside in iodine-sufficient countries do not require iodine supplementation.
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... There is no apparent regional difference in the rate of thyroid cancer cases among the residential areas at the time of the earthquake and, hence, exposure status of the patients (50,66). The mean age of the subjects diagnosed with thyroid cancer was 10-15 years at the time of accident, while there were no cases in younger children (aged 0-5 years for the first four years), who are more vulnerable to radiation exposure (67)(68)(69). Although it is expected that thyroid cancer will also be detected at certain frequencies in those who were infants at the time of accident after some years, its causes need to be specially investigated. ...
Lessons from Fukushima: Latest Findings of Thyroid Cancer After the Fukushima Nuclear Power Plant Accident
Article
  • Sep 2017
The increase in risk for late-onset thyroid cancer due to radiation exposure is a potential health effect after a nuclear power plant accident mainly due to the release of radioiodine in fallout. The risk is particularly elevated in those exposed during infancy and adolescence. To estimate the possibility and extent of thyroid cancer occurrence after exposure, it is of utmost importance to collect and analyze epidemiological information providing the basis for evaluation of radiation risk, and to consider radiobiology and molecular genetics. In this regard, the dose-response of cancer risk, temporal changes in the rates of thyroid cancer, its histopathological types and subtypes, and frequency of underlying genetic abnormalities are important. At present, however, it is difficult or impossible to distinguish radiation-induced thyroid cancer from spontaneous/sporadic thyroid cancer because molecular radiation signatures, biomarkers of radiation exposure or genetic factors specific to radiation-induced cancer are not identified yet. The large-scale ultrasound screening in Fukushima Prefecture of Japan demonstrated high detection rate of thyroid cancer in young individuals revealing 116 and 71 cases in the first and second rounds, respectively, among the same cohort of approximately 300,000 subjects. These findings raise concerns among residents and the public that it might be due to putative exposure to radiation from the accident at Fukushima Daiichi Nuclear Power Plant. Here we summarize evaluations by the international organizations and review scientific publications by the authors and others on childhood thyroid cancer, especially those relevant to radiation, including basic studies on molecular mechanisms of thyroid carcinogenesis. We also provide clinical details on surgical cases in Fukushima Prefecture and discuss the effect of thyroid ultrasound screening. Correct understanding of "radiation and the thyroid" issues are essential for interpretation of thyroid cancer in Fukushima.
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Thyroid Cancer in Ukraine after Chernobyl Book 2014
Book
Full-text available
  • Feb 2014
The international team of authors of the present book attempts to sum up and overview the enormous and unique materials obtained from studies of Ukrainian thyroid cancer that have been accumulated over the years after the Chernobyl accident. Comprehensive scientific analysis is now expected to be useful for the future studies of radiation-associated thyroid cancers.
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Erratum to: Ultrasonography survey and thyroid cancer in the Fukushima Prefecture
Article
Full-text available
Thyroid cancer is one of the major health concerns after the accident in the Fukushima Dai-ichi nuclear power station (NPS). Currently, ultrasonography surveys are being performed for persons residing in the Fukushima Prefecture at the time of the accident with an age of up to 18 years. Here, the expected thyroid cancer prevalence in the Fukushima Prefecture is assessed based on an ultrasonography survey of Ukrainians, who were exposed at an age of up to 18 years to 131I released during the Chernobyl NPS accident, and on differences in equipment and study protocol in the two surveys. Radiation risk of thyroid cancer incidence among survivors of the atomic bombings of Hiroshima and Nagasaki and preliminary estimates of thyroid dose due to the Fukushima accident were used for the prediction of baseline and radiation-related thyroid cancer risks. We estimate a prevalence of thyroid cancer of 0.027 % (95 % CI 0.010 %; 0.050 %) for the first screening campaign in the Fukushima Prefecture. Compared with the incidence rate in Japan in 2007, the ultrasonography survey is predicted to increase baseline thyroid cancer incidence by a factor of 7.4 (95 % CI 0.95; 17.3). Under the condition of continued screening, thyroid cancer during the first fifty years after the accident is predicted to be detected for about 2 % of the screened population. The prediction of radiation-related thyroid cancer in the most exposed fraction (a few ten thousand persons) of the screened population of the Fukushima Prefecture has a large uncertainty with the best estimates of the average risk of 0.1–0.3 %, depending on average dose. Electronic supplementary material The online version of this article (doi:10.1007/s00411-013-0508-3) contains supplementary material, which is available to authorized users.
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Scientific Annex A. Levels and effects of radiation exposure due to the nuclear accident after the 2011 great east-Japan earthquake and tsunami
  • Jan 2013
UNSCEAR 2014 Sources, effects and risks of ionizing radiation. Volume I: Scientific Annex A. Levels and effects of radiation exposure due to the nuclear accident after the 2011 great east-Japan earthquake and tsunami. UNSCEAR 2013 Report. United Nations, New York.