Results of the first-round thyroid examination of the Fukushima Health Management Survey
Results of the first-round thyroid examination of the Fukushima Health Management Survey
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福岛健康管理调查第一轮甲状腺检查结果
DOI：
10.20683/jniph.67.1_42
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发表时间：
2018
期刊：
影响因子：
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通讯作者：
Hideto Takahashi
中科院分区：
文献类型：
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作者：
Hideto Takahashi
在东京电力公司的福岛第一核电站发生事故后，福岛健康管理调查（FHMS）启动。家庭健康调查包括一项基本调查和四项详细调查：甲状腺超声检查、全面健康检查、精神健康和生活方式调查以及怀孕和分娩调查。本文根据FMHS第一轮甲状腺检查结果，简要总结辐射暴露与甲状腺癌病例观察之间是否存在关联。关于这个问题，Tsuda和他的同事通过内部比较(优势比（OR)=2.6, 95%可信区间（CI）： 0.99-7.0）和外部比较（发病率比=50,95% CI: 25-90）证明了两者之间的关联。然而，为了进行内部比较，Ohira和他的同事使用了两种方法对福岛地区进行客观分类；(1) 5毫西沃特以上的外源暴露剂量水平所占比例大于等于1%（≧5毫西沃特1%）的市组，小于1毫西沃特的外源暴露剂量所占比例大于等于99.9%（≧99.9% m毫西沃特<99%）的市组，以及其他市组，(2)世界卫生组织适用的地点组。对于分类(1)，他们从最高组到最低组得到OR=1.49 (95% CI: 0.36-6.23)，这与分类(2)的结果相似。对于外部比较，Takahashi和他的同事开发了一个非事故条件下具有几种敏感性的癌症进展模型，并表明在非事故条件下，福岛可能观察到116例病例。Katanoda和他的同事发现，在20岁以下的居民中，甲状腺癌患病率的观察/预期比率为30.8 (95%CI: 26.2-35.9)（160.1例观察病例和50.2例预期病例），福岛县40岁以下甲状腺癌死亡的累积人数为0.6。这种巨大的差异暗示了甲状腺检查中过度诊断的可能性。一名研究人员报告说，研究结果不太可能用筛选效应来解释，筛选效应意味着甲状腺癌病例与外部辐射暴露之间存在关联。然而，随后，这可能是甲状腺检查过度诊断的结果。采用客观的地区分类和提高与全日本发病率数据的可比性，均未发现显著相关性。在FHMS的基本调查中，只观察了事故发生后头四个月的个体外剂量。所以四个月后的外部剂量和内部剂量都没有在这些研究中使用。需要进一步的研究，通过应用个人甲状腺总剂量的估计来澄清这种关联的存在。关键词：甲状腺检查，福岛健康管理调查，甲状腺癌，辐射外照射，第一轮调查（接受发表，2018年2月15日）主题：福岛第一核电站事故的公共卫生教训
After the accident occurred at the Tokyo Electric Power Companyʼs Fukushima Daiichi Nuclear Power Plant, the Fukushima Health Management Survey (FHMS) was initiated. The FHMS consists of a basic survey and four detailed surveys: a thyroid ultrasound examination, a comprehensive health check, a mental health and lifestyle survey, and a pregnancy and birth survey. In this article, we briefly summarized whether an association exists between radiation exposure and the observation of thyroid cancer cases according to the results of the first-round thyroid examination in the FMHS. Regarding this issue, Tsuda and his colleagues showed an association using an internal comparison (odds ratio (OR)=2.6, 95% confidence interval (CI): 0.99-7.0) and an external comparison (incidence rate ratio =50, 95% CI : 25-90). However, for this internal comparison, Ohira and his colleagues used two ways of objective classifications of districts in Fukushima; (1) the group of municipalities of which proportion of the exposed external dose level of more than 5 mSv was higher than or equal to 1% (≧1% of 5 mSv), the group of municipalities of which proportion of the exposed external dose level less than 1 mSv was higher than or equal to 99.9% (≧99.9% of 1m Sv<99%), and others, and (2) the location groups applied by WHO. For the classification (1), they obtained OR=1.49 (95% CI : 0.36-6.23) from the highest group to the lowest, which was similar to the results of the classification (2). For the external comparison, Takahashi and his colleagues developed a cancer-progression model with several sensitivities under non-accident conditions, and showed 116 cases were possible to observe in Fukushima under non-accident conditions. Katanoda and his colleagues found an observed/ expected ratio of 30.8 (95%CI: 26.2-35.9) of the prevalence of thyroid cancer among residents aged ≦ 20 years (160.1 observed of cases and 50.2 expected cases), and a cumulative number of thyroid cancer deaths in Fukushima Prefecture of 0.6 under age 40 with the same method. This large disparity implied the possibility of over-diagnosis in thyroid examinations. A researcher reported the results were unlikely to be explained by a screening effect, which implied the association between thyroid cancer cases and external radiation exposure. However, subsequently, a possibility that it might be a result of over-diagnosis of the thyroid examinations was pointed. And, no significant associations were found by applying objective classification of districts and by raising comparability with the incidence data of whole Japan, respectively. In the Basic Survey of FHMS, only individual external doses in the first four months after the accident has been observed. So neither external dose after the four months nor internal dose was applied in these studies. Further studies are necessary to clarify the existence of the association by applying the estimation of individual overall thyroid dose. keywords: thyroid examination, Fukushima health management survey, thyroid cancer, radiation external exposure, the first-round survey (accepted for publication, 15th February 2018) Topics: Lessons learned on public health from the Fukushima Daiichi Nuclear Power Plant accident